Conquering fussy eating
Fussy eating is one of the most common problems seen by paediatric dietitians in the outpatients setting. It is something that seems to be universal to all parents as almost all children will go through a period of ‘picky’ or ‘fussy’ eating. Sometimes it lasts no more than a few days or weeks but in extreme cases it can persist for a number of years with medical, dietetic and/or psychological intervention sought to help alleviate the problem. There is no doubt that fussy eating can put huge strain on parents and indeed all the family as mealtimes are changed from a social gathering into a battleground.
So why do some children develop into fussy eaters while others just go through a passing phase of being picky? In fact, little is really known about fussy eating.
Other research has shown that babies who were exposed to a variety of vegetables during the weaning phase were more likely to accept a new vegetable than those fed only one vegetable during the weaning phase. Clearly, exposing children to a range of flavours both in breast-milk and on weaning is important to help increase the chances of the child accepting new foods. However, studies have also shown that there is a genetic element to fussy eating.
So what is one to do when faced with a fussy eater? Firstly, it is important to check the child’s weight and height to ensure that they are following their growth centiles or that there isn’t a large discrepancy between their height and their weight centiles. If the child is growing normally, reassure the parents that fussy eating is a normal developmental stage that all children go through.
Toddlers, especially, tend to have erratic appetites, eating very little one day and lots of food the next. This ‘up and down’ pattern of eating is normal and nothing to worry about when the child is growing normally and gaining weight.
Over-drinking is one of the main causes of fussy eating. Whether it is milk, juice or soft drink, toddlers have quite small stomachs that are easily filled up with fluid, taking away their appetite for food.
In 2004, the Institute of Medicine set an adequate intake of fluid for toddlers of 1.3 litres of fluid per day. As this includes water from food as well as drinks, and can also vary based on their weight, a general guide is about six to eight drinks per day, of 150-200mls/5-7oz each. Toddlers only need about two beakers of milk per day (150-200mls/5-7oz per beaker), so the rest should come from water.
Any more than this and it can start affecting their appetite for solid foods. Avoid soft drinks completely. They are not suitable for small children and should only be given to older children as a treat. It is also a good idea to implement a rule of no drinks at all for thirty minutes before meals.
It is important for families to develop a routine around mealtimes. If children eat at the same time every day it can help to program their appetite so that they become hungry at mealtimes. Ideally, children should be having three meals and two to three snacks per day. Try to have the snacks at the same time every day also. Children who eat a continuous stream of tit-bits throughout the day never really work up an appetite for a meal, therefore aim to have a decent break between meals and snacks.
Mealtimes should take about 30 minutes. Don’t allow them to drag on much longer than this. Children will eat the majority of a meal in the first 30 minutes and making them sit at the table over a cold plate just creates negative associations with mealtimes and gets everyone’s tempers flaring. The best thing to do if a child hasn’t finished their meal, is to take it away after 30 minutes without comment and do not allow them to have anything else for at least an hour or two. It is important to remember that the child will not starve and they need to be shown that if they do not eat their dinner there is no alternative in the form of a sweetened yogurt or cereal bar. Children are allowed have likes and dislikes but if they are refusing to eat a meal that they normally like and are ‘acting up’ as such, they should not be offered an alternative.
However frustrated a parent may feel with their child refusing food, it is very important that he or she tries not to react to the child refusing to eat. While this is most definitely easier said than done, it should be kept in mind that children often refuse food in order to get attention and pleading with them to eat is only reinforcing the behaviour. As far as possible it is best to say nothing at all when the meal is not eaten, giving the child no attention for refusing to eat.
Any efforts to eat or to try new foods should conversely be met with lots of praise and attention. Needless to say, force-feeding is never recommended as it brings negative associations to mealtimes that will be very difficult to undo.
Encourage families to eat together where possible as it teaches younger children how to behave at mealtimes. Also, a fussy child may see another child eating something they dislike, encouraging them to try it also.
In summary, breastfeeding and exposing children to a wide range of tastes in early childhood may help prevent a ‘fussy eater’ in later childhood. For children who are refusing foods, ensure they are not over-drinking and try to get them into a good meal-pattern. Allow 30 minutes for mealtimes and try not to react if they refuse to eat the meal. If a child is a healthy weight and growing satisfactorily a few missed meals will not make any difference to their health and well-being.
Author: Valerie Kelly is a senior paediatric dietitian in Temple Street Hospital
- Sullivan SA, Birh LL. Infant dietary experience and acceptance of solid foods. Paediatrics 1994;93:271-277
- Gerrish CJ, Mennella JA. Flavor enhances food acceptance in formula- fed infants. Am J clin nutr 2001;73:1080-1085
- Birch L. Development of food preferences. Ann Rev Nutr 1999;19:41-62
- American Academy of Paediatrics Committee on Nutrition. The use and misuse of juice in paediatrics. Paediatrics 2001;107(5):1210-1213