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How do I deal with my toddler's fussy eating?
Is it normal for a toddler to be a fussy eater?
By Melbourne Dietitian, Nicole Bando
As a children's dietitian, this is a commonly asked question. Many parents feel concerned about the variety and quantity of food their toddler eats. A fussy eater is defined as a child who refuses to try a new food at least 50% of the time. Fussy eating behaviours in the second year of life are normal and part of how your child expresses their new found independence whilst exploring the world around them. It is normal for children to be uncertain of new tastes and textures; an evolutionary mechanism designed to keep us safe from danger! We have a natural preference for sweeter foods as they are higher in calories, another survival mechanism which no longer serves us.
Establishing healthy habits early in life is important for a child’s optimal growth and development, and reduces the risk of obesity and chronic disease later in life. When a child develops fussy eating behaviours, meal times can become stressful for the whole family. There are many strategies to prevent and manage selective eating habits, making meal times enjoyable once again.
When should I worry about my toddler's eating?
Growth slows during a child’s second year, and so their intake reduces. Many parents worry that their child isn’t eating enough, however may have unrealistic expectations of how much their child needs each day. Toddlers have a small stomach capacity and need to graze frequently throughout the day. Remember that a healthy child will never go hungry, and if energetic and thriving, they are likely eating enough. Seek help from your GP, Maternal Health Nurse or Paediatric Dietitian, if your child is:
- exhibiting extreme fussy eating behaviours and mealtimes are very difficult
- lethargic and lacks energy for daily activities
- appears unwell
- gagging or vomiting often, or has problems with chewing or swallowing
- eating a very limited variety of foods and missing out on entire food groups
- unable to drink from a cup from around 16 months
- rejecting whole food groups or groups of foods of a similar texture
- not growing or developing as expected
How can I encourage my toddler to eat what I offer them?
Are you or any other adults in the house fussy eaters? Research shows that eating meals (as often as possible) demonstrates positive role modelling. If children see their parents eating a variety of foods, they are more likely to learn and copy that behaviour. These times give opportunity to chat, as well as share a meal. Try to cook 1 family meal, so that everyone is eating the same food (may need slight modification for texture), together as often as possible. It doesn’t matter if your child doesn’t want to eat or try everything on the plate. Repeated and exposure of a variety of new foods will help your child to develop healthy habits.
The below strategies can help manage fussy eating behaviours:
- Parents use a consistent approach with all strategies
- Keep calm, avoid a fuss as this gives issue more attention which can lead to a power struggle
- Avoid using punishment or bribes e.g. dessert as reward for eating vegetables
- Minimise distractions: eat at table, away from television, devices or toys.
- The Division of Responsibility: it is the parent’s job to offer a variety of healthy foods at the right times and the child’s role to decide what, and how much to eat.
- Offer foods in different ways e.g. broccoli with melted cheese, or stir-fried to promote enjoyment and acceptance
- Keep meal times to a reasonable time limit and develop a routine around meals.
- A new food may need to be offered up to 15 times before it is accepted. Many parents give up after a few times.
- Harness your toddler’s independence and encourage self-feeding, with a mixture of finger foods and mixed textured foods, requiring a spoon or fork
- Children love helping and can assist with shopping for the family’s food and simple meal preparation.
- Your child’s appetite can vary considerably day-to-day depending on activity and growth. If your child rejects the food offered, avoid offering an alternative, instead reoffer the food at a later stage, perhaps they are just not hungry.
- Sometimes children can be filling up on milk and this takes away their appetite for other foods. They may not be fussy, just full.
- Toddler formula is not necessary in a child’s diet. It displaces food gives preference to sweet tasting drinks. After 12 months, cow’s milk or a suitable dairy alternative can be provided as a drink. Breastfeeding may continue for as long as mother and child are enjoying it.
- Keep high sugar and high fat treat foods to a minimum. These can take place of foods from the other food groups, which means your child does not have the appetite for nutritious foods.
Should I force my toddler to eat?
Forcing a child to eat will create a negative association with food, which can have long-lasting effects, such as poor relationship with food, food aversions and worsening fussy eating behaviours, a high level of stress at mealtimes and reinforcing an idea that healthy foods are bad. It also overrides your child’s own hunger and fullness cues, and this can contribute to weight gain and obesity in later life. Forceful behaviour includes coercion, ‘have one more mouthful’ and negotiation, ‘eat this and you can have dessert’. If your child does not want to eat at a particular time, it can be for a whole range of reasons, so if you feel concerned, see your health professional to discuss. Children are excellent at regulating their own appetites and by using the above strategies, you can help your child to create a healthy relationship with food.
