When does picky eating become restricted eating, and who can help?

The short answer

Limited eating needs assessment when the amount or range is persistently too small to support health, growth or daily life, not only when the list reaches a particular number. Look for weight loss or poor growth, nutritional deficiency, reliance on prescribed supplements, dehydration, weakness, an absent food group, coughing or choking, difficulty chewing, repeated pain or vomiting, a rapidly narrowing list, severe distress or being unable to eat at school, on trips or with other people. Keep reliable foods available and record a week of intake, drinks, symptoms, setting, medication and impact. Start with the GP, health visitor, school nurse, prescriber or existing paediatric team as appropriate. Depending on the concern and local pathway, help may involve paediatrics, dietetics, speech and language therapy for feeding and swallowing, occupational therapy, dentistry, mental-health or a multidisciplinary feeding service. ARFID is one possible clinical diagnosis, not a synonym for autistic selective eating or a label to establish at home.

• Health, nutrition, feeding skill and daily-life impact matter more than one food-count threshold.
• A stable weight does not rule out nutritional deficiency or substantial distress.
• Coughing, choking, wet voice, food sticking or repeated chest infections need swallowing assessment.
• Record the support, preparation and reliable foods that make current intake possible.
• Ask who owns follow-up and what change should trigger earlier review.