My child is a picky eater. What can I do?

Picky eating is common in young children and usually a phase: the US CDC says it often goes away by the time a child is about 5. What helps is patience and routine rather than pressure. Look at what your child eats over a week, not one meal; put vegetables on the table at every meal and keep offering refused foods; eat together; space meals so your child comes to the table hungry; and never force or bribe with sweets. Thai surveys show that low vegetable intake is widespread: in the 2015 national school survey, 70.0% of 12 to 15 year olds ate fewer than 5 servings of fruit and vegetables a day. See a doctor if your child is not putting on weight as expected or seems unusually tired.

Is picky eating normal for children?

For most young children, yes. England's NHS says it is perfectly normal for toddlers to refuse to eat or even taste new foods. A paediatric nutrition specialist at Ramathibodi Hospital, interviewed in @Rama magazine, describes the eating problems seen most often in children aged 1 to 3: eating slowly, playing instead of eating, holding food in the mouth, filling up on snacks and not eating vegetables.

Look at the week, not the meal

The NHS advises not to worry about what your child eats in a single day or whether they finish every meal. It is more helpful to think about what they eat over a week. If your child is active, gaining weight and seems well, the NHS says they are getting enough to eat.

What counts as "enough variety"

The NHS says that as long as your child eats some food from the 4 main food groups, you do not need to worry:

• fruit and vegetables
• potatoes, bread, rice, pasta and other starchy foods
• dairy or dairy alternatives
• beans, pulses, fish, eggs, meat and other proteins

Tastes change

Children's tastes change, the NHS notes: one day they hate something, and a month later they may love it. The CDC adds that it may take 8 to 10 exposures before a young child is willing to try a new food. One refusal is not a final answer.

How well do Thai children and teenagers eat vegetables?

Thai studies suggest that eating few vegetables is common, not only among children labelled "picky".

What Thai studies found

What these numbers can and cannot tell you

The school surveys relied on students' own answers, and the lunch and Nakhon Pathom studies covered only 2 schools each, so the numbers are not exact figures for all Thai children. The 2008 and 2015 surveys also used slightly different age groups. Taken together, they show that falling short on vegetables is common among Thai school-age children and teenagers, and that the home environment, such as what is on offer and how children feel about vegetables, is linked with how much they eat. These studies show links, not proof of cause.

Thai parents worry about it too

A study by Supthanasup and colleagues looked at 200 posts in 5 Thai Facebook groups about feeding children. Parents expressed anxiety and tension about fussy eating, which created a need for emotional support. In a separate survey of 379 Thai parents by the same team, around 70% had joined social media groups about children's food. Advice in such groups varies, so it is worth checking it against guidance from hospitals and health agencies.

How much should a school-age child eat from each food group?

The NHS and CDC advice above is written for toddlers and young children. This section is for children aged 6 to 12.

A Ramathibodi Hospital @Rama magazine column, based on the Thai Department of Health's guide to nutrition for every age, lists these amounts a day for children aged 6 to 12:

The same column suggests getting children used to eating vegetables at every meal and changing the kind often, fresh fruit every day, 3 main meals without skipping (especially breakfast), and 2 snacks, mid-morning and afternoon, that are not too sweet, salty or fatty, such as plain milk with a tuna sandwich, boiled corn or roasted sweet potato.

Compare a picky eater's week with this table. If one group is missing for days, that is the group to keep putting on the table, without pressure. If breakfast is the meal that goes missing, see My child won't eat breakfast before school. What can I do?

What can I do at mealtimes?

Let your child come to the table hungry

The Ramathibodi specialist explains that a child needs to be hungry to eat, so meals should be spaced well and grazing between meals avoided. The NHS says 2 healthy snacks a day is plenty, and advises not to leave meals until your child is too hungry or tired to eat. Sweet foods and drinks fill a child up: if sweet drinks are a daily habit, see My child drinks sweet drinks every day. What should I do?

For children over 1, the specialist says milk is no longer the main food, and recommends no more than 20 to 24 ounces a day, about 3 glasses, because too much milk leaves children too full to eat their meals.

Eat together and eat the vegetables yourself

The NHS says the best way for a child to learn to eat new foods is to copy you, so eat with them as often as you can. The Ramathibodi specialist recommends that children from about 1 year sit at the family table, and that parents eat vegetables in front of them. The NHS also suggests inviting a child of the same age who eats well, or an adult your child looks up to, such as a grandparent, to share a meal.

Keep offering, in small amounts and new ways

• Put vegetables in every meal, even if your child pushes them aside, so they learn that vegetables are part of eating (Ramathibodi specialist).
• Serve small portions and praise your child for eating, even if they only eat a little (NHS).
• After a refusal, the CDC suggests waiting a week before offering the same food again, and offering it next to a food your child already likes.
• Change how the food is served: a child who refuses cooked carrots may enjoy raw grated carrot (NHS).
• Offer a choice of foods to try and make food fun, for example by arranging it into a funny face (CDC).
• Let your child help prepare food, which the CDC lists among its ways to keep food fun.

Make mealtimes calm

The NHS suggests sitting down and chatting about other things, so mealtimes are not just about eating, and being patient with a slow eater. The Ramathibodi specialist advises turning off the TV and putting toys away during meals, and letting young children feed themselves even if it gets messy.

What tends to make picky eating harder?

Some well-meant habits work against you. The NHS and the Ramathibodi specialist point to these:

When should I talk to a doctor about my child's eating?

England's NHS advises seeing a doctor if you are concerned about your child's health or development at any point. Signs it lists that are worth checking with a doctor:

• not growing or putting on weight at the expected rate
• changes in behaviour, such as being unusually irritable, slow or anxious
• low energy levels and tiring more easily than other children

For everyday worries about fussy eating, the NHS suggests looking at what your child eats over a week rather than in a single day.