Picky Eaters: When to Worry about Your Child’s Nutrition
Picky Eating or Health Problem?
Normal Picky Eating vs. Feeding Disorder
Nearly every child goes through a phase of rejecting food, usually during the toddler years. Broccoli may be left untouched on the dinner plate, peas thrown at the wall, or a nose wrinkled in disgust at the sight of a healthy meal.
This phase is common and usually overcome with consistency and time, but sometimes “picky eating” is a sign of a medical or nutritional problem in a child. How can one tell if a child is merely going through a normal developmental stage or experiencing a health problem?
When Not to Worry about Feeding Problems
A two year old toddler will eat in fits and spurts – one day he may eat only a few handfuls of cereal, and the next day he may eat everything in sight! In general, don’t look at what a child eats in a single day, but over the course of time. If a toddler has an “off” day but eats well over the course of the week and is gaining weight well, this is usually typical pickiness common to all toddlers and preschoolers. If, however, that toddler only eats a handful of cereal all week, refuses all other food, and doesn’t gain (or even loses) weight, see a doctor immediately.
When a Child Doesn't Eat Enough
Feeding Problems: A Poll
What type of feeding problem does your child have?
Ten Signs of Feeding Problems in Children
The following signs indicate a feeding or health problem, and the child should be seen by a pediatrician or other physician for review:
1. Refuses all food: while picky eating involves a child who will eat their favorite, limited food items, it is not normal for a child to refuse to eat all types of solid food.
2. Gags or chokes on food: swallowing difficulties including gagging or choking should be immediately investigated by a physician or a feeding clinic.
3. Refuses all foods of a specific texture: some children have sensory processing difficulties and will only tolerate crunchy foods or soft foods, for example. A child who will only tolerate one food texture should be evaluated.
4. Vomits frequently: any child who regurgitates food should be reviewed by a physician.
5. Failure to thrive: if a child is not growing and gaining weight appropriately (maintaining their own percentile on growth charts), immediate review is necessary. Children who fall below the 5th percentile should also be reviewed and monitored.
6. Develops stomach bloating: if a child’s belly becomes distended and bloated after eating, a physician should be seen.
7. Will not allow a spoon to pass through the lips: some children have oral defensiveness, and will gag or vomit if an object passes (or even touches) their lips.
8. Cries or has behavior problems at mealtimes: while typical children will have tantrums at the table, a child who has a tantrum at every single meal or snack opportunity should be seen by a doctor.
9. Has constipation or frequent diarrhea: bowel problems can contribute to a lack of appetite and should be reviewed by the appropriate specialist.
10. The parent has a worry that is not being addressed: sometimes a parent’s intuition is the most powerful tool in existence. If you are concerned about your child’s growth or nutritional status, take them to the doctor.
Diagnostic Tests for Feeding Problems in Children
Eosinophilic Esophagitis: One Cause of Feeding Problems in Children
Conditions that Cause a Poor Appetite in Children
There are many conditions that can cause children to eat poorly – and the cause for each child must be investigated by his or her doctor. The following is a list of some of the conditions that can cause a child’s appetite to wane:
· Acid Reflux: children who have reflux often refuse to eat food because they associate food with pain. Some children have frank reflux (vomiting) which contributes to weight loss, and others have “silent” reflux which has no outward symptoms, but causes pain with eating. Medication is generally helpful to children with this condition.
· Delayed Gastric Emptying: some children have stomachs that empty slowly, so they feel full too soon and don’t feel hunger. Medication and diet changes are sometimes helpful in managing this condition.
· Constipation: children who are chronically constipated may feel nauseated or have stomach pain, limiting the amount they eat.
· Food allergies: a child may have a food allergy, contributing to stomach pain and lack of appetite. Some children, for example, have a milk allergy that causes bloating and diarrhea. Eosinophilic Esophagitis is a condition where eosinophils (a type of white blood cell) attack the lining of the esophagus – this condition requires specialized care.
· Dysphagia: occasionally, a child may have difficulty swallowing. This condition is called dysphagia and must be evaluated by a physician promptly.
· Sensory Processing Disorder: some children are extremely averse to certain textures, smells, or tastes, causing them to severely limit the type of foods they are willing to eat.
Food Chaining Success Story
Feeding Clinic Success Story
Treatment for Feeding Problems in Children
Once a child has been identified with a true feeding problem, the next step is to find the underlying cause of the food refusal. A child will often be referred to a Gastrointestinal specialist (GI) and/or to a feeding clinic for evaluation and feeding therapy. Depending on the cause of the eating difficulties, a child may need medication, surgery, or supplemental nutrition while they are going through a feeding clinic program.
What does a feeding clinic do? They monitor the weight and growth of the child while helping children to explore and learn to eat different types of food. A child who has difficulty coordinating chewing and swallowing, for example, may be given a dissolvable food like cheese puffs under the close supervision of a speech-language pathologist and nursing staff. For children with texture issues, a technique called “food chaining” can help a child learn to accept a greater variety of foods.
The basic premise behind food chaining lies in identifying a food the child already accepts, and then expanding the child’s food repertoire based on that one food item. For example, say a child will only eat pretzels. With food chaining, a food with similar characteristics is found: hard breadsticks may serve as the first food following pretzels. If the child accepts eating the crunchy breadsticks, soft bread may be tried. This technique allows for a gradual widening of the child’s accepted food items.
A feeding clinic will help a family set up a routine and diet that works for a specific child. They may encourage a family to allow the child to “play” with his or her food – painting with pudding and applesauce may be a recommended activity. Smearing a favorite taste on a child’s cheek is one technique to encourage a child to learn to use his or her tongue (the child will try to lick the flavor off his chin and cheeks).
Sometimes, a feeding clinic cannot help a child eat enough to gain weight. This is often the case with complicated, significant medical issues. In these cases, supplemental nutrition is generally required.
Supplemental Nutrition for Children with Feeding Problems
For children with complex medical needs, metabolic disorders, or severe gastric motility problems, supplemental nutrition is often needed. Sometimes the supplemental nourishment can be provided orally, but some children will require enteral nutrition through the use of a gastrostomy tube (g-tube). A g-tube is generally only placed for children who cannot take in enough food to grow and develop appropriately. Children who receive g-tubes will be monitored closely by a physician, have frequent weight checks, and may attend a feeding clinic on a regular basis.
This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.
Questions & Answers
What type of diet should be given to a two-year-old child to help them like food?
Firstly, if your child is not growing as they should, I would seek a physician's advice to ensure there are no underlying medical issues that need treatment. If your child is simply a "picky eater," one great technique is called food chaining. You find food the child will eat without complaint, and then slowly expand the food the child likes by adding to the repertoire. For instance, if a child likes french fries, you could slowly expand this to include tater tots, then baked potato, then mashed potato over time. Some children do not like mixed textures in their food or do not care for a specific texture. Identifying foods with "problem" textures can also help to find the food your child will eat readily. Providing lots of opportunities to try new food is also important, without any pressure.
One fun idea is to place blueberries in the squares of a waffle. The child may or may not want to eat the blueberries, but continue to offer the food item. It can take many, many exposures and "tries" for a child to try a new food.
Toddlers also have very small stomachs, to begin with (their stomach is about the size of their fist), so if they are growing normally and appear picky with the quantity they eat, be sure you aren't applying an adult's idea of a "portion" to the toddler's meal.
As in any situation, if there is a legitimate concern about a child's growth or nutrition patterns, seek medical advice. A pediatrician may refer you to a pediatric nutritionist or dietitian to help correct any problems in your child's diet.Helpful 2