Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
!
Airway compromise, aspiration or severe dehydration
Choking with inability to breathe, cyanosis, recurrent aspiration, marked respiratory distress, severe dehydration, hypoglycaemia or inability to take any safe fluid requires urgent care.
Action: Use the age-appropriate choking and basic-life-support sequence and call 999 for airway compromise. Stabilise airway, breathing, circulation, temperature and glucose. Stop unsafe oral intake, obtain same-day paediatric and speech-and-language-therapy assessment and provide hydration or nutrition by the safest temporary route while the cause is evaluated.
Synopsis
Separate normal developmental food refusal from unsafe swallowing, oral-motor, sensory, medical and relational feeding disorders; observe a representative meal, protect nutrition and positive oral experience, and coordinate family-centred multidisciplinary care.
Feeding difficulty is descriptive, not a diagnosis. Define the domain: medical pain, nutritional insufficiency, oral-motor or swallowing impairment, sensory aversion, developmental or behavioural pattern, and caregiver-child interaction.
First-line assessment is a detailed history, growth and developmental review plus an observed representative meal or feed in the child's usual position with familiar foods and caregiver.
Normal picky eating includes variable appetite and food neophobia with maintained growth and at least some foods across groups. Progressive restriction, nutritional consequences or severe distress is not a normal variant.
Key red flags
Cough, choke, wet voice or breathing, colour change, desaturation or recurrent chest infection during meals suggests aspiration.
Investigation priorities
01
First-line: multidisciplinary clinical feeding assessmentFirst stepFirst line
Define safety, skill, nutrition, sensory and interaction domains.
Management branches
TriageEstablish safety first
A child coughs, chokes, loses colour or cannot maintain hydration.
Assess airway, breathing, hydration and acute illness and stop clearly unsafe textures.
Obtain urgent paediatric and specialist speech-and-language-therapy assessment.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.