How does one handle a child who won't eat enough?
After assessing the child in the clinic, there are two main steps.
The first step is to ensure that the expectations of his parents are appropriate.
Some children simply do not eat as much as their peers, but they are healthy and growing steadily. This is normal and I am happy to send them home after the clinic consultation.
MINIMISING STRESS AT MEALTIMES
The next step is to manage the child appropriately. In a straightforward case of picky eating in a very young child, this comprises reinforcing the "food rules".
These rules govern when and how the child should eat meals, and the conduct of the parents or anyone else who is eating with the child.
These rules are aimed at helping parents to raise their child to eat properly for the rest of his life.
Doing this minimises the amount of stress and conflict the parents have to go through during mealtimes.
I am sure most, if not all, parents will agree that they have enough things to worry about, without having to burden themselves with battles during feeding.
Several versions of the "food rules" exist on the Internet.
Some of them are universal to children of all ages and the principles also apply to parenting in many other situations.
Universal rules include having the child eat in an appropriate environment, such as at the dining table - not the playroom, television room or computer room.
Make mealtimes relaxing and encouraging, but without inappropriate distractions, such as television programmes, handheld electronic devices, games or toys.
The child should eat at the same time with other family members, where possible, and these family members should strive to be role models when it comes to good eating behaviour.
These provisions encourage family bonding, while allowing the child to observe and learn good habits and social interaction at mealtimes.
DO NOT FORCE FEED
Also, practise responsive feeding.
This means anticipating and reacting appropriately to the child's hunger or satiety cues.
The most common mistake is to force feed the child, instead of acknowledging that he is full.
Some parents do so because they were brought up with the mindset that one should not waste food.
Though this is certainly a prudent view, this mindset is inappropriate in the early years of a child's life.
This is because children's appetites wax and wane frequently.
To address the "no-wastage" philosophy, the child should, once he is old enough to understand, be taught not to pile excessive amounts of food on the plate, so as to avoid wastage - a principle that applies similarly to people at a buffet.
Plus, the value of a particular food item should not be placed above or below another item. A practical example involves not using a "preferred" food as a reward for eating other foods, or withholding it from the child as a punishment for not eating a healthy meal.
This may inculcate in the child the perception that some foods are more valuable than others. It may then prompt the child to seek to eat that food over and above the balanced diet that his parents are trying to teach him to accept.
Moreover, it detracts the child from the lesson that all kinds of food are important in a healthy diet. What's worse, the preferred food is often something unhealthy, such as a sweet or a fried snack.
The environment or the way the feeding process is handled can veer between following the food rules to a tee and deviating far from them.
This is understandable as parents may be tired from a long day at work and be tempted not to enforce the rules. Sometimes, other adults, such as grandparents, wish to pamper the child with his favourite snacks or worry that a picky child who refuses to eat may go hungry, and hence choose to bend the food rules.
But consistency in all of the above situations is a must. As tempting as it may be to the tired parent or concerned grandparent to break the food rules from time to time, inconsistency can cause more mealtime conflicts, disrupt family harmony and worsen bad habits.
DANGER OF UNREALISTIC RULES
Some of the food rules found online are age-specific and, therefore, unsuitable for very young children.
Be careful of what you choose to follow, as inappropriate expectations may lead to unnecessary frustration and stress for both parent and child.
One example is "ensuring the child does not make a mess".
It is rare for toddlers not to make a mess when they eat.
In addition, every child may respond to the same food rules differently. The longer inappropriate feeding habits are allowed - and the more often they are tolerated - the harder it would be to reverse them.
Hence, the importance of addressing this problem early and consistently.
Do note, however, that food rules work well only for a typical one- to three-year-old picky eater.
Some trickier cases that I have come across include a four-year-old girl with constipation who was not the classic picky eater. Her mother explained that she did take plenty of dietary fibre, but would vomit out all types of meat and fish.
In another instance, a 10-year-old boy's parents expressed concern that his picky eating habits may impact his future health and ability to cope with national service. Unfortunately, he was too old for food rules to effect any change.
Parents may find dedicated feeding clinics helpful in identifying and solving some of their concerns.
Older picky eaters can also be treated in such clinics, as an ingrained habit can be difficult to eradicate without specialised expertise.
If parents have any concerns or difficulties feeding their child, they should discuss them with their doctor.
Aside from the above examples, there may be other concerns or difficulties that parents have when feeding their child. Given how important nutrition is to a growing child, it would be prudent to discuss such issues with a doctor.
The battle - be it an open one between parent and child, or a silent one in the mind and heart of the parent - does not have to be fought by only the parents.
Dr Soh is an associate consultant at the division of paediatric allergy, immunology and rheumatology at National University Hospital.
This article was first published on Jan 8, 2015.
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