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The Picky Eating Toddler & You

As promised, here is third and final blog post relating to feeding difficulties.

We all have experiences where our little ones refuse to eat their sweet potato that evening, or only wants to eat a portion of their meal…but when should you be concerned? When should we be worried if our child’s mealtime preferences are more than just a quirk? Below you’ll find a very quick overview of what to keep an eye on, and what you should do if you suspect your child is a Picky Eater. This by no means is the picky eater’s “bible” but I hope that it is informative and helpful to you to know if your child’s picky eating warrants professional help!

Red Flags of Picky Eating
– poor weight gain or weight loss
– ongoing choking, gagging or coughing during mealtimes
– ongoing problems with vomiting immediately before, during or right after mealtimes
– more than one incident of nasal reflux
– history of traumatic choking incident
– history of eating and breathing coordination problems with ongoing respiratory issues
– inability to transition to baby food purees by 10 months of age
– inability to accept any table food solids by 12 months of age
– inability to transition from the breast/bottle to a cup by 16 months of age
– has not been weaned off baby foods by 16 months of age
– an aversion or avoidance of all foods in a specific texture or food group (i.e. will only eat foods when pureed smoothly, or won’t eat any proteins, or won’t eat any orange coloured foods etc.)
– a food range of less than 20 foods (especially if these foods are being dropped over time by the child, with no new foods replacing those lost foods)
– crying/arching at most meal times
– it is difficult for every/anyone to feed the child
– family history of eating disorders

Why Is My Child A Picky Eater?
There could be a number of reasons as to why a toddler will present as a Picky Eater. It may be any one of the reasons listed below or it could be a combination of reasons.

Physiological
– oral motor weakness
– food allergies (some of these you may not know about as yet)
– reflux/GERD
– dysphagia/swallowing difficulties

Psychological
– traumatic experience in the past with certain foods (i.e. a choking episode, an allergic reaction etc.)
– history of being force fed
– traumatic experience orally (i.e. may have been intubated at birth with tubes through the mouth etc.)
– reflux (the knowledge that the food will hurt/burn when it is refluxed)
– anxiety and/or fear

Sensory
– heightened gag reflex
– oral defensiveness (doesn’t want anyone or anything touching the inside of their mouth)
– sensory defensiveness (this can include being defensive of seeing an undesired food or smelling an undesired food)
– sensory processing disorder

Behavioural
– frequent tantrums at mealtimes
– strong dependence on being “entertained” during meal times (i.e. watching the television etc.)
– general attention difficulties (i.e. is unable to focus for the short period of time to eat a meal).
– the toddler enjoys the reaction from the adults around him/her and continue to do it as an attention seeking opportunity).

Other Contributing Factors
– late exposure to solid foods (after 12 months of age)
– family history of picky eating/feeding disorders
– medical history (i.e. toddler may have been a premature baby etc.)
– developmental disorders (i.e. Autism Spectrum Disorder)

Picky Eater or Problem Feeder?
Typically Picky Eaters have two classifications – Picky Eaters and Problem Feeders, with “Picky Eaters” being the umbrella term for both.

Picky Eaters usually have…
– decreased range of foods that he/she will tolerate (however it is usually at least 30 different foods that he/she will eat)
– some foods may be lost due to “burn out” but will be re-gained after a break (i.e. won’t eat bananas after enjoying one daily for a month, but will start eating them again in a few weeks)
– able to tolerate new foods on their plate
– eats at least one food from most food texture/nutrition groups
– frequently eats a different set of foods at a meal than the rest of the family

Problem Feeders usually have…
– restricted range of foods (usually 20 different foods or less that he/she will eat)
– foods that are lost due to “burn out” will not be regained
– behavioural tantrums/melt downs occur when a new food is presented
– will often refuse to eat an entire category of food groups or textures (i.e. no solids, or no crunchy foods)
– always eats a different set of food at a meal than the rest of the family

What Do I Do?
If your child demonstrates red flags of picky eating, it is definitely worth taking him/her to see their Paediatrician. If there are concerns regarding weight gain, or regarding the range of foods that your child can eat, your Paediatrician will refer you to a Feeding Therapist. Usually this person is a Speech Language Pathologist or an Occupational Therapist but there are other allied health fields such as Physiotherapists or Dieticians/Nutritionists who may also be feeding therapists (in other jurisdictions). Keep in mind that there is no “cure all” for picky eating…each child is an individual and their needs are going to be unique. As a result, the team of professionals working with your child (Paediatrician, Nutritionist, Speech Language Pathologist, Occupational Therapist and whoever else may be working with your child) will try to take a very holistic approach to help your child overcome their battle with food!

