Food Fussiness in Children (counter-intuitive ways of making your child eat better)

Updated: 2 days ago


(The same article is also available in Nepali and Hindi)

Food fussiness (also called picky choosy or faddy eating) is a common condition in children. Almost 50% of children are reported to have food fussiness at some point of time in toddlerhood and early childhood years. These children tend to eat small meals, eat slowly, be less interested in food. They have acceptance of a limited number of foods, unwillingness to try new types of foods, limited intake of vegetables and fruits, and exhibit strong food preferences. It is equally common in boys and girls and is more likely to occur in the middle and higher socioeconomic class. It may also run in the families. Food fussiness does not usually cause significant health, developmental or social problems in the future. A fussy child is expected to have similar height and weight gain as compared to other children. However, low intakes of dietary fiber, as a result of low intakes of fruit and vegetables, are associated with constipation in picky eaters. Note that I have chosen the word "have" instead of "suffering from" as most often it is a normal part of development. As young children transit to the preschool phase, food fussiness typically subside.

Causes of food fussiness (Why your child does not eat anything?)

Reasons for picky-eating behavior are complex and can include poor food quality, inappropriate feeding behavior of parents or caregivers, lack of food variety, and the family social climate. In each child, there is more than one cause, and also every child may not have all of the following

1. Slowed growth rate- After a rapid growth period in infancy (first 1 year). The growth rate slows down. It is least in toddlerhood (although the expectation of the child’s family for growth and the amount of food intake increases)

2. Emotional swings- Toddlers and small children are very much influenced by a change in the mood and emotions. Improved growth rate, emotional maturity, and increased autonomy in feeding are the reasons that food fussiness subsides as the child grows.

3. Parental and household influence- This is one of the most important factors. And also the factor which can be modified. It is well established that the family environment is a key influence on children’s eating behavior. Most of these behaviors of the family are aimed at increasing the amount and speed of eating in the child. However, these lead to food fussiness in the long run. The factors in a child's house which cause or worsen fussy eating behavior are

  1. Fussy eating in the parents- Children model parent's fussy eating habits. It is more likely to develop and persist when the parents are concerned and the child is punished, bribed, or rewarded for their eating habits.

  2. Parental concern (and comments) regarding “thinness” or “shortness” or eating habits of their child especially compared to someone else's child. Remember how did we feel when our parents or society pointed out that we got fewer marks or have a less paying job compared to others. The same psychology operates in children.

  3. Inappropriate timing of introduction of complementary food- If exclusive breast feeding is not practised for 6 months it may lead to early onset food fussiness. Similarly, not starting complementary food at 6 months or and not introducing lumpy food 9 months of age may lead to food fussiness. Early-onset food fussiness is more likely to persist.

  4. Separate food for the child- Parents often prepare separate food for the child even beyond 1 to 1 and 1/2 year. This is due to fear that the child may not be able to chew or digest the food prepared for other family members. Or when the child refuses to eat food prepared for others. In the long run, separate food leads to food fussiness.

  5. Always spoon-feeding beyond 1 to 1 and 1/2 years. Children are ready to participate in self-feeding by 1 year at least. When the child eats by himself, he can decide the speed and amount (and sometimes food items) of eating. Spoon feeding by parents leads to loss of autonomy and it may become unpleasant experience for the child.

  6. Food faddiness-Thinking that the child may not like or digest certain food (or spicy, bitter, or sour taste) even without trying. Also, beliefs about food items that has no scientific basis (although it may sound scientific). Example, avoiding banana or other foods in common cold or avoiding chicken during fever, since “hen are a warm blooded animals and hence worsen fever”.

  7. Use of addictive distraction techniques like mobile or TV. These are used to speed up feeding, but leads to fussy eating behaviour in the long run. In fact, studies show that excessive smartphone use (even during non meal hours) is associated with negative eating behaviours in children. This is because their use release dopamine in brain (a pleasure causing and addiction inducing chemical), which a healthy food is unable to provide. We ourselves had experiences of delaying food and/or sleep because we were in middle of a video game or Facebook chat. Advertisements might also encourage your child to desire sugary and less nutritious foods.

Prevention and treatment of fussy eating (What can you do to make your child eat better?)

Although food fussiness usually does not affect the growth of the child, I recommend that the child should be shown once to a pediatrician if the behavior is extreme. Often reassurance by the pediatrician improves parental response thereby improving eating habits in the child. If the child’s weight and height are within normal limits (which is usually the case), there is not much concern. If they are abnormal, a checkup by the pediatrician is useful. This can also be done when the child is shown for some other ailments. If you are visiting a pediatrician for food fussiness, it is a good idea to note down everything the child ate starting three days before the visit. You can also track the growth of your child by using the Indian Academy of Pediatrics growth charts app.

Mindset

Always have the long term goal of preventing (or treating) food fussiness rather than finishing a meal at a particular instance. This mindset is the cornerstone of all the prevention/treatment strategies. If you are unwilling to adopt this mindset for your child, knowing anything that follows will not help. Also remember that if your child is a fussy eater, it will not change overnight. Always ignore and do not reward or punish, child's eating habits.

