MOST mothers will agree that it is nerve-wracking when their child refuses to eat or is extremely fussy about food. Besides normal weight gain, meeting the nutritional needs of the child is the other main concern.
“Probably the most universal complaint of parents is that their child is not eating the food, or amount of food, offered,” said Prof Dr Mauro Fisberg, paediatric nutritionist and head of the paediatrics department at Federal University of Sao Paulo, Brazil.
There are many ways to get a picky eater to finish his meal. Dr Fisberg was invited by PaediaSure Complete (Abbott Nutrition) to come to Kuala Lumpur recently to share his expertise on the latest developments on picky eating and other feeding problems.
An author of six books on children’s eating disorders, Dr Fisberg said that in general, paediatric clinics record about 10% to 25% of children as being picky eaters.
“Picky eating is becoming a major concern because it can contribute to under-nutrition, (thus) impairing children’s growth and development which includes social and academic performance as well,” he said.
Studies have shown that picky eating can lead to growth complications, increased chronic illness and increased risk of developing eating disorders later in life.
In some cases, picky eating may also cause short-term nutritional deficiencies and produce life-long implications such as social and emotional problems, including aversion to touch, lethargy or lack of interest in playing or learning.There is no standard definition of picky eating but researchers typically examine a variety of factors, including nutrient intake composition, weight of child, food volume and duration of refusal.
These children also tend to eat small amounts, prefer only selected foods such as carbohydrates or dairy products, avoid trying new foods and take a long time to eat their meals.
There is usually a combination of reasons for picky eating, including physiological factors such as appetite, genetics and growth. Psychological issues such as the struggle for autonomy, changing emotions and moods, and level of affection or adverse interaction between mother and child could also lead to the problem.
Children also go through picky eating phases.
“We do not know why a child who has been eating the same food for a few months simply refuses to eat it the next day,” said Dr Fisberg.
However, he said a majority of picky eaters take after examples set by their parents at home, as many studies indicate that food rejection is a learnt behaviour in almost all cases.
“However, contrary to what many people think, we cannot solve problems of poor appetite in a day or even a week,” he said,
“It all starts with recognising that the child has a right to preferences and aversions. Forcing a child to eat what he does not like is not going to make things better. Make a list of his or her preferences and every week, add two new types of food,” he advised.
Dr Fisberg said sometimes the use of oral supplements was important to maintain balanced nutrition in children.
Dr Pedro Alarcon, paediatric gastroenterologist and international medical director with Abbott Nutrition, said a 2003 study conducted in Taiwan and the Philippines showed that nutritional supplementation increased not only the weight but also the height of children.
The study was done on 92 children aged three to five who were classified as picky eaters. The children were separated into two groups and monitored for three months. One group only received nutritional counselling while the other, nutritional counselling combined with nutritional supplement.
After 60 days, the second group of children recorded significant weight gain compared to the first. Both groups also recorded increases in height.
“That was surprising for us too because we were only expecting weight gain,” he said.
In a year, said Dr Alarcon, a child roughly gains 3cm in height but the children in the study gained more than half of that within three months.
Overall, 28% of children in the second group developed upper respiratory infections compared to 51% in the group which only received nutritional counselling.
“Nutrition in the future will not only target, weight, height and less illness in children, but also more body immunity, brain development or even stronger gastrointestinal defence,” said Dr Alarcon.
In another study headed by Dr Fisberg in 2002 on children aged three to five, adding synbiotics (prebiotics and probiotics) to oral supplements showed that there were more sick days recorded in groups which did not take synbiotics. The period of the study was four months.
“Paediatric oral supplementation should be considered as part of a comprehensive strategy when dealing with picky eating to prevent children from becoming undernourished,” said Dr Alarcon.
Dr Fisberg said probably the most prescribed solution by doctors for picky eating is appetite stimulants, mainly to avoid mothers forcing their children to eat.
“I would not recommend that because the stimulants probably work for one or two weeks only, after which the body will adapt to it,” he said, adding that vitamin supplements should only be recommended if the child has a specific vitamin deficiency.
Dr Alarcon added that picky eating in children below one year old is rare and thus should be checked to ensure there were no other health problems.
After one year, a child may also develop some picky eating because that was when they achieve autonomy and have new habits and ability, hence become less interested in food, said Dr Fisberg, adding that weight gain may slow down at that time too.
Generally, when should parents be concerned that their child is having a picky eating problem?
“Usually one month is enough to rule out other possibilities such as medical problems and to see if the picky eating problem is serious,” said Dr Fisberg, who also anchors a television programme called Body Sciences on University TV in Sao Paulo.
Positive reinforcement
Tips to cultivate healthy eating habits:
1. Avoid distractions during mealtime.
2. Adopt a neutral attitude – do not pressure a child to eat.
3. Encourage appetite by limiting snacks and balancing food portions.
4. Limit duration of meal time.
5. Provide age-appropriate foods.
6. Introduce new foods to a child gradually and regularly.
7. Encourage children to eat independently – do not spoonfeed a child who is old enough to use utensils.
8. Allow children to make a mess when they eat.
