• Child must be aged 12 months – Prep entry and present with significant mealtime difficulties (+/- current nutritional deficiencies and/or growth concerns), which may include the following identified concerns:
  • Significant dietary restriction* or food selectivity and/or reduced volume of dietary intake (+/- need for oral supplementation)
  • Oral-motor skill delay impacting child’s ability to eat age appropriate foods
  • Sensory processing differences impacting child’s ability to eat age appropriate foods
  • Behavioural feeding problems (food aversion or anxiety, food refusal, vomiting at mealtimes).

*a significant dietary restriction can be defined as <20 individual foods and/or minimal acceptance of entire categories of texture (>12-18months of age) or food groups (fruit, vegetables, meat/meat alternatives) in the diet. (Picky Eaters vs Problem Feeders)

The following are not seen at the CDS Mealtime Service:

• Children aged less than 12 months
• Children aged older than Prep entry
• Children who are medically complex or not medically stable
• Children with suspected pharyngeal phase swallowing difficulties
• Children who require non-oral feeding (e.g., requiring management of non-oral feeding or tube-weaning programs)
• Children undergoing investigation for developmental diagnoses such Autism Spectrum Disorder (ASD) or Global Developmental Delay (GDD)
• Children whose mealtime concerns exist in the context of significant broader parenting difficulties relating to routine, sleep/settling, behaviour management etc. or associated with parent stress and/or anxiety.
• Children who require an intensive model of service delivery (e.g., ongoing blocks of weekly therapy)

Other useful resources:

• It is highly recommended children referred for mealtime difficulties also have a medical review with their GP (or Paediatrician) to explore whether investigations/tests (e.g., blood test for possible nutritional deficiencies) or medical management (e.g., for constipation) for mealtime related issues may be required.
• Referring practitioner to consider whether a separate referral to general paediatrics clinic or nutrition service is required in conjunction with mealtime service referral (e.g., if child is losing weight or dropping percentiles) due to limited access through CDS Mealtime Service.
• Referring medical practitioners to consider whether a separate referral for investigation into suspected allergies is required in conjunction with mealtime service referral (e.g., if child is presenting with concerns indicative of possible diet related allergy).
• In addition to significant mealtime concerns, if the child also has delays in at least one other area of development (i.e., communication, social skills, motor skills, cognition/learning etc), it is highly recommended that a referral to ECEI is made.
• Children with the following presentations should be referred to the Gold Coast University Hospital (GCUH) Paediatric Outpatient Department:
  • Those who are medically complex/not medically stable
  • Those who require non-oral feeding (e.g., requiring management of non-oral feeding or tube-weaning programs)
  • Those aged less than 12 months with acute mealtime concerns
• Children with suspected pharyngeal phase swallowing difficulties should be referred to GCUH paediatric speech pathology team.
• Children who present with less significant mealtime concerns than those seen in the CDS Mealtime clinic can be referred to the CHN team for more general mealtime support strategies or to private mealtime service providers.
• Referrals for children who fit the ‘fussy feeder’ / ‘picky eater’ category rather than ‘problem feeder’ category may be triaged to the CDS ‘Navigating the Maze of Mealtime’ parent workshop (with no further mealtime support provided by CDS team).
• Children aged older than Prep entry can be referred to the CDS ‘Navigating the Maze of Mealtime’ parent workshop only (will not receive further mealtime support through CDS).
• Children currently undergoing investigation for developmental diagnoses (e.g., ASD or GDD) are not accepted by the CDS Mealtime Service, however a referral may be made following completion of developmental assessment where the child remains eligible for CDS services.
• Children whose mealtime concerns exist in the context of significant broader parenting difficulties relating to routine, sleep/settling, behaviour management etc, should initially be referred to another service/stream to address these concerns (e.g., EIPS, a family support service such as Benevolent Society) prior to the mealtime service.
• Children who require an intensive model of service delivery (e.g., ongoing blocks of weekly therapy) should be referred to a private mealtime service provider - consider whether child may be eligible for funding via GP managed Enhanced Primary Care / Mental Health Care plan or ECEI.

Clinician Resources:

• Red flags for Eating
• Picky Eaters Vs. Problem feeders handout
• Feeding developmental milestones table

Patient Resources:

• Red flags for Eating
• Division of responsibility
• Healthy foods and drinks for children aged 1-4 years