What are the common feeding behavioral problems?
The common patterns of feeding behavior problems include:
Partial to total refusal of food.
Food selectivity or ‘pickiness’ where kids have a very limited range of food.
Vomiting or spitting out food during or immediately after feeding.
Requiring very soft or inappropriate textures even after a certain age.
Delay in self-feeding and requiring family members to feed the child.
Tantrums and other behavioral problems during mealtimes.
Pica or eating inappropriate foods.
Why do children refuse food?
Not hungry: In the majority of the cases, children refuse food because they are not hungry. In other words parents do not give enough time between the feeds for the baby to become hungry. We come hungry only when there are enough gaps between the feeds. It is the same with children as well.
Tastier alternatives: With increasing affluence and availability of a wide variety of foods, children are having several other tastier options (like processed and junk food) which are only increasing the problem. The home food appears bland to them compared to the tastier but less healthy junk food.
Likes and dislikes: Sometimes children refuse foods they have been enjoying before. This leaves the parents perplexed. We need to understand that children also have their likes and dislikes and like adults could get bored of a food they were enjoying in the past. The only difference being that they cannot express their feelings. However this doesn’t mean that they will never have the food again.
Illnesses: Children’s appetite also goes down when they are suffering from any infections or chronic diseases. This could be common cold, flu, throat infection, gastroenteritis, urinary tract infection or any other serious infections.
Picky eaters: Some children are “picky eaters”. In other words they have a very narrow range of foods they prefer where as other children readily experiment with new flavors and textures.
Attention seeking: Older children and toddlers may refuse food in order to gain attention or assert their independence. Sometimes toddlers may be too busy with their activities and play so that food may become less of a priority.
Food allergies: Children who are allergic to foods also may avoid particular foods. This is because the food they are allergic to might be causing them discomfort like itchy sensation in the mouth, tummy pain etc.
What are the common mistakes that parents make?
Trying distraction: When babies refuse feeds, rather than leave them to become hungry, parents try all the tricks like distracting them with TV and mobile phones, taking them around the house etc.
Misconceptions: When infants are initially weaned to solids, they may not initially show interest or even spit the food. Some parents feel that the particular food doesn’t suit their child and may never offer the food again. However, research has shown that some children may require exposure to a particular food several times before they accept it.
Frequent feeding: Some children are fed every 2 to 3 hours. This could either be in the form of home food or regular snacks in between the meals. As a result, the children are never hungry nor do they ask for food. We need to remember that it takes some time (3 to 4 hours) for the food in the stomach to be digested and emptied. Only then the stimulus for eating food arises. If we do not allow for this natural hunger to arise by feeding at very short intervals, it would seem that the child is never hungry.
Prolonged feeding: Some parents feel that the child must finish a particular amount of food for that meal. As a result they may feed the child for prolonged period sometimes even exceeding an hour. Apart from being a frustrating experience for both the child and the parent, this would also result in reduced gap between the meals.
Offering alternatives: It is a common practice for parents to offer alternative foods like chocolates, biscuits, snacks etc. if the child doesn’t finish the meal prepared at home. Parents do that because they do not want the child to remain hungry. However, the child soon develops that as a habit. He realizes that if he refuses the home made meal, his parents would give in and offer him a snack instead. Of course for the child, the nutrition aspect of the food doesn’t matter and he would always like to eat tasty food.
Bland food: Some parents feel that children’s food should be completely bland and do not add any sweet or spice as a result of which the food becomes tasteless. We need to remember that like adults, children prefer to have tasty and variety of food. Although too much sugar and salt are not healthy, small and healthy amounts can be added to make food tasty and attractive to children.
Denying self feeding: Some infants are more independent than others and would like to feed more by themselves. Some parents refuse to allow children to feed by themselves because they might mess up the dining area. Others might refuse in the fear that they may not feed enough or may feed for a long time if left to themselves. By refusing to allow these children to feed by themselves, parents can create a conflicting situation.
Lack of family mealtimes: Children learn eating habits by observing and mimicking adults. The best time for this would be the family meals. In these busy days where different members of the family eat at different times, children are losing the opportunity to watch the adults feed during family meals.
Inappropriate texture: Some parents grind the food to make it liquid so that the children can be fed easily and in a shorter time. They do it even when the child grows older as a result of which the child doesn’t acquire the skill of chewing and swallowing food.
