Child’s Relationship with Food – Part II

Let’s talk about PICKY EATER OR FUSSY EATER which is a commonly used term by the parents and caregivers.

The problems manifests in various ways and here are the concerns of most parents:

How can I get my child to increase their food volume, eat more vegetables or try new foods?

Are there any meds to improve my child’s appetite?

I am concerned my child is losing out on nutrition due to picky eating habits.

Picky/fussy eating has been defined as an ‘unwillingness to eat familiar foods or try new foods, severe enough to interfere with daily routines to an extent that is problematic to the parent, child, or parent–child relationship ‘as described aptly in The Handbook of Developmental and Behavioural Pediatrics. Although definitions and measures vary, estimates of picky eating are quite high in the preschool age group, with 14-50% of parents identifying their preschool age children as picky eaters.

My effort as a paediatrician and a mom is to help all parents to understand effective ways to feed their pre-schoolers and toddlers so that mealtime is not a daily battleground.

Children aren’t usually born as picky eaters. Let’s figure out what actually leads us down this lane:

• Parents tend to pressure child with unrealistic expectations to eat more without appreciating physiological decrease in appetite between 1-5years age. Healthy children have an amazing capacity to maintain energy balance over time.
• Toddlers develop a sense of autonomy – they prefer self-feeding and have a very strong choice of foods. This state prevents them to eat when pressurized.
• Young children are neophobic i.e., they are resistant to new foods initially but eventually they do learn with repeated and neutral (not negative and forced) exposures.
• Excessive intake of beverages (milk, fruit juice) or sweet food (chocolates) can actually reduce the appetite.
• Inappropriate feeding techniques like threat, punishment, scolding, bribing etc. will reduce the appetite and intake as per recent studies.
• Negative mealtime atmosphere is an important aspect. This concern may be exacerbated because of parents’ perception that their child’s refusal of certain foods constitutes disobedience or noncompliance.
• Eating habits of parents play a major role as children largely imitate parents. So, refusal of a food group, junk food etc. will reflect in child’s eating pattern too.

Clinical evaluation is essential to understand average diet, potion intake, signs of any underlying disease and signs of any nutritional deficiency. Measurement of weight and height over a period can also assure us that the child is healthy.

What matters the most to a parent are the solutions to help them deal with their healthy / fussy eater?

• Parents please understand that the reduced appetite in 2-5year old is normal and matches to the slowed growth rate in this age.
• Parents are responsible to introduce nutritious and healthy food at appropriate meal and snack timings but children should be allowed to decide how much and what they want to eat from what is being offered.
• Start with small amounts of food on plate so that the child is not overwhelmed and gradually increase if child is able to finish.
• Snacks should be offered mid meals, should be nutritionally rich and grazing all day should not be encouraged as it reduces appetite.
• Meal time should be brief and fun. It should not extend beyond 20-30minutes. If child is not interested, he can be offered something in the next meal time.
• Children need to have adequate play and activity to stimulate appetite. Avoid distractions like television, toys and books during mealtime.
• Family should eat together whenever possible
• Appetite stimulants are not a solution to food refusal. When a child is growing well there is no need for a growth supplement, special toddler formulas etc.

Please feel free to contact me on FB messenger in case you wish to discuss it further.