Nutritional Disorders Telehealth Network Project

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Increase Food Variety

Strategies to increase the variety of foods consumed by the child are used to stabilize a child’s nutritional status (e.g., improved micro & macro nutrition). Typically, foods are selected when menu planning for inclusion into the child’s diet. Strategies typically include exposure, appetite manipulation, differential reinforcement techniques, and shaping/chaining of foods (e.g., selection of new/non preferred foods which share characteristics of foods already accepted).
Background Education for Providers
Previous studies have shown that increasing food variety is difficult in young children. Often children will “outgrow” picky behaviors, but many children maintain or show a worsening of selectivity in food choices as they grow. Recent studies estimate food selectivity in 25-45% of typically developing children at some point in their development. Efforts to treat selective eating habits primarily consist of exposure strategies. Some previous studies have shown that children typically need multiple exposures to a food before it becomes a well accepted item (e.g., typically between 10-15 exposures). Therefore, by increasing the frequency of exposures to new and non preferred foods, a child presumably will expand their diet and reduce the probability of nutrition compromise.
Treatment Issues
Assessing the existing diet – Caregivers and providers must understand where food deficiencies exist in the child’s diet. Typically, diet records are reviewed by professionals to assess “Macro Nutrient” deficiencies. 
Menu Selection – Introducing food groups that are not represented or are underrepresented in the child’s current diet.
Response Burst – Efforts to introduce or expose the child to new foods will typically be met with resistance. At these times, it is important to maintain efforts to complete the exposure as withdrawing the non preferred food will inadvertently reinforce the child’s food refusal strategy. Similarly, if parents do not maintain their efforts to expose the child to new/non preferred foods, there will likely be a return to food refusals in the future. 
Typically, we prefer to use more “positive” or “neutral” strategies to complete food exposures. Caregivers are generally instructed to use mealtime structure and routine along with positive reinforcement techniques. If additional intervention is needed, consultation with a behavioral health professional is recommended.
Instructions for Provider
First, a dietary assessment of the child’s current intake should be completed. This is typically done by way of 24-hour recall interview or by written diet record. Gross assessment of food intake can be estimated and strategies to increase calories (exposure, appetite manipulation, differential reinforcement techniques, and shaping/chaining of foods) may be discussed with the family. 
Supplemental Materials
© 2015 Medical College of Wisconsin
Page Updated 04/15/2014