Dr Fran Arcuri Consultant Perinatal Psychiatrist
Body Image and motherhood By Dr Sam Margis (Consultant Perinatal Psychiatrist)
Bringing your kids for an immunisation can be daunting...... For your child and yourself! Rest assured that our practice nurses are very experienced and they have some tips to help you prepare. Bring your child’s health and development book (green book) to every appointment. Although most records are now online sometimes these records need to be double checked. Having your child’s vaccines documented in their green book provides a consistent record. Preparation is key, it is important to talk with your nurse or doctor about your concerns about vaccines. Before administering any vaccine, the nurse will talk you through the process and develop an effective plan to ensure it is smooth and easy. If you have any requests from the nurse on how to approach yourself or your child, it is important to discuss these further. Bring along your child’s favourite toy or a treat for afterwards. Distraction, relaxation, and other measures reduce distress and pain after vaccination in young children. Topical anaesthetics, such as EMLA or Angel cream, are not routinely recommended. They could be considered in a child with excessive fear. For older children relaxation techniques can often be helpful. Vaccines are administered in the legs for children under the age of 12 months and in the arms for children over the age of 12 months. Therefore, we would recommend suitable clothing depending on your child’s age. The Royal Children’s Hospital provide some further resources about providing comfort for kids https://www.rch.org.au/comfortkids/for_kids/
UPDATE JULY 2021 Extraordinary times require extraordinary changes. This could not be more relevant during a worldwide pandemic. Just like you and your family, NEST has had to implement many changes to adapt to the current situation. Our services are all still operational, albeit in a slightly different way to normal. Please read below for the most current update. Health care is an essential service and now more than ever, it is important to take care of your physical and mental health! We continue to enforce strict screening and infection control measures (in line with the latest government health advice) to ensure that our patients have access to the care they need whilst reducing the risk to our staff and other patients. NEST continues to provide excellent health care to your family. Our staff have been working harder than ever during the COVID pandemic. The government has extended the telehealth options and we are pleased to provide flexible and convenient ways to continue to care for your families during the current health crisis by offering the choice of telehealth and face to face appointments. MASKS: Masks are still required when inside NEST Family Clinic. Please ensure you have one with you when you arrive for your appointment. COVID VACCINE: NEST is not stocking the COVID vaccine (AZ or Pfizer). For information on where and how to book this in, please visit https://www.coronavirus.vic.gov.au/book-your-vaccine-appointment NEST General Practice: Telehealth and face to face appointments can be booked online (via HotDoc) or by calling reception (1300 637 832). Please ensure you answer questions truthfully when booking in, so that our staff and other patients are not put at risk. Please wait in your car or outside the clinic and your GP will call you and go through our screening questions before bringing you into the clinic. Please note that patients with symptoms such as cough, sore throat, runny nose, fever, shortness of breath and/or loss of taste or smell and patients who have been in close contact with a positive COVID case or are waiting on a COVID test result or patients who have returned form interstate or overseas travel in the past 14 days or been to any recent 'hot spots' will need to begin with a telehealth consultation or be seen in our 'Respiratory Clinic' times. If the GP feels that they are unable to see you face to face owing to their screening criteria, they will discuss this with you. **If attending the clinic for a face to face appointment, please do not bring any additional family members so as to reduce the number of people in the clinic. Repeat scripts & referrals: Repeat scripts or referrals for regular medications or referrals that have been previously done at NEST, can be requested via HotDoc - https://repeats.hotdoc.com.au/#/clinic/282/prescription-request Please note the term and conditions. NEST Nursing & Immunisation: Our Practice Nurses are available for consultations and immunisations as normal. It is especially important at this time to keep up to date with scheduled vaccinations. We ask that patients remain in the car when they arrive for their vaccination and we will advise you when the nurse is ready to see you. That way, you are reducing the amount of time spent in the clinic. **For safety reasons, patients must remain at the clinic for 15 minutes after any vaccination. Should you wish to wait outside, this is fine but you must be visible to NEST staff. NEST Psychology & Psychiatry This is an incredibly challenging time for everyone and can lead to an increase of anxiety and depression. Our team of psychiatrists and psychologists are still here for you and encourage you to continue your therapy with them (either face to face or via telehealth) as now more than ever it is important to keep a check on our mental health. Some of our clinicians have moved solely to a telehealth system and our reception team will be in touch with you to advise you of this. Otherwise please continue to attend your appointments in the clinic. And if you have a loved one in need of additional support at this time, please call us to discuss appointments