Feeding problems, food refusal and selective eating — formative SAQs

SAQ 1 — Preschool selective eating with growth concern (10 marks)

A 3-year-old eats five foods, gags on mixed textures and has crossed two weight centiles downward over 8 months. Caregivers force spoonfuls at every meal. No cough with fluids and no body-image concerns. [1] [2]

Questions

1. Write a one-sentence problem representation and state whether this is likely ordinary neophobia, PFD and/or ARFID-pattern restriction. (3 marks) [1] [2] [3]
2. Map the active PFD domains and list three history or examination priorities today. (4 marks) [2] [6]
3. Give three immediate management steps for this week. (3 marks) [1] [2]

Model answer

Problem representation (3). Example: “Three-year-old with severe texture-limited diet, force-fed meals and falling weight trajectory over 8 months; clinically significant feeding disorder spanning nutritional and psychosocial domains with ARFID sensory-pattern features rather than ordinary self-limited neophobia.” Ordinary neophobia alone is unlikely once growth is clearly deteriorating. [1] [2] [3]

Domains and priorities (4). Active domains: nutritional (centile fall, narrow diet), psychosocial (force-feeding conflict), likely feeding skill/sensory (gagging on mixed textures); medical domain needs screening but no current cough with fluids. Priorities: full accepted-foods list and mealtime tactics; plot serial growth; examine oromotor status, hydration and micronutrient-risk signs; screen development/autism traits and organic red flags. [2] [6]

Immediate steps (3). Stop force-feeding and restructure meals/snacks with responsive feeding coaching. Urgent dietetic input to protect energy and micronutrients using accepted foods. Book early multidisciplinary feeding review and set concrete red flags for earlier return if intake collapses. [1] [2]

SAQ 2 — Autism, brand rigidity and escalation (10 marks)

A 7-year-old with autism eats two brands of dry carbohydrate foods only. Growth is currently stable but iron studies are low. Parents ask about a feeding tube “to end the stress.” [5] [2]

Questions

1. How do autism-related sensory selectivity and ARFID/PFD frameworks help organise care without moralising the child? (3 marks) [5] [3]
2. Outline a stepwise plan before considering tube support. (4 marks) [2] [7] [4]
3. State when temporary tube feeding could be justified and what must accompany it. (3 marks) [8] [7]

Model answer

Frameworks (3). Autism sensory selectivity commonly produces brand- and texture-rigid diets. Frame the problem as sensory and skill limits plus nutritional risk, not naughtiness. PFD domains and ARFID-pattern language organise multidisciplinary care; consensus work reduces fruitless label wars while keeping impairment central. [5] [3]

Stepwise plan (4). Confirm swallow safety and exclude new medical drivers. Dietetics for fortification of accepted foods and iron repletion strategy. Sensory-informed graded exposure with feeding therapy, changing one variable at a time. Caregiver coaching to stop coercion. Psychology if fear or high family accommodation blocks progress. Consider intensive multidisciplinary programme if outpatient care fails. [2] [4] [7]

Tube threshold (3). Temporary tube support is a bridge when oral energy or safety cannot be met despite structured care, or when medical risk is high. It requires clear goals, monitoring, skill-building and an exit or reassessment plan — not a permanent substitute for therapy. [8] [7]