How should I deal with my toddler's difficult behavior towards food?

Question

My daughter is almost 15 months old and has always been a small eater. She was breastfed for the first 5 months then solids were gradually introduced. It went okay for the first few weeks but soon it was difficult to get her to eat the recommended amounts and types of foods she needs. Since she turned 1 year old, she has become more and more difficult: slowly but surely I can see a trend over the last 6 months where she decreases the quantities she eats as well as the types of foods.

Her typical intake for a day:

• BF: 300ml of milk and a small handful of corn flakes
• Lunch: 200ml vegetables & fruit juice, 100g of yoghurt. Sometimes will nibble a bit of meat, sometimes will have just juice (not even yoghurt), refuses everything else (pasta, rice, vegetables, bread, etc.).
• PM snack: 100g fruits (puree or fresh), a couple of biscuits or small bowl of cereals.
• Dinner: half a dozen teaspoons of pasta or rice, a little milk, a yoghurt. Sometimes (say twice a week at the moment) will have nothing at all.

She is at 3% of her weight curve (always has been a small size). I don't mind she is a light-weight, she has a small body and that's ok. She is very active, in good health and generally happy. I am however concerned about long-term effects on her health given the limited food range she accepts and the fact she can go with very little food, and that this trend is worsening. I struggle to understand her behavior at the table and why she systematically refuses almost everything we put in front of her. We don't force her at all and are very patient, but we are not sure how we should deal with this as parents.

Paediatricians have been unhelpful about this (just saying she should eat more and more varied...). She has a twin sister who is a little bigger than her (but not much) but who does eat well and pretty much of everything.

Answer 1

Liquids can be filling and reduce food intake. Guidelines for liquids for toddlers include no more than 4-6 oz. of juice and 2-3 cups of milk daily for preschoolers. Pudding, cheese, yogurt and other milk products would be counted as part of the daily milk allowance.

A child's stomach is the size of their fists, so only a small amount satisfies their hunger. Therefore, they need frequent food offerings. Three meals and 2 snacks are recommended daily. They can also become overwhelmed with too much food. I've found that the use of muffin tins or ice trays with just a few food items in each compartment is a novel and interesting presentation for some. I've even used halves of plastic Easter eggs as food containers to increase interest. These containers also keep food from touching which is appealing to some youngsters.

Structure and opportunity is important. Having the child participate in mealtimes with the family will increase their exposure to food. Children learn much from imitation and you are their most valued role model.

Encourage your child to play with food. I offered some ideas for making food fun at this question How can I switch an exclusively breastfed 1-year-old to food?

Toddlers are known for picky eating and this stage takes lots of patience and persistence. Fortunately, this too will pass with time.

Answer 2

In the UK parents are recommended to avoid fruit juices, or heavily dilute them to 1 part juice to 10 parts water.

I agree with Marie Hendrix, especially with the parts about playing with food.

You can use food outside of meal and snack times as a plaything. This allows your child to get used to different smells and textures. Cooked (cooled!) pasta, baked beans, cooked cooled rice, etc, all make fun messy playthings.

Make sure you let your child explore and play with different foods at the table. Maybe there's no interest today, but if you keep offering small amounts there might be in a few days.

Annabel Karmel has some useful information and some good books. Some of the information is not supported by evidence, but most of it is good.

Answer 3

When you say you give her fruit juice, be aware that most juice contains lots of sugar. In comparison, that makes most food very boring. Sugar also provides lots of energy, although it's not the best way to get it.

If your juice choices contain sugar, you should consider switching to other fluids, like watered-down fruit teas, or just plain regular tap water.

Some vegetables have a natural sweet taste without containing sugars, like soft-boiled carrots, or yellow paprika, and some kinds of potato. If the sweetness is her driving factor, try gearing up on such foods. Try to serve it in many different ways, e.g. boiled/raw (except potatoes), diced/sliced/pureed, etc.

Answer 4

I can't contribute any specific tips, but it sounds like your daughter's (non-)eating habits are already very ingrained. Especially since she's already at the low end of the weight chart, I would not rule out some sort of eating disorder.

If you have ruled out allergies (as caterpillar suggested) then I would suggest consulting with a second paediatrician, specifically for references to child dieticians.

Answer 5

My 1 year and 11 month old son is a picky eater, so somehow I can relate with your problem. Every children is different, so you really need to find a way on determining which strategy will work for her or not. Good thing, you are very patient about your child's pace and you do understand her needs and on what amount of food she can take on a daily basis. You really cannot force her to take more than what she needs. But maybe exploring other alternative techniques can help her change her behavior towards foods. You may also try to consider having behavioral management consultation with a child psychologist, so you would know how to change her behavior or attitude towards food.

Just be sure, that when you are trying different techniques, you have to monitor your child's progress like for example using a Baby Weight or Height Percentile Calculator so you would know if the technique effective or not.