with our team. Nutrition & Dietetics: NEST’s Family and Paediatric Dietitian and Lactation Consultant, Nicole Bando, is still available for face to face consultations, home consultations or telehealth consultations. Nicole has some great ideas about how to keep up healthy eating habits for you and the kids whilst staying at home. Please call NEST reception to make appointments with Nicole. Physiotherapy: NEST’s Physiotherapist Genia Barmakov, is still available for face to face consultations. However, if you are self-isolating at home, Genia can offer telehealth consultations too! Rest assured there is still plenty that can be achieved over the phone or a video chat with your physio. Genia is an expert musculoskeletal and pelvic floor physio and can offer you advice, exercises and products to men and women through this time. If you are pregnant or post-natal and want or need guidance on how to manage or return to exercise, pelvic instability and/or pain, pelvic floor concerns pre or post-natally, please call reception to make an appointment with Genia. Lactation consultations: Nicole Bando, APD and Lactation Consultant and Dr Maryallan Girolami are available for face to face consultations, home consultations or telehealth consultations. Please reach out if you need help with breast feeding or bottle feeding your baby. Being isolated from friends and family with a small baby can be very hard but rest assured that Nicole is here for you if you need guidance or assistance with any feeding problem or query. Paediatrics: During this time, many normal routines have dramatically changed, including regular check ups with Maternal & Child Health Nurses. This can often be stressful and anxiety provoking for many parents. NEST's, Dr Danielle Freeman is a neonatal paediatrician treating bubs (from 0 to 12 months of age) and mums to be (prenatally) to treat and look after many different concerns/conditions. Dani is available for face to face and telehealth appointments (when preferred or needed) at NEST Elsternwick. COVID-19 INFORMATION: If you have any further queries please contact the Coronavirus Hotline number (provided by nurse-on-call) - 1800 675 398. And refer to the latest information at - https://www.dhhs.vic.gov.au/coronavirus The COVID testing centres are located here: https://www.coronavirus.vic.gov.au/getting-tested A reminder, that: • All patients are screened thoroughly prior to entering the clinic, • All patients attending the practice must wear a mask (children under the age of 12 years old are exempt from this), • The consultation rooms are regularly cleaned in between patients and the premises are cleaned regularly with hospital grade disinfectant, • Hand Sanitiser is readily available and • PPE (Protective personal equipment) is worn by all clinicians when required Lastly, we are experiencing higher than normal call volumes, email requests and general enquiries so please be patient as we attend to your queries and requests as soon as we can.
The Coronavirus pandemic has dramatically disrupted the way we live and work. Remember you are not alone. AT NEST we are noticing many families concerned about their children’s mental health during this time and moving forward. It is important to acknowledge our children may also be experiencing feelings of anxiety and depression during this time. Communicate with your children and have open conversations about the pandemic. Ensure you expectations are not too high and be kind to yourself. This situation is completely new and whilst trying to maintain a sense of normality it brings many challenges. Do not put too much pressure on yourselves as parents, on your children or as a family. The COVID pandemic has had a significant impact on the way we live our lives. This means it is extremely important to look after your mental health. Tips to help maintain good health during the COVID Pandemic: • Keep to a routine. We are used to having routines to guide our days and give us a sense of achievement. When so much seems out of our control, establishing some structure in our days will help to provide stability and a ‘new normal’. This is particularly challenging for families adjusting to home learning. Try to create new routines as a family to help separate ‘work and school time’ and ‘family time’. • Make sure your children still go to sleep and wake up at a reasonable time. Sleep is extremely important for routine as well as maintaining good physical and mental health. • Stay hydrated. • Find a new hobby you can do with your children or start a long-term project you have always wanted to do. • Stay connected. Maintaining social connections is important to feeling safe and well. • Encourage your children to stop to breathe. An easy way to stop and reset is to use the 4-7-8 breathing technique. Breath through your nose for 4 seconds, hold your breath for 7 seconds and exhale for 8 seconds. • Be kind to yourself and take time just for you, even if it is just a few minutes to take some deep breaths and step outside into the fresh air. • Reach out to others and seek support. It is normal to have ups and downs, and it is important to talk about how you are feeling with family and friends. In times like these, they are likely experiencing similar feelings. The Australian Government has provided 10 additional Medicare-subsidised psychological therapy sessions for Australians affected by the second wave of the COVID-19 pandemic. People will have to have a Mental Health Treatment Plan and a review with their GP to access the additional sessions. This will allow them to continue to receive mental health care from their psychologist, psychiatrist, GP or other eligible allied health worker. NESTs highly experience team of GPs and Psychologists can help. Please contact us to make an appointment.
