“My 3-year-old will only eat a handful of foods and refuses everything else — mealtimes are a battle and I’m worried she’s not getting enough”

PICKY/FUSSY EATING is very common and usually a normal developmental phase in toddlers/pre-schoolers (food neophobia), typically self-limiting, and the most important step is to confirm the child is GROWING and THRIVING — weighing, measuring and plotting growth on the UK-WHO chart (NICE NG75 faltering-weight thresholds) and checking weight/height tracking, energy, development and general wellbeing — because growth, not the food diary, is the key reassurance. Reassure the parent it is common, not harmful when the child is thriving, and not a reflection of poor parenting. EXCLUDE red flags/organic causes: faltering growth/weight loss, a very restricted intake risking deficiency, dysphagia/choking/recurrent vomiting, GI symptoms/coeliac, food allergy, developmental or social communication concerns/autism (sensory food selectivity; NICE CG128), or features of a feeding disorder (ARFID — extreme restriction/distress; DSM-5-TR, international) — which would change management and prompt assessment/referral. Give practical feeding/behaviour advice: regular family mealtimes and role-modelling; repeated LOW-PRESSURE exposure to new foods (it can take 10+ tries — keep offering without forcing); avoid pressure, force-feeding, bribery and battles (which worsen refusal); realistic toddler portions; limit grazing, excess milk and juice between meals; keep mealtimes positive, short and distraction-free; and involve the child. Address the parental anxiety and mealtime battles — a major part of the consultation — avoid unnecessary investigations and supplements when the child is thriving (but recommend the daily vitamin A, C and D drops UK advice gives all children aged 6 months to 5 years; Healthy Start for eligible families), and refer to a dietitian/health visitor/paediatrics only for faltering growth, very restricted intake with nutritional concern, or red flags. The skill is growth/red-flag exclusion, reassurance, practical feeding advice and parental support — not unnecessary testing.