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]