Table 9 Strategies to improve feeding problems in children with PKU

Parents should eat with children to encourage positive role modelling and social interaction [30]. Eating together, with at least one suitable low protein shared dish allows children to observe their parents eat and enjoy their foods.

Develop consistent mealtime routines, so that parents help children learn to anticipate when they will eat. The intake of sweetened drinks or low protein milk should be controlled.

Parents should give a suitable, healthy and varied low protein diet. Offering a child too many food choices is confusing and may cause conflict and toddler tantrums.

Parents should allocate adequate time for each meal. When mealtimes are too brief (< 10 min) children may not have enough time to eat, particularly when they are acquiring self-feeding skills. In contrast, sitting for > 20–30 min is often difficult, and mealtimes may become aversive.

Increasing familiarity with the taste of a food increases the likelihood of acceptance. Offer new foods several times, even if initially rejected.

Children should be encouraged to ‘play with food’ e.g. decorate low protein biscuits or garnish a low protein pizza with vegetable toppings. This will ensure their food is fun.

Friends should be invited to low protein birthday parties, teas and picnics. Low protein food enjoyed by others, will help food acceptance.