• Alyssa Fontaine, RD
• Jun 30, 2026

When Should I See a Pediatric Dietitian? Signs Parents Often Miss

Mealtimes can be stressful, especially when your child rejects foods or eats only a small amount. While picky eating or feeding challenges are a normal part of childhood development, many parents wonder: “Is this typical behaviour, or is there something more going on?”

If you’ve found yourself worrying about your child’s nutrition, growth, or eating habits, you’re not alone! These concerns are common, and it’s not always easy to know when extra support is needed.

As pediatric dietitians, we help families understand what is typical during childhood and identify signs that may point to a deeper nutrition or feeding concern.

Growth Concerns: When Percentiles Actually Matter

Have you ever looked at your child’s growth chart at the doctor’s office and wondered what those percentiles really mean?

Growth is one of the most important signs of a child’s overall health and nutrition. However, many parents worry when they see their child in a lower percentile, even when their child is growing perfectly well.

What’s Normal?

As children grow, they naturally go through periods of faster growth and periods where it slows down. This variability is completely normal.

A child in the 10th percentile can be just as healthy as a child in the 90th percentile. What matters most is not the percentile itself, but whether your child is following their percentile curve over time. 

When Should Parents Be Concerned?

Growth charts become more concerning when a child shows a significant change from their usual pattern.

Some signs of concern include:

• Weight gain that has stalled or declined
• Height growth that has plateaued or slowed unexpectedly
• Missing milestone markers

Unlike adults, children are expected to grow continuously. While growth rates vary, we generally want to see ongoing increases in both height and weight as they develop.

You Don’t Need a Referral to See a Dietitian

A pediatrician may refer your child to a dietitian if they notice:

• Growth faltering or poor weight gain
• Crossing two major growth percentile lines on their growth chart
• Signs of nutrient deficiencies (fatigue, weakness, poor concentration, constantly sick)
• Concerns about an underlying medical condition

However, you don’t need to wait for a referral or for a concern to become serious. You can speak to a pediatric dietitian the moment you see a negative change, have a concern or any questions regarding your child’s nutrition. 

Persistent Picky Eating vs. Nutritional Risk

Picky eating is very common and is often a normal part of development. 

Many children go through phases where they:

• Prefer familiar foods
• Refuse a food one day and eat it happily the next
• Have appetites that vary from day to day
• Feel hesitant or cautious about trying new foods

While these behaviours can be frustrating, they typically don’t affect a child’s growth, health, or nutritional wellbeing. 

When Picky Eating May Be More Than a Phase

It may be worth speaking with a pediatric dietitian if your child:

• Eats a very limited number of foods (fewer than 15–20 foods)
• Refuses entire food groups
• Consistently avoids or rejects certain textures
• Has an intense fear of trying new foods
• Avoids eating with others
• Is having difficulty gaining weight or growing as expected
• Shows signs of possible nutrient deficiencies
• Experiences significant stress or anxiety around mealtimes

Sometimes, these eating patterns can increase the risk of inadequate nutrition. A pediatric dietitian nutrtionist can help determine whether your child’s eating habits fall within the range of typical picky eating or whether additional support may be beneficial.

Common Pediatric Nutrient Gaps

Childhood is a time of rapid growth and development, so getting enough key nutrients is especially important. While most children get what they need from food, there are a few nutrients and symptoms to keep an eye on such as fatigue, low energy, weakness, irritability and difficulty concentrating. 

Some of the most common nutrients to monitor: 

Iron

Iron is one of the most common nutrient deficiencies in children. It’s important for growth, brain development, and carrying oxygen throughout the body.

Children who eat a very limited variety of foods or avoid iron-rich foods may be at higher risk.

Some good food sources include: 

• Meat (beef, chicken, pork)
• Seafood (Tuna, salmon)
• Dark leafy greens (Spinach, Kale, Chard)
• Beans
• Tofu

Vitamin D

Vitamin D supports healthy bones, immune function, and overall growth.

Because we get much of our vitamin D from sunlight, many Canadian children may not get enough throughout the year. Depending on your child’s age and diet, supplementation may be recommended.

Some good food sources include: 

• Milk or fortified beverage such as soy, oat or almond milk
• Yogurt
• Cheese
• Fortified cereals

Vitamin B12

Vitamin B12 plays an important role in brain and nerve development.

Children, especially those following vegetarian or vegan diets, may need fortified foods or supplements to meet their needs. 

Some good food sources include: 

• Meat 
• Seafood
• Fortified products (cereals, plant milks, nutritional yeast)
• Dairy
• Eggs

What About Protein?

Protein is one of the nutrients parents ask about most, and fortunately, it’s usually not a nutrient we worry too much about.

Most children meet their protein needs, even if they’re somewhat selective eaters. More often, we focus on the variety of foods they’re eating rather than the total amount of protein they’re getting.

Digestive Issues That Shouldn’t Be Ignored

Sometimes, what looks like picky eating is actually a sign that a child is experiencing discomfort when they eat.

