Nourishing a Picky Eater

Infants and children develop ‘food fads’ as they grow older. A previous favourite at mealtime may suddenly elicit shrieks of disgust or be pushed aside when it is served. This is normal and not an unexpected phenomenon. After all, your child’s preferences will change as he gets older. When coupled with increased levels of activity and a short attention span, mealtimes become a challenge. As a result, he may choose to eat only a small amount of food, preferring those that are easy to eat and digest.

Food such as vegetables are not popular amongst children due to its taste, and likewise, meat is unpopular as it is difficult to chew and digest. Most children are also intent on getting back to having fun and as a result, tend to sacrifice their food for more play time.

Under normal circumstances, your child will consume sufficient amounts of food to maintain growth. However, nutritional imbalances may occur in some cases, especially if he consumes a very limited amount of certain types of food. For instance, insufficient intake of:

• carbohydrates and proteins – may lead to impaired growth resulting in poor weight gain.
• fibre – can lead to constipation.
• vitamins and minerals – may lead to problems such as anaemia.

Consequences of picky eating

Children who are picky eaters are more likely to grow up more selective with their food. This, in turn, may lead to nutritional imbalance and unhealthy eating habits as an adult. A child who has not been previously encouraged to take fruits and vegetables is less likely to do so as an adult.

While nutritional supplements may appear attractive as a means of providing your child with a balanced diet, they should only be used on a short term basis and not to complement the diet of a picky eater.

Identifying picky eating

Poor appetite and food refusal are often first noticed during the transition to spoon-feeding and self-feeding. It is important to ensure that your child’s refusal to feed is not a sign of illness.

It is therefore important that your child be seen by his paediatrician to rule out medical causes of his food refusal, such as reflux, cow’s milk protein allergy, or choking.

Picky eaters can essentially be divided into four different categories based on their traits, namely:

• Fear of feeding – they equate feeding time with ‘torture’ and may cry when offered food or sometimes even when they see feeding utensils. They usually resist feeding by screaming, crying and pushing the food away. This situation is usually caused by:
  • previous traumatic event such as choking or gagging
  • previous history of tube feeding or use of life support
• Highly selective food intake – these children will only eat certain types of food and refuse to eat other types of food.
• Energetic child who rarely seems hungry – such children appear to be full of energy despite seemingly not eating much.
• Parental misconception – such children are often perceived to be eating too little by their caregivers. A detailed history however, reveals otherwise, that the child is actually receiving adequate nutrition.

Dealing with picky eaters

Here are some tips on how to work with your child in order to ensure that he does not miss out on the essential nutrients he needs to grow. These include:

• Stick to a schedule – mealtimes should be around the same time, e.g. if lunch is at 12pm, then it should be at this time every day. Keeping his snack or mealtimes constant means that he will know when his next meal is, and it also makes it easier for you to keep track of what/when he eats. Ensure that he is sufficiently hungry at mealtimes, otherwise he may not want to eat.
• Keep snacks healthy – offer healthy food (and keep portions small) such as fruits (e.g. one or two apple slices or half a banana), vegetables (e.g. a few carrot slices or, a few tablespoons of boiled or steamed sweet potato), yogurt, cereal, or a sandwich.
• Avoid all-day snacking – Do not feed him all day long. This includes drinks such as milk or juice. If he keeps filling up on snacks or comfort foods the whole day or before mealtimes, it will affect his appetite and he may refuse to eat his meals. As a general guide children between 1-6 years should:
  • eat no more than six times a day (three meals and two to three snacks, at least two hours before mealtime).
  • drink no more than 2-3 glasses of milk a day. Limit fruit juices to no more than ¾ cup of freshly squeezed juice and avoid giving him store-bought juices, as these are loaded with sugar. Plain water is best, but you can opt to dilute the juice with water before serving.
• Keep your cool – do not give up and keep trying even if he rejects new foods at first, especially veggies. It may take multiple attempts, but keep offering him a variety of healthy foods such as fruits, vegetables, and even “grown-up” food. However, do not pressure him to eat. You can try serving the same food using different cooking methods or by combining it with other foods. Dips are a great way to encourage them to eat.
• Get him involved – most children will be more open to eating vegetables if you can get them involved. You can do this by letting him pick his own veggies when you go grocery shopping or by getting him to help out in the kitchen when you prepare his meals.
• Make it fun – children love to play! Turn mealtimes into a fun experience for him by:
  • using cookie cutters to turn his food into interesting shapes,
  • making a game of ‘eating all the colours’ during mealtimes,
  • having a picnic just for a change of scenery.
• Avoid food bribery – you may be tempted to tell him to eat all his veggies and that you will reward him with some ice cream. However, this strategy is a poor long-term solution as it sends him the wrong message, i.e. he will learn to value the treats you offer rather than the healthy foods he should be eating.

An educational contribution by Malaysian Paediatric Association.