PediaSure® image of a child enjoying oatmeal

PROLONGED FEEDING DIFFICULTIES CAN LEAD TO SERIOUS CONSEQUENCES SUCH AS:

  • Impaired growth complications due to low nutrient intake
  • Emotional consequences resulting from overly anxious parents who adopt coercive feeding methods that negatively affect the interactions between them and the child
  • Frequent mealtime battles
  • Mealtime anxiety that affects other family members in addition to the child who is difficult to feed
  • Socially unacceptable mealtime behaviour

TYPES OF FEEDING DIFFICULTIES

Different children have different reasons for resisting food.

 

  1. Kerzner B. South Afr J Clin Nutr 2008;21(1):45.
  2. Chatoor I. Diagnosis and Treatment of Feeding Disorders in Infants, Toddlers, and Young Children. Washington, DC: Zero to Three Press; 2009.
FEAR OF EATING1,2
  • Your child not only refuses to eat but also seems to be afraid to put food in his mouth.
  • Your child shows strong resistance to any attempts at getting him to eat and may cry at the sight of the bottle, high chair, or other item associated with meals. Infants and young children may show fear of eating by crying, arching, or refusing to open their mouths when food is offered.
  • It's possible this fear developed after a traumatic experience or frightening event such as choking, gagging, or vomiting. Or perhaps there's been a medical condition and your child had tubes inserted through the mouth or throat.
  • Children with little appetite and no experience of normal eating are especially resistant to feeding.
  • It's very important that children who are afraid to eat receive the complete and balanced nutrition they need to ensure normal growth and development. Your doctor may recommend a nutritional supplement such as PediaSure Complete® to fill nutritional gaps until the feeding difficulty is overcome.

TIPS THAT MAY IMPROVE YOUR CHILD'S FEAR OF EATING BEHAVIOURS

  • Make sure that all family members and caregivers understand your child's eating difficulty and the need to avoid further distress or anxiety in association with eating.
  • Ensure that feedings are never coercive or threatening.
  • Be sure that everyone who feeds your child agrees to follow your plan.
  • Do not force your child to eat a food or use an instrument he fears.
  • Try to desensitize him by offering food when he is relaxed.
  • If your child fears solid foods, offer liquids; gradually progress to purees, then soft foods, and eventually to regular table food.

It's important to note that you should seek medical advice if your child continues to refuse foods and/or fluids.


  1. Kerzner B. South Afr J Clin Nutr 2008;21(1):45.
  2. Chatoor I. Diagnosis and Treatment of Feeding Disorders in Infants, Toddlers, and Young Children. Washington, DC: Zero to Three Press; 2009.
Highly Selective Intake1,2
  • Your child's feeding difficulty is characterized by consistent refusal of specific foods or food groups because of taste, texture, temperature, smell, or appearance.
  • Children with highly selective food intake often have difficulties with a variety of sensations such as loud noises, messy hands, labels on clothing, grass or sand under their feet, and bright lights.
  • Food refusal in these children goes beyond normal childhood resistance to new foods and may persist over time. Many parents first notice symptoms when they try to feed "baby foods" with small chunks and other textures, which often trigger gagging and sometimes even vomiting.
  • Highly selective eaters may become visibly nervous when asked to eat foods with the kind of taste, texture, smell, temperature, or appearance they find disagreeable.
  • It's good to know that most picky eaters—managed according to the principles you'll find here—grow up to be adults who accept a variety of foods. Still, because of the very limited variety in their diet, children who accept very few foods may be at risk for nutrient deficiencies. A nutritional supplement such as PediaSure Complete® may be recommended to fill the holes in your child's diet.

TIPS THAT MAY IMPROVE YOUR CHILD'S HIGHLY SELECTIVE INTAKE

Your child may always accept fewer foods than other children, but mealtimes can be better for everyone.


  • Feed foods your child likes; don't force your child to eat foods he cannot tolerate.
  • If a new food causes distress, remove it and try something more closely resembling a preferred food.
  • Do not push your child to try new foods; always respect your child's aversions.
  • Eat new foods in the presence of your child without offering any provide a taste only at your child's request; stay neutral about his reaction to the food.
  • Prevent your child from becoming anxious by making the diet a non-issue.
  • Don't praise your child for trying a new food; stay neutral whether your child likes the new food or not. (Even praise can make a child anxious.)
  • If your child loves desserts or candy, don't refuse sweets until more healthy foods are eaten. In-stead, on some days, put a small amount of the sweet food with other foods on the table and let your child eat the sweets first. Eventually, your child will stop thinking of sweets as a special reward and will be less likely to want only sweets.

Following these principles, your child will gradually start trying and accepting new foods.

