PAEDIATRIC
HOW TO MANAGE FUSSY EATING IN TODDLERS Dr Gill Harris Child and Clinical psychologist and member of the ITF Gill is Honorary Senior Lecturer in Applied Developmental Psychology at the School of Psychology, University of Birmingham. She is also Consultant Paediatric Clinical Psychologist at Birmingham Food Refusal Service.
REFERENCES For full article references please CLICK HERE . . .
Coping with a fussy eater is something most parents find really difficult. The parents themselves have different histories and experiences with food and will also have taken advice from many different sources all conflicting and most not evidence based. Added to this, one family’s experience with their child will not be the same as the next family. For every parent who has succeeded with ‘sitting their child in front of the food until it is eaten’, there will be another parent whose child is hiding the food behind the radiators or feeding it to the dog. Food fussiness is on a continuum; we are all different. Some children will only eat an extremely restricted range of foods, whereas other children will be described as fussy because they are not too keen on green vegetables, but will eat most other things. Most of the really food fussy behaviour that is seen in children is genetically determined.1 It doesn’t matter much what the parents did in the early stages of introducing complementary foods,2 these children will always be fussy. Indeed, some parents will have three children who eat well and one who picks their way through every meal. There are also innate differences in taste responsiveness.3 An example of this is bitter taste sensitivity. Some children (and adults) will always find bitter foods rather disgusting and are never going to like them however hard their parents try with those bitter tasting foods, such as green leafy vegetables. However, having said this, most toddlers do go through a stage when they are fussier than they were in early infancy: the neophobic stage.4 This starts at around the age of two years
and gradually improves by the age of five years or so. This is the stage at which toddlers will refuse new foods just because of the way they look. They will also refuse foods that they have eaten before, especially if these are foods that are ‘mixed’5 and so can change the way they look from serving to serving. But there are differences here too, some toddlers are much more neophobic and reluctant to try new foods than others. This difference is linked to sensory hypersensitivity, a reaction to the taste, smell and, most importantly, the texture of foods.6,7 So, some fussiness is due to the taste of the food, but most fussiness is due to the texture of the food, i.e. the feel of the food in the mouth.8,9 And toddlers can tell whether or not they are going to like a food by the way the food looks,10 so rejection is on sight. The thinking is that, “If it isn’t a safe food - a food that I know that I like - then I’m not going to put it into my mouth.” And the more worried the toddler gets about whether or not they are being given a ‘safe’ food, then the more anxious they get. The more anxious they get, then the more hypervigilant they get; they focus on small differences between new foods and foods they know to be ‘safe’. They will refuse a biscuit that is broken, toast that is the wrong colour, yoghurt that is the wrong flavour, etc.11 www.NHDmag.com July 2018 - Issue 136
29