Feeding problems, food refusal and selective eating — branching viva

Station flow (12–15 minutes)

Stem A — Toddler vegetable refusal

A 2-year-old previously adventurous eater now refuses vegetables and many proteins. Growth is on the 50th centile and stable. Parents are force-feeding purees. [1]

Expected opening. Separate parental distress from medical risk. This may be ordinary food neophobia. Check growth trajectory, variety still providing energy, swallow safety and force-feeding practices. [1] [6]

Branch question. “What do you tell the parents tonight?” [1]

Strong answer. Stop force-feeding. Offer structured meals and snacks. Keep pleasant exposure without pressure. Review if variety collapses further or growth slips. Avoid unnecessary bloods today if history and examination are reassuring. [1]

Stem B — Autistic school-age extreme selectivity

A 6-year-old with autism eats three beige foods. School lunch is refused daily. Weight is slipping slowly. [5]

Expected synthesis. Multi-domain problem: nutritional risk plus sensory feeding skill limits plus psychosocial/school impact. ARFID sensory pattern and PFD language both fit; do not moralise. [5] [2] [3]

Branch question. “Who do you involve and in what order?” [2]

Strong answer. Dietetics now for energy and micronutrients. Feeding therapy/OT for sensory-informed graded exposure. School liaison for lunch plan. Psychology if fear or high accommodation dominates. Medical review for red flags. Intensive programme later if outpatient fails. [2] [7] [4]

Stem C — Post-choking fear

A 5-year-old stopped all solids after a choking episode two months ago. Accepts only milk and yoghurt. Wet voice is absent; growth is starting to fall. [4]

Expected synthesis. Fear/aversive ARFID-pattern restriction. Confirm no ongoing dysphagia risk if history/exam raise it, then graded fear treatment rather than force. [4] [8]

Branch question. “When would you consider a tube?” [7]

Strong answer. If oral energy or hydration cannot be maintained safely despite structured support, or medical risk is high. Tube is temporary with goals and exit plan, paired with skill and fear treatment — not a standalone fix. [7]

Examiner close — three high-yield checks

1. Can the candidate define significance using growth, nutrition and family function? [1]
2. Can they name PFD domains and ARFID patterns without getting stuck in labels? [2] [3]
3. Do they stop force-feeding and safety-net clearly? [1]