If eating is associated with pain, bloating, nausea, or other digestive symptoms, it’s understandable that a child may start avoiding certain foods or eating less altogether.

Some common digestive issues include:

Chronic Constipation

Constipation can affect much more than bowel movements. It may lead to:

• Reduced appetite
• Early fullness
• Abdominal pain
• Changes in eating behaviours
• Poor growth over time

Reflux (GERD)

Children with reflux may experience symptoms such as:

• Burning or discomfort after eating
• Frequent burping
• Nausea
• Refusal of certain foods or meals

Suspected Food Intolerances

Symptoms such as bloating, abdominal pain, diarrhea, or constipation can sometimes lead parents to suspect a food intolerance.

However, not all digestive symptoms are caused by food intolerances. A pediatric dietitian can help determine whether an intolerance is probable and how to manage it.  

When Digestive Symptoms Affect Eating

Children often avoid foods that cause them discomfort. What appears to be picky eating may actually be a symptom rather than the root cause. 

A pediatric dietitian can help identify nutrition-related triggers, support symptom management and work alongside your child’s healthcare team such as their pediatrician, gastroenterologist or allergist when needed.

Special Diets: When Professional Guidance Is Essential

If your child follows a special diet or has specific feeding needs, a pediatric dietitian can help ensure they are getting the nutrients they need to grow and thrive while respecting your family’s preferences. 

Vegetarian and Vegan Diets

Vegetarian and vegan diets can absolutely support healthy growth in children. However, they often require a bit more planning to ensure children are getting enough:

• Iron and Zinc
• Vitamin B12
• Omega-3 fats
• Protein
• Calories 

Food Allergies and Elimination Diets

If your child is avoiding foods because of a suspected allergy or intolerance, it’s important to make sure they’re still meeting their nutritional needs.

A pediatric dietitian can help:

• Identify appropriate food substitutions
• Prevent unnecessary food restrictions
• Support growth while managing symptoms

 Neurodivergent Children (ASD, ADHD, etc)

Many neurodivergent children experience sensory sensitivities, strong food preferences, or limited food variety.

A pediatric dietitian can help assess whether nutritional needs are being met and provide strategies to support variety while respecting your child’s sensory needs and comfort level.

Cultural and Religious Eating Patterns

Every family has unique food traditions, preferences, and values.

A pediatric dietitian can help adapt nutrition recommendations to fit your family’s cultural or religious eating patterns while ensuring your child receives the nutrients they need for healthy growth and development.

The goal is never to change the foods that are important to your family, it’s to help make those foods work for your child’s nutritional needs.

You Don’t Have to Wait for a Crisis

Many parents think they should only see a dietitian when there is a serious concern. In reality, early support is often the best way to prevent small concerns from becoming bigger challenges.

Early support can help:

• Prevent nutrient deficiencies
• Support healthy growth and development
• Reduce stress around meals
• Address picky eating early on 
• Build healthy eating habits and a positive relationship with food

Sometimes parents simply want reassurance that their child is on track. Other times, they have questions about growth, nutrition, feeding, or dietary restrictions. Whatever the concern, a pediatric dietitian can help provide personalized, evidence-based guidance tailored to your child and family.

What to Expect

During an initial consultation, your dietitian will review:

• Growth and medical history
• Current eating patterns
• Nutrition and feeding concerns
• Your family’s goals and priorities

From there, you’ll receive individualized recommendations designed to fit your child’s unique needs and your family’s lifestyle.

At Family Dietitians, we provide virtual nutrition services across Canada. Whether you’re concerned about growth, picky eating, digestive issues, food allergies, or specific diet restrictions, our team can help connect you with a dietitian that fits your needs. 

Most importantly, you don’t have to figure it out alone. Getting support early can provide clarity, confidence, a plan to help your child thrive and remove some of that additional stress.  

FAQs

What does a pediatric dietitian do?

Pediatric dietitians assess a child’s growth, eating habits and nutrient intake to develop evidenced-based suggestions and strategies. They will help you manage your concerns and ensure your child is getting the necessary nutrition they need while aligning with your family’s beliefs and lifestyle. 

Can a dietitian help with picky eaters?

Absolutely! Pediatric dietitians are well-equipped to help you determine the cause of your child’s picky eating, provide individualized strategies and counselling to help your child explore and accept more foods at their own pace. 

What are the signs that my child may have a nutrition problem? 

Signs that your children may face a nutrition-related problem include: poor growth, low energy levels, frequent illness, digestive issues, difficulty concentrating and delayed developmental milestones. Children who eat very little or have limited variety could also benefit from nutritional guidance. 

Is it only for children with medical conditions?

No! While dietitians can provide support for children with specific medical concerns and it is an important aspect of their care, dietitians also work with healthy children. If parents have any questions, concerns or would like practical nutritional guidance, we are here to support them!

How is it different from general nutrition advice? 

Meeting with a pediatric dietitian ensures you have a tailored, individual approach that will allow you to achieve your specific goals using expert nutritional knowledge and advice. General nutritional information does not take your child’s habits, preferences or specific needs into account.