• No h/o Food Intolerance

• Normal Weight and Height

• No parental concern about child’s eating

• No psychological and behavioural factors

Healthy EatersHealthy Eaters

Eating ProblemsEating Problems• Food refusalFood refusal• Poor appetitePoor appetite• Inappropriate food Inappropriate food

for agefor age• Extreme or very Extreme or very

limited food choiceslimited food choices• Poor table Poor table

behaviourbehaviour

Picky EatersPicky Eaters

• Some have past h/o. organic difficulties• Have psychological based feeding problem• Failure to Thrive

• Some have past h/o. organic difficulties• Have psychological based feeding problem• Failure to Thrive

Picky EatersPicky EatersYou

know! My son hardly takes four

gulps at lunch.

Oh! My son Eats only two

gulps.

Eating ProblemsEating Problems• Failure to thriveFailure to thrive• Developmentally Developmentally

delayeddelayed• Infantile anorexiaInfantile anorexia• Picky eatersPicky eaters

Picky EatingPicky Eating

Food refusal of the Food refusal of the child for at least one child for at least one

month that may month that may involve all or certain involve all or certain

types of foods.types of foods.

Definition:Definition:

Doctor’s RoleDoctor’s Role

Solve our Solve our problem, problem,

Pl.Pl.

Picky EatersPicky Eaters

• What was wrong? • Why were these kids such picky eaters?

Doctor’s GoalsDoctor’s Goals • Identification and

management of eating problems in childhood.

• Appropriate management strategy.

• Provide opportunities for early detection.

• For suggestions about prevention and treatment of eating problems.

….if someone yells “no” daily at your dinner table, you’re not alone.

NO NO

NONO

NO

Why toddlers are pickyWhy toddlers are picky

(Between 1 and 3yrs). (Between 1 and 3yrs). • After a year of rapid growth, toddlers

gain weight more slowly. So,they need less food.

• The fact that these little ones are always on the go also affects their eating patterns. They don't sit still for anything, even food.

• Snacking their way through the day is more compatible with these busy explorers' lifestyle than sitting down to a full-fledged feast.

Being a picky eater is part of what it means to be a toddler.

• Children fight with parents for control during mealtime

• Conflict can develop around:– What the child will eat

– How much they will eat

– Where they will eat it.

Parenting styles may interfere with self-regulation of children’s feeding behaviour.

Battle for ControlBattle for Control

If you don’t eat …..If you don’t eat ….... I won’t

talk to you !

.. I give

you

good

beating!

.. I take you to Doctor

and get you an Injection

Parental ResponseParental ResponseChild’s ResponseChild’s Response

– Highly controlling

– Laissez faire

– Responsible

Medical AssessmentMedical Assessment• Clinical history: Exclude

organic and severe psychological problems

• Physical examination• Laboratory profile• Treat and monitor medical

problems

Often a combined medical and dietary approach to the management of constipation can be beneficial.

Treatment OptionsTreatment Options

• Behavioural interventions

• Mealtime suggestions

• Oral supplements

Mealtime Suggestions Mealtime Suggestions for Parentsfor Parents

• Make meals a pleasant family time• Eat as a family at the earliest age possible• Serve the nonpreferred or new foods -frequently

encourage tasting new foods• “Neophobia” – Children are vary of new foods.• Familiarity promotes shifts in food preferences

Aim for a nutritionally-balanced week, not a balanced day.

Expect your child to eat well one day and eat practically nothing the next.

Toddlers from one to three years need Toddlers from one to three years need between 1,000 and 1,300 calories a day, yet between 1,000 and 1,300 calories a day, yet

they may not eat this amount every day.they may not eat this amount every day.

Toddlers like to binge on one food at a time. They may eat only fruits one day, and vegetables the next.

Tactics for ParentsTactics for ParentsTactics for ParentsTactics for Parents

To tempt little To tempt little taste buds taste buds

& & minimize minimize mealtime mealtime

hassles.hassles.

1. 1. Offer a nibble Offer a nibble traytray

Toddlers like to graze their way through Toddlers like to graze their way through a variety of foods, so why not offer them a a variety of foods, so why not offer them a

customized smorgasbord? customized smorgasbord?

Use an ice-cube tray, a muffin tin, or a compartmentalized dish, and put bite-size portions of colorful and nutritious foods in each section.

Call these finger foods playful names that a two-year-old can appreciate

Young children think that

immersing foods in a tasty dip is

pure fun (and delightfully messy).

2. 2. Dip itDip it

Some possibilities to dip into:

Cottage cheese, fruit juice-sweetened preserves, pureed fruits or vegetables, yogurt, plain or sweetened with juice concentrate.

3. 3. Spread itSpread it

Toddlers like spreading, or more

accurately, smearing.

Show them how to use a table knife to spread cheese, peanut butter, and fruit concentrate

onto crackers, toast, or rice cakes.

Toddlers are into

toppings.

4. 4. Top itTop it Putting nutritious, familiar favorites on top of new and less-desirable foods is a way to broaden the finicky toddler's menu

Favorite toppings are yogurt, cream cheese, melted cheese,tomato sauce, applesauce, and peanut butter.

Make a smoothie – together. Milk and fruit – along with supplements such as juice, egg powder, wheat germ, yogurt, honey, and peanut butter – can be the basis of very healthy meals.

5. 5. Drink itDrink itIf your youngster would

rather drink than eat, don't despair

So what if they are consumed through a straw?

One note of caution: Avoid any drinks with raw eggs or you'll risk salmonella poisoning.

How much a child will eat often depends on how you cut it.