  1. Kerzner B. South Afr J Clin Nutr 2008;21(1):45.
  2. Chatoor I. Diagnosis and Treatment of Feeding Disorders in Infants, Toddlers, and Young Children. Washington, DC: Zero to Three Press; 2009.
POOR APPETITE IN A VIGOROUS CHILD1,2
  • Some children who are very active, playful, and curious can be particularly difficult to feed because they rarely show signs of hunger, seem more interested in playing than eating, and seldom want to sit down to eat. In general, they show very little appetite, fill up quickly, and are easily distracted from food and eating.
  • Poor appetite and food refusal in these children are usually first noticed during the transition to spoon- and self-feeding—between 6 months and 3 years of age.
  • Food is such an important part of family life, it's important that all family members and caregivers agree on structuring meals in ways that stimulate feelings of hunger and appetite.

TIPS THAT MAY IMPROVE YOUR VIGOROUS CHILD'S EATING DIFFICULTIES

Apply these principles and over time your child will start to understand that mealtime is for eating, not playing.


  • Offer meals and snacks 3 to 4 hours apart at the same time every day.
  • Always feed your child in a high chair or at a table.
  • Limit the duration of meals—about 20 to 30 minutes or 15 if your child is not eating.
  • Avoid unscheduled snacking, "grazing", or milk from the bottle between meals.
  • Provide only water between meals.
  • Teach eating to fullness by serving tiny portions repeatedly and offering a new helping as soon as the previous one is consumed.
  • Feed your child with the family so other family members can act as role models.
  • Praise self-feeding skills, but maintain a neutral attitude about your child's food intake.
  • Serve age-appropriate foods and portions.
  • Encourage independent feeding and tolerate age-appropriate messiness.
  • Introduce new foods one at a time.
  • Discourage disruptive behaviours and distractions such as toys, books, or TV during meals.
  • Never pressure your child to eat.
  1. Kerzner B. South Afr J Clin Nutr 2008;21(1):45.
  2. Chatoor I. Diagnosis and Treatment of Feeding Disorders in Infants, Toddlers, and Young Children. Washington, DC: Zero to Three Press; 2009.
UNDERLYING MEDICAL CONDITION
  • In some children, food refusal or poor appetite may be a sign of an underlying medical problem. If an underlying medical condition is suspected, your doctor will do further testing and evaluation to make a proper diagnosis and develop a plan for treatment.
  • In some children, appropriate treatment of the underlying medical condition resolves the feeding difficulty. However, some children also develop specific feeding difficulties which can persist even after the medical condition has been resolved.
  • If this is the case, it is necessary to also address the specific feeding difficulty (i.e., highly selective food intake or fear of feeding).

TIPS THAT MAY IMPROVE YOUR CHILD'S NUTRITIONAL INTAKE WHEN HE HAS AN UNDERLYING MEDICAL CONDITION

  • Introduce new foods one at a time.
  • Respect your child's aversions.
  • Provide a calm eating environment.
  • Some children with underlying medical conditions require nutritional support in the form of a complete and balanced nutritional supplement such as PediaSure Complete®.

You may also find some of the suggestions for specific feeding difficulties are especially helpful for your child. Try them to find which strategies work best.

  1. Kerzner B. South Afr J Clin Nutr 2008;21(1):45.
  2. Chatoor I. Diagnosis and Treatment of Feeding Disorders in Infants, Toddlers, and Young Children. Washington, DC: Zero to Three Press; 2009.
APATHY1,2
  • Children with apathetic feeding often have a general reduction in emotional expressiveness and show little interest in eating. Their loss of appetite is part of an overall withdrawal in which smiling, babbling, and eye contact between the child and the caregiver is highly limited.
  • Poor appetite in a child who is also withdrawn and depressed may be a sign of insufficient emotional attachment between caregiver and child.
  • These children are at risk for substantial weight loss and malnutrition. A nutritional supplement such as PediaSure Complete® may help fill their nutritional gaps.

TIPS THAT MAY IMPROVE YOUR APATHETIC EATER'S FEEDING BEHAVIOURS

  • Apathetic children tend to respond positively to a warm, caring, and experienced feeder.
  • Use of a complete and balanced nutritional supplement (children 1 year or older) or a high-calorie infant formula (for children less than 1 year) may be required to help meet nutritional require-ments.
  • In more serious cases, admission to an in-patient program may help provide a positive feeding environment.
  1. Kerzner B. South Afr J Clin Nutr 2008;21(1):45.
  2. Chatoor I. Diagnosis and Treatment of Feeding Disorders in Infants, Toddlers, and Young Chil-dren. Washington, DC: Zero to Three Press; 2009.
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