When planning management strategies priority should be given to optimizing the treatment of  any underlying medical conditions contributing to the feeding difficulty [10].   While feeding difficulties may continue despite treatment of underlying medical issues [5, 9] it is reasonable to expect that this is a prerequisite to achieving change  e.g. child who experiences pain with eating is unlikely to achieve improvements with eating while pain persists.

Nutrition counselling may be a high priority for children with poor growth or dietary deficiencies.  For example providing strategies for increasing energy intake to improve growth or increase intake of  ironcontaining foods for those with iron deficiency or fibre for children with constipation or low fibre intake.  Sensitive discussions regarding the benefits of tube feeding may be indicated. 

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