Force feeding: As the feeding problem continues and especially if there is some weight loss, the parents panic. In the worst case scenarios children are even restrained and fed forcibly.
Why do parents resort to force feeding?
Parental anxiety: Children are force fed mainly due to the parental anxiety that the baby is not feeding the required amount and not gaining adequate weight. In most of the cases, it is the only the parental perception of poor feeding and poor weight gain. When the children’s weight is plotted on the growth chart the child seems to be growing appropriately for his age.
Comparison: Parents also get worried when they compare their baby with other babies. Although everyone would love to have a chubby baby, we need to understand that being chubby necessarily doesn’t mean being healthy. Like adults, the dietary intake and weight gain in all the babies is not the same.
Family pressure: Comments from friends and relatives that the baby looks thin only aggravate the problem. In some families, the sole aim of all the family members including the parents and grandparents seem to feed the child all the time so that the child becomes chubby.
What is the outcome of force feeding?
The outcome of force feeding is food aversion and feeding behavioral problems. Imagine as an adult you are force fed three times a day! It is therefore not surprising that babies who are force fed develop food aversion. The moment they are offered the food, they turn the head away, shut their mouth tightly or spit the food out. Even if the parents do manage to push the food in forcibly, the child might soon vomit the food.
Once the baby develops these symptoms it becomes an uphill task for the parents. Every meal time becomes a battle of wills between the mother and the child. As a result the mother becomes stressed and upset. All the family members become worried.
What is the solution to this problem?
The most important thing parents need to understand is that children’s feeding needs to be driven by their hunger. When a child is not hungry, even a tasty food will not be appealing to them. They should enjoy their food and look forward to the mealtimes. Feeding should be driven by hunger and the joy of eating food.
Parents need to be reassured that no healthy child would not starve themselves. Feeding to survive is a natural instinct in all animals including humans. We should not forget the aim of feeding is adequate growth and activity of the child. As long as the growth and activity are appropriate we could relax with regard to the quantity of food they are taking.
What useful tips can parents have to resolve this problem?
Some useful tips for the parents to solve this problem are:
Hunger: Ensure a gap of 3 to 4 hours between the feeds. This would ensure that the child becomes hungry. Start early in the day so that you can have enough time between the meals.
Tasty: Make food according to the child’s taste. Some children like sweet food, some salty and others spicy.
Avoid alternatives: Once you make food according to the child’s taste, do not give alternatives if the child doesn’t eat the home made food. Do not give junk food regularly between meals as this will only reduce the hunger and make the children addicted to them.
Avoid prolonged feeding: Do not feed the child for prolonged periods. This would reduce the gap between the feeds and also result in overlapping of the feeds.
Family meals: Having meals together as a family would help the child develop a healthy feeding behaviour by observing his parents and siblings. In other words you have to be a good role model for your children.
Self feeding: Children also enjoy when they eat by themselves. Therefore, once the child is old enough, giving finger foods would also help them become more interested in food.
Variety of foods: If your child is a picky eater offer small amounts of new foods regularly without pressurizing them to eat. They will gradually learn to accept new food.
Involve kids: Involving children in deciding and preparing food could increase their interest in that particular food.
Expose repeatedly: When infants are initially weaned to solids, it is important that parents keep trying with new foods several times. Sometimes slightly changing the flavor might help.
Relaxed approach: Above all, parents need to have a relaxed and flexible approach when feeding the children. Even if the child does not feed well for a particular meal, they would feed well later if they are allowed to become hungry.
When should parents seek medical help?
In case of following examples, parents should see their Paediatrician who will be able to support and guide them.
Difficulty in chewing and swallowing.
Coughing or choking during feeds.
Persistent vomiting after most feeds.
Poor weight gain (as determined from the growth charts)
Abnormal feeding behaviors.
About the Doctor:
Dr. Srinivas Jakka,
Consultant Paediatrician, pulmonology and allergy specialist
MD (Paediatrics), MRCPCH (UK), diploma in allergy (UK)
Dr. Srinivas Jakka is an experienced Paediatrician, Pulmonologist and Allergy Specialist. He completed his training in India and world renowned hospitals in UK. He has vast experience in the management of children with complex paediatric problems, asthma, complex respiratory diseases and allergies.
About The Hospital:
Ankura is a chain of Children’s Hospital in Hyderabad. Set up in the year 2011 in KPHB, near Hitech Railway Station, the Ankura Hospitals family has today spread its wings to Secunderabad, Khammam and Vijayawada.