She has always been picky, but is now withdrawn at mealtimes and nervous at the prospect of eating. I am concerned for her mental and physical health, and also that of her younger sister. Annalisa Barbieri advises a reader

I am concerned about the eating patterns of my nieces, who are five and 10. I have a close relationship with my brother and sister-in-law, and spend a lot of time with them. Both girls have always been extremely picky about food, with tantrums at most meals. They regularly refuse to eat anything, and a “win” for their parents is if the girls eat more than a few forkfuls of plain pasta or rice. The response has been to give up arguing with them as it is too distressing, and to agree to them eating anything they want as long as something is going in. The result is that their diets are very narrow. It is not just the quality of food that worries me, but the amount – not much.

The five-year-old’s moods are very up and down, with a regular pattern of tantrums and hyperactivity. However, I am particularly concerned about the 10-year-old. She is quiet and withdrawn at meals and I have noticed she “hides” food, by moving it around the plate or putting it on her sister’s plate. I feel she has become adept at giving the impression of eating without actually doing so. She seems nervous at the prospect of having to eat and creates distractions. My brother has discovered that she has been throwing her school packed lunch away so that she “doesn’t get told off for not eating it”.

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