Feeding in the first 1 year (infancy)

  1. Give exclusive breastfeed for 6 months and then introduce complementary feed. Introduce a variety of vegetables early (one at a time). I will have a separate article for infant and childhood feeding at a later date.

  2. Start lumpy and granular foods by 9 months. Encourage the child to participate in self-feeding (by finger dipping in food) even at this stage.

Switching to family food and increasing autonomy

1. Serve the same food as other family members-

Encourage the child to eat everything prepared at home by 1 year of age. This is also the time when they should be eating the same food as prepared for other family members with an altered consistency. However, adding too much water leads to dilution of nutrients and may lead to malnutrition. Parents and other family members eating the same food act as role models that encourage the child to eat. If you eat a lot of fruits and vegetables, your child will follow.

2. Don't be a short-order cook-

Preparing a separate meal for your child after he or she rejects the original meal promotes food fussiness in the long run. Encourage your child to stay at the table for the designated mealtime even if he or she doesn't eat.

3. Let the child eat by himself-

This is also the right time spoon should be handed over to the child. Starting from 1 year age the child taking responsibility and autonomy to eat by themselves (as opposed to parents always spoon-feeding them) encourages them to eat. They will spill a lot in the beginning but this is part of the process. By 18 months they will be able to feed themselves without much spillage.

4. Stick to a routine-

Serve meals and snacks at the same time every day. If your child chooses not to eat a meal, a regular snack time will offer an opportunity to eat nutritious food. A snack here means homemade food like pakora, omelet, etc. But you should avoid commercial snacks like chips, chocolates, juices, bakery, and fast food items. They are unhealthy, addictive foods and kill the appetite.

5. Respect your child's appetite (or lack of one)-

If your child is not hungry, don't force a meal or snack. Likewise, don't bribe or force your child to eat certain foods. This might only ignite a power struggle over food. Also, your child might come to associate mealtime with anxiety and frustration or become less sensitive to his or her hunger and satiety cues. Serve small portions to avoid overwhelming your child and give him or her the opportunity to independently ask for more.

6. Increase the child’s participation in food selection and preparation-

Involving the child's participation in food selection (during shopping and at home) and preparation (with closed supervision from parents) is especially helpful. Encourage your child to help you rinse vegetables, stir during cooking count the number of times pressure cooker whistles or to set the table. Consider you do not like a certain dish. However due to some reason you have to participate in the preparation of the dish. You are more likely to like the food (in fact you will defend its taste). Children are more emotional than us. They often like the food if they are actively involved in the selection and preparation of the food

7. Be patient with new foods-

Young children often touch or smell new foods, and might even put tiny bits in their mouths and then take them back out again. Your child might need repeated exposure to a new food before he or she takes the first bite. Encourage your child by talking about a food's color, shape, aroma, and texture (not whether it tastes good). Serve new foods along with your child's favorite foods. Keep serving your child with healthy choices until they become familiar. Also, do not be discouraged if the child rejects the first time you prepare it. Often, graded and repeated exposure to unfamiliar foods (10–15 positive experiences may be needed) before you realize that the child does not like the item. Many times food needs to be reintroduced after a few months and the child may like it. However, do not force him or her to eat if it is established that the child does not like a certain item (provided it is limited to a few items).

8. Make it fun and be creative-

Many times the child may not like a certain item (like broccoli or cabbage) but eat them when served with sauce or jam. Cut foods into various shapes with cookie cutters and make it shape like a cookie. Offer breakfast foods for dinner. Serve a variety of brightly colored foods. Introduce a variety of food items early and maintain it

9. Minimize distractions-

Limit smartphone and TV use at home. Since children model parents, their use in children can be reduced only if parents themselves use them less. If it is not possible, make a ritual of stopping electronic gadgets use at least half an hour before meals. Let the child indulge in some other activity for half an hour. Since it is difficult to switch from dopamine releasing activity to non dopamine releasing one immediately, half an hour gap is helpful. This will also help your child focus on eating. Remember, your goal is long term prevention and treating of picky habits, not finishing a meal.

10. Never offer chocolates or sweets as a reward-

Sweets or chocolates as rewards sends the message that they are the best foods, which might only increase your child's desire for them. You can redefine dessert as fruit, yogurt, or other healthy choices. Also, discourage friends and other family members from giving chocolates or chips as gifts. They can bring healthy food instead. If at all you want to reward your child, give non-food rewards (like visiting a park) and give it for maintaining the behavior for a week. You should however never punish the child.

Finally, parents often ask for vitamins when their child is not feeding well. However vitamins usually do not work because

  1. The cause for food fussiness is most often socio-psychological described above

  2. Vitamins as a cause for low appetite is rare. I guess not more than 5% of all children. If your car's tyre is punctured, how much ever petrol you put, it is not going to run. Since food fussiness does not cause adverse health effects, they are not usually deficient in vitamins. Inappropriate use of vitamins may have adverse effects.




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