New consensus highlights tailored exposure-based approaches for paediatric feeding disorders

A recent consensus paper underscores the importance of personalised, exposure-focused therapy involving children and families for treating avoidant and restrictive eating problems in children, emphasising gradual exposure, goal-setting, motivation, and caregiver involvement.

Psychological treatment for avoidant and restrictive eating problems should centre on repeated, planned contact with food and the act of eating itself, according to a consensus paper in the current literature on paediatric feeding disorder and avoidant/restrictive food intake disorder. The paper says the shared elements across approaches are exposure, collaborative goal-setting, motivation-building and caregiver involvement, with the exact mix of techniques shaped more by severity, developmental stage and the main pattern of difficulty than by diagnosis alone.

The authors describe exposure as the common thread running through treatment. Depending on the child and the clinical picture, that can mean gradually trying feared foods, practising meals in ordinary settings, working with sensations such as fullness or nausea, or facing anxiety linked to choking or other adverse events. The paper distinguishes between methods such as in vivo exposure, imaginal exposure, interoceptive exposure and systematic desensitisation, alongside related behavioural techniques including shaping, fading, food chaining and response prevention. For children with more limited language or self-regulation, the approach is usually more behavioural and tightly scaffolded, with progress guided by observable signs of distress and coping.

Goal-setting, the paper says, should be practical and tailored to why the child is being treated. In a nutritionally stable child with selective eating, the aim may be greater variety and flexibility at meals. In a child whose intake is restricted by fear after choking, the first priority may be restoring adequate weight and intake before moving back towards a broader diet. The authors also note that, when there is no immediate safety risk, the child and family should have substantial input into the targets, rather than the clinician imposing a one-size-fits-all plan.

Motivation and family work are presented as essential rather than optional. The paper says psychologists may use psychoeducation, motivational interviewing and reinforcement strategies to help children and caregivers engage with treatment, while parents are often coached to reduce accommodation and to support exposures at home. In younger children or in cases with more severe impairment, caregivers may need to act almost as co-therapists, structuring meals, managing contingencies and helping the child generalise gains beyond clinic sessions. The consensus view is that, although feeding problems may look different across children, successful treatment usually depends on the same basic formula: repeated exposure, clear goals, active support and gradual transfer of skills into daily life.