Is your child an extremely fussy eater? Or one who takes two hours to finish a meal? He or she may have a feeding disorder. International pediatric nutrition expert Dr William MacLean, who was invited by Abbott Nutrition to speak at the International Summit on the Identification and Management of Children with Feeding Difficulties in Singapore earlier this year, tells us how to feed our children right.
Yes, it’s not just what you feed your child that matters. How you feed your child, the attitude that you, the parent, brings to the table, is just as important. This is because feeding problems can become very severe and compromise the child’s physical and mental development over time.
Problems with such a level of severity are called ‘feeding disorders’, said Dr MacLean, adding that among the children who have feeding problems, no more than five per cent will be severe enough to be considered a ‘feeding disorder’.
“I recently heard about two children who illustrate this kind of problem. One would not eat foods unless they were a specific color, which as one can imagine leads to a very abnormal diet. Another child whose friend had had a serious choking episode developed a fear of feeding and did not want to eat solid foods because he was afraid he would choke,” the clinical professor from The Ohio State University and president of Life Science Research Organization and International Fund for Infant Nutrition shared.
Which Feeding Style Are You?
Dr MacLean points out four basic feeding styles:
This is the preferred style. These caregivers share the responsibility of feeding with their child. The caregiver decides “What”, “Where” and “When” the child eats. The child is allowed to decide how much he or she wants to eat. The goal here is to help the child recognise hunger and satiety. These caregivers have a reciprocal relationship with their child. Children who are raised by parents/caregivers with this style are more likely to have a very diet and also to be of normal weight as time goes on.
These parents want to control all aspects of the feeding, including how much the child will eat. These parents will bribe or punish their children to get the desired result. The child does not learn to recognise hunger and satiety. In the long run the child will have a less varied diet.
These parents cater to their children’s wishes. If the child doesn’t like a particular food they will find something the child does like, even if it means preparing it specially for the child. These children end up eating a less varied diet and because they are offered whatever they want may have a tendency to obesity later in life.
These parents are either too busy with their own work or perhaps having their own problems. They tend to not provide the child as much attention as needed. Some of these children will have such low nutrient intakes that they may not grow and develop properly.
The four basic styles of parenting and feeding are seen worldwide. What may vary is the frequency with which each style is used in various cultures.
In general, majority of children are perfectly normal and eat well. Parents should operate on this assumption, Dr MacLean advises, and not look to identify feeding problems: “Remember that even in the group of children whose parents are concerned about how they are eating, 20 per cent of the children are perfectly normal.”
However, if the parent senses there may be a problem or has a concern about how the child is eating, that should be enough to take the child to see a healthcare professional who can do an appropriate history and physical exam and recommend management. The healthcare provider will decide whether the child with a feeding problem is basically having a problem with poor appetite, selectivity, or fear of feeding. In each of those groups, the problem can be a misperception on the part of the parents or can be related to behavioral problems or organic disease. Each problem leads to different approaches of management.
Basic Feeding Guidelines
Prevention is always easier than treatment. Here are some guidelines that should be followed for all children whether they are doing well or perhaps have a feeding problem.
1. First, minimise distractions at mealtime (no cell phones or television).
2. Second, schedule regular meals (three to four per day plus one to two small snacks) with nothing in between except water or low calorie beverages. The goal here is to help the infant develop hunger prior to the next meal.
3. Third, limit the duration of the meal to about 25 minutes. If the child has not finished eating at that point, simply remove the plate without comment. If the child did not eat all it wanted in that amount of time, he or she will be hungry at the next meal.
4. Fourth, offer age-appropriate foods.
5. Fifth, systematically introduce new foods, especially vegetables. This means repeated exposures to small amounts (up to 15 tries of the same food over a period of weeks).
6. Finally, parents should encourage self-feeding after the age of eight to 10 months and should be prepared to tolerate the mess that accompanies this.