I hope that this was informative and not too overwhelming!

Until next time,

Cayman Mummy

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Top 10 Tips for Toddler Mealtimes

As promised, here is my second blog post on feeding, continuing on from the Feeding Milestone post I did last week. These are some general parent tips that I share with parents when they express frustrations or concerns with their toddler’s mealtimes.

1. Respect Your Child’s Appetite.
If your child isn’t hungry, don’t force them to eat a meal or a snack. Don’t use food to bribe your child, and don’t force your child to “clean their plate”. This leads to unhealthy mealtime habits and can lead to power struggles over food.

2. Stick To Mealtime Routines
Mealtime routines help to reduce anxiety for children. Children thrive on schedules and routines and it is very helpful for them when they know they have set mealtimes/snack times. Remember as a baby you could predict exactly when your baby would want their next feed? The same goes for your toddler – it’s just that instead of being nursed or getting a bottle of milk, they are getting solid foods. Additionally, you want to discourage grazing throughout the day. This reduces your child’s appetite and a reduced appetite will lead to food refusals!

3. Be Patient With New Foods
It can take 10-12 times for a child to truly know if they dislike or like a food. Also keep in mind that at this age, your toddler’s taste buds are very sensitive. They are predisposed to enjoy sweet tasting food (think of how breast milk or formula taste – both are very sweet) and are extremely sensitive to bitter tastes (i.e. green veggies). The more exposure they have to a food, the less likely it is that they will refuse it over time.

4. Make Mealtimes Fun!
Don’t let mealtimes become a chore. Instead, allow your child to get messy during meals, and explore their foods. Make food art, let your child use dipping sauces, make different sounds when they eat different foods…whatever floats your child’s boat. Also, it’s good to keep in mind that children explore new foods with ALL of the their senses. So if instead of eating the squash, they want to squish it in their hands, rub it on their cheeks and hair, sniff it, inspect it and throw it over the high chair to hear it “plop”….LET THEM! It is how they are learning what squash is! You want mealtimes to be the times of the day he/she looks forward to, not the time that they dread.

5. Grind Up Real Foods
Avoid being a short order cook – use the family pot to introduce foods. Making spaghetti? Grind it up for your little one to enjoy. (Or if you’re like me – use cous cous – instant child friendly pasta that cooks up in a cinch!) The more your child is exposed to the foods you enjoy as a family, the more your child can be a part of your family mealtimes.

6. Ensure Food Is Age and Stage Appropriate
By making sure that your child’s foods are age and food stage appropriate it prevents mealtimes from becoming overwhelming. Additionally, offer small amounts of food at a time. If he/she is still hungry, they can always get more food. This works two fold – it reduces food wastage during their exploration time but it also reduces any anxiety your child may have about the amount of food that they are expected to consume.

7. Try Preparing The Same Food In Different Ways
Provide soft baby carrots at one meal and carrot slices at another meal OR provide meatballs on one day and make a meat loaf the next…switch up the way the food looks to help your child learn that the same food can come in different forms. This also includes “hiding” undesired foods (like vegetables) into desired foods (for example, I fine slice kale and spinach and add it into my spaghetti sauce…not even my husband notices!)

8. Be Creative
If your child is old enough, recruit their help as your “sous chef” to help prepare the meal. Instead of a boring sandwich, make sandwich faces. Create dishes that promote interaction and appeal to your child visually. Remember we all eat with our eyes first!

9. Minimize Distractions
Allow the focus on mealtimes to be on the family meal. This not only involves the actual food but the conversations and interactions at the family table as well. Avoid using the television or other electronics to distract your child while you feed them.

10. Be A Good Example
Eat the way you want your child to eat. You can tell your child to eat their vegetables until the cows come home, but if you don’t eat your vegetables – it’s pretty hard to convince your child to eat them! Even if your eating habits aren’t perfect, do the best you can to show them what well balanced meals look and taste like. You want to teach your child to eat healthily and to have a healthy relationship with food as well.

Until next time,

Cayman Mummy