Hi, I’m Dr. Jessica Donaldson from Children’s Care at Memorial Health. About a year ago, I gave some thoughts on infant nutrition. Today, I’d like to continue on the topic of nutrition for another tricky age group- Toddlers!

(I will start off by saying that these are general recommendations, derived from The American Academy of Pediatrics, but may not apply to every situation, so please discuss specific concerns with your child’s Pediatrician)

These days, we see as many “picky eaters” as “over-eaters” in the toddler age range, so we’ll discuss both!

What do I do for a picky eater?

This is a common concern brought by parents; in fact, about 25% of parents will bring up concerns for feeding problems in toddlers. The majority of these children fall into the category of “misperceived” feeding difficulties or mild behavioral feeding issues, and only about 1-5% have a serious feeding disorder (which we will briefly discuss later on). However, a little parental anxiety mixed with a little picky eating can lead to some problematic feeding practices that may have undesired effects.

One common (and normal) reason for a limited appetite might be that the child is genetically a small child (based on parental stature) and therefore should have a smaller than expected appetite than other children their age. Let’s look at 3 common feeding issues: limited appetite, selective intake, and fear of feeding.

We also commonly see the energetic, active child, who is much more interested in playing and talking than eating. These children may refuse to sit still to eat or not eat for long before they are “full” and ready to play. Sometimes these active children will even fail to gain weight.

For the selective eaters, that is, kids who don’t like to eat a variety of foods, there is also a range from “age-appropriate” to highly selective. For example, it is completely normal for toddlers to reject new foods multiple times before actually trying or liking the food. Research suggests that it make take up to 20 times for a child to finally accept a new food. If, even after significant exposure to the new food, the child still will not accept new foods, he may have a mild selective feeding disorder. The treatment? Continue to offer the new foods! When there is severe selectivity and/or sensory food aversion, Pediatricians may begin to worry about developmental causes for the eating habit.

Parents may find their child tends to cry, choke, gag, or vomit during feeds, and this may represent a “fear of feeding.” Parents should begin by trying to reduce anxiety around eating, and give reassurance and positive reinforcement.

Here are some general guidelines to help parents have an appropriate response to these common scenarios:

1. Avoid distractions during mealtimes (television, cell phones, etc)

2. Maintain a pleasant attitude throughout meal

3. Feed to encourage appetite:

a. Limit meal duration (20–30 min)

b. Offer a max of 4–6 meals/snacks a day with only water in between

4. Serve age-appropriate foods

5. Systematically introduce new foods (up to 8–15 times)

6. Encourage self-feeding

7. Tolerate age appropriate mess!

I especially like to encourage parents on #3: Parents should work to keep a feeding schedule that encourages hunger. For example, limiting to only small snacks in between meals, and allowing only water as a drink throughout the day, except at mealtime, when milk can be served. Juice is often a pediatrician’s enemy! Juice provides very minimal nutritional value, but often fills kids up in between meals so they are not as hungry later. (Juice also can be a source of excess calories for kids who are overweight, which we will discuss later on). Not to mention, all the cavities juice is associated with. My advice: don’t buy the juice, feed the fruit instead!

Good luck to all you parents of toddlers out there! Its tough work, but it is worth it! Tune in next week for part 2!