6. Cut it 6. Cut it upup

Cut sandwiches, pancakes, waffles, and pizza into various shapes using cookie cutters.

7. 7. Package itPackage itOur kids enjoy the unexpected and fanciful when it comes to

serving dishes – anything from plastic measuring cups to ice-cream cones.

"Doctor, he won't eat his vegetables"

8. Become a veggie 8. Become a veggie vendorvendor

So if you aren't the proud parent of a veggie lover, try the following tricks

•Plant a garden with your child.

•Slip grated or diced vegetables into favorite foods

•Use vegetables as finger foods and dip them in a favorite sauce or dip.

•Concoct creative camouflages.

•Cut the vegetables into interesting shapes (Make veggie art).

9. Share 9. Share itit

If your child is going through a picky-

eater stage, invite over a friend who is

the same age or slightly older whom you know “likes to

eat.”

Your child will catch on. Group feeding lets the other kids set the example.

10. Respect tiny 10. Respect tiny tummiestummies

This less-is-more meal plan is not only more successful with picky eaters, it also has the added benefit of stabilizing blood-sugar levels, which in turn minimizes mood swings.

Dole out small portions at first

and refill the plate when your

child asks for more.

11. Make it 11. Make it accessibleaccessible

Reserve a low shelf in the refrigerator for a variety of your toddler's favorite (nutritious) foods and drinks.

This tactic also enables children to eat when they are hungry, an important step in acquiring a healthy attitude about food.

Give your toddler shelf space.

12. Use sit-still 12. Use sit-still strategiesstrategiesOne reason why toddlers

don't like to sit still at the family table is that their feet dangle. Try sitting on a stool while eating.

Children are likely to sit and eat longer at a child-size table and chair where their feet touch the ground.

13. Turn meals upside 13. Turn meals upside

down.down. The distinctions between The distinctions between breakfast, lunch, and breakfast, lunch, and dinner have little meaning dinner have little meaning to a child. to a child.

If your youngster insists on If your youngster insists on eating pizza in the morning eating pizza in the morning or fruit and cereal in the or fruit and cereal in the evening, go with it – better evening, go with it – better than her not eating at all. than her not eating at all.

This is not to say that you should become a short-order

cook, filling lots of special requests,

but why not let your toddler set the menu sometimes?

14. Let them 14. Let them cook. cook. Let your child help Let your child help

prepare the food. prepare the food.

Use cookie cutters to Use cookie cutters to create edible create edible designs out of foods.designs out of foods.

Give your assistant Give your assistant such jobs as tearing such jobs as tearing and washing lettuce, and washing lettuce, scrubbing potatoes, scrubbing potatoes, or stirring batter.or stirring batter.

15. Make every calorie 15. Make every calorie count. count. Offer your child foods that pack lots of nutrition into

small doses.

Nutrient-dense foods that most children are willing to eat include:

•Pasta,Brown rice and other grains, Potatoes,Cheese, Poultry, Eggs, Squash, Fish, Sweet potatoes, Kidney beans,Yogurt, etc.

16. Count on 16. Count on inconsistencyinconsistency

What and how much they are willing to eat may vary daily.

Don't be surprised if

"The only thing consistent about toddler feeding is "The only thing consistent about toddler feeding is inconsistency."inconsistency."

•your child eats a heaping plateful of food one day and practically nothing the next,

•adores spinach on Tuesday and refuses it on Thursday

• wants to feed herself at one meal and be totally catered to at another.

17. 17. RelaxRelax"Try to make mealtime a really relaxed atmosphere talking about

the day. Don't bribe and reward your child with things like 'eat your peas and you'll get your desert'. - Breton- Breton

• It's not easy to reason with an opinionated two-year-old.

• Better to learn to make the sandwich the child's way.

• Don't interpret this as being stubborn. Toddlers have a mindset about the order of things in their world.

• Any alternative is unacceptable.

This is a passing This is a passing stage. stage.

Golden RulesGolden RulesNo child has ever died of starvation when

presented with an array of healthy food choices.

Kids often simply don't want to be bothered with having to eat. For them, meal times often represent an unwelcome interruption in their playtime.

When children are truly hungry, they will eat.

Golden RulesGolden Rules

• DON'T force kids to eat. Instead, offer children the opportunity to sample a variety of healthy food choices at all meal times.

• Don't expect a complete turn-around over night.

• Don't expect your kids to like every new recipe the first time they try it.

• Don't give up!

Enforcing meal times and/or requiring kids to eat a certain amount of food at mealtimes only serves to frustrate both child and adult, and can also lead to the development of life-long eating disorders.

Children come to associate food with conflict, and may turn down an offering of their favorite foods just to avoid this situation

Why Children Should Grow Healthy?

• Child under-nutrition or failure off children to

grow properly in early childhood ,, results in greatly increased child mortality..

• At more than 3000 infants a day,, the death toll from under-nutrition by far exceeds even the Tsunami or Bhuj..

• Those children that survive do so with a greatly reduced capacity to lead productive and healthy lives..

Malnutrition 55%Causes of Infant Mortality

SILENT KILLER

• Prolonged eating

problems can seriously affect a child’s

growth and development

Danger of Picky EatingDanger of Picky Eating

Role of Oral Supplements

Role of SupplementsRole of Supplements

For any child, it is important to get some food from each of the food pyramid groups every day. That's because, for the most part, nutrients aren't shared between them.

Pickiness is a Pickiness is a ChallengeChallenge

Pickiness is a Pickiness is a ChallengeChallenge

Yes, but one that is worth meeting.