Ana-Kristina provides advice for managing fussy eating in children

November 1, 2014

The problem
Martha’s food issues crept up on us gradually. When we started weaning, she was quite enthusiastic. She wasn’t particularly fussy, and would happily tuck into our leftovers, as well as her own food. The only thing that seemed slightly strange was she wouldn’t touch fruit, and completely refused the apple and pear purées that her big brother loved as a baby. From 12 months on, we noticed Martha’s diet becoming narrower. She always preferred carbs, but gradually, the number of things she would eat got smaller. Now, at 3 years old, she has a very restricted diet. In general, she won’t eat any fruit and veg, and survives mainly on toast, pizza, pasta and yoghurt. Occasionally she’ll go mad for a particular vegetable and want to eat it every day, but after a few days she goes off it again. She also gets constipated. Although I’m happy that Martha is getting enough calories and is growing normally, it’s frustrating to have to cater for such a limited diet. I would love her to broaden her tastes and eat the same as us.”

  1. Routine matters
    “Having a pattern to mealtimes helps to differentiate them from playtime, and this structure will help your child to know what your expectations are. Regular mealtimes and a structure for sleep and play are important for helping Martha develop healthy eating habits: being tired or grazing on snacks could affect her appetite for her main meals.”
  2. Eat together
    Encourage family meals: eating together will give you an opportunity to model the behaviour you’d like Martha to develop, and also provides her with the chance to be exposed to food on your plate. Children tend to eat what their parents eat, so eat a variety of foods in front of Martha to show her this is normal. If she sees you enjoying foods, it may trigger her curiosity. Eating with other children of a similar age may also help.”
  3. One step at a time
    “Every new food has its own texture, smell, taste and appearance, so avoid overwhelming Martha by introducing one new food at a time, and offering it alongside a familiar  food. Touching, smelling and tasting food, even if she only eats a tiny amount – or none at all – is essential in helping Martha to become familiar with new foods.”
  4. Make fruit and vegetables fun
    “Many children prefer crunchy veg, so instead of cooking everything, try offering Martha raw vegetable batons such as cucumber or carrot sticks. Add a novelty factor, such as peanut butter or cheese spread. Offer fruits in different forms – fresh, tinned, poached, dried – and add custard or yoghurt to make a nutritious snack. Use a cookie cutter to cut fruit and veg into attractive shapes, or arrange pieces as a smiley face.”
  5. Don’t overdo it
    “Parents are often unsure how much their child should eat. A normal portion of fruit or veg for a toddler is 20g-40g, about the size of her own palm. Children tend to know when they have had enough to eat, so be guided by Martha and never force her to eat, as this will only increase her negative feelings. Keep mealtimes under 30 minutes, as prolonging them will heighten her anxiety.”
  6. Get her involved
    “Children should be involved in  the preparation and cooking of meals from a young age. This helps build their curiosity and awareness of foods, which is the first step towards trying a new food. Let Martha be involved in shopping trips and helping in the kitchen, and allow her to have some choice. Avoid open questions like, ‘What would you like?’ as this may seem overwhelming. Instead, offer two or three suitable choices: ‘Would you like potatoes, rice or pasta?’ This enables Martha to exercise her choice.”
  7. Seek expert advice
    “Martha suffers from constipation, which may be giving her the sensation of being full even if she hasn’t eaten much. It’s also possible that she is deficient in iron, which may be affect in her appetite. Children who show signs of being a selective eater should be seen by a GP, who may decide to refer them to a paediatrician for a developmental assessment and tailored advice.”
  8. Don’t give up
    “Children are naturally neophobic – that is, they have a fear of new things or change. Refusing foods is part of them expressing their anxiety about the new. As a result, we have to offer new foods repeatedly to build familiarity. Typically, they need to be exposed to a food ten to 15 times before they will accept it, so keep persevering even if it feels like you’re not making progress.”

The results
After eight weeks, we asked Sarah whether Martha’s diet had broadened…

I’ve always assumed that as Martha is reaching her milestones, she was getting what she needed from her diet – even if she was living on toast, yoghurt and pasta. But speaking to Ana-Kristina made me realise she was potentially lacking in nutrients, so I started giving her multivitamin and iron supplements straight away.

Ana-Kristina’s advice to eat as a family more often came at a good time, as we were about to go on holiday with my parents. We had lots of meals with all three generations and, to our amazement, Martha tried foods she had never attempted before, including sweetcorn fritters and fruit bars. Ana-Kristina carefully assessed Martha’s feeding history as she always struggled with eczema and constipation.

We trialled excluding dairy for a short period with her guidance on replacing with suitable alternatives for calcium. Within 48 hours her bowel habits became more regular. This made me realise Martha’s food refusal may have been in part due to an underlying problem. Although Martha’s diet is still limited, Ana-Kristina has given me the push I needed to try a bit harder. I’m cooking more from scratch, such as pasta sauces with veg blended in. I’ve been putting different things in Martha’s lunchbox, even though I don’t expect her to eat them, and feel stronger in dealing with the rejection. I’m inspired to keep trying to widen Martha’s diet, and confident that if we handle it sensitively, we’ll keep progressing.