Hello dear Moms

How are you today? Hope the little ones are doing good too!

Coming up with this week's topic wasn't so difficult because of the high prevalence of the issue that I have written about today(according to a study conducted by Jani Mehta et al. 2014 on the Indian immigrant mothers 34.1% of children were found to be fussy eaters). Almost every mother of a young one especially around the age of 2-3 years is facing similar challenge of how to get their young ones to eat nutritious food.

Let me begin by asking you a question and keep reading if your answer is yes (don't forget to mention it in the comment box down below). Does feeding your child one way or the other pose a challenge everyday, does it seem like a herculean task now a days? Well if you answered yes then my dear moms you are dealing with a fussy eater! But I don't want you to be at your wits' end because firstly most children go through a fussy eating stage between 2-5 years of age & naturally grow out of it as long as they are given a variety of food and maintain a mealtime routine and secondly I am here going to give tips about how to handle the various types of fussy eaters.

What is Fussy Eating?

The most commonly accepted definition for Fussy/Picky eating is an "Unwillingness to eat familiar foods or try new foods, severe enough to interfere with daily routines to an extent that is problematic to the parent, child, or parent–child relationship (Lumeng, 2005, cited in Ekstein et al., 2010).

According to my research a proper definition (above mentioned) was only metioned by NCBI & NIH. There was hardly much on IAP website based on my study. But I did find a 2018 study based in India on approx 1600 Indian children & their parents focusing on the picky eating as a prevailing problem in India as well while seldom being taken seriously by Paediatricians (guilty). As per my view Indian kids were not facing such feeding issues while we were still living in joint families where many adult members of the family were present to look after the children & also there were more than one kid so togather they would eat & play and mothers rarely had to worry about such problems. Now with changing times our societal structure has changed so does our problems. According to that 2018 study (KumarKP, SrikrishnaS, PavanI, CharyE.Prevalence of picky eating behavior and its impact on growth in preschool children. Int J Contemp Pediatr 2018;5:714-9.) 58.9% of Indian children were found to be picky eaters. So that means a lot of parental anxiety & family conflicts due to the same, right? We want to change that don't we!

How to know if your child is a fussy eater

Based on my research I found out that several different measures have been developed to assess picky eating, ranging from a single item question to more complex multi-item sub-scales in larger questionnaire this is because there is no single widely accepted definition of picky eating, although most definitions include an element of restricted intake of familiar foods. This is further complicated by the use of a variety of terminology used to describe the same problem, including picky eating, fussy eating, choosy eating and faddy eating.

In my view, mothers or the primary care giver is the best judge of any ill change in the patterns of eating in a child additionally we can always keep track of the weight and height and overall health status of the child with help from your paediatrician which can help us understand whether or not an intervention is needed. So let us move ahead by understanding how many types of fussy eaters there can be & how to manage them.

Types of fussy eaters

(based on my clinical & personal experiences with inputs from colleagues)

Moms of all fussy eaters are dealing with the same anxiety about their child not getting enough nutritious meals but every fussy eater has a different pattern in their turned up noses at the sight of food and so our management depends on the specific pattern or issue.

Type #1

These are the ones that have been eating & trying new food enthusiastically since weaning but suddenly after they turned 2 or 2.5 they have suddenly become choosy, lost interest in previously loved food items. Do not worry its normal and they are still trying to experience new flavours and experiment with them, they will eventually get back to eating what they ain't eating today but were eating earlier. Stay creative with your menu and do not omit items that they are refusing now also let them experiment. this way they will develop their own bond with food.

Studies show that the more flavors babies try, the more likely they are to enjoy a wide variety of foods when they get older i.e., after 10 years of age. So keep introducing those flavours mommies! (only make sure they are healthy & home made).

Type #2

Sometimes when kids become of school going age their meal requirements vary as their growth rates slows down, their physical activity may also not be the same everyday. "Your child may eat a lot at one meal and very little at another, and that's OK," according to Katja Rowell, M.D., a childhood-feeding specialist and author of Helping Your Child With Extreme Picky Eating.

Another interesting thing at this age could be the power struggle, kids realise that they have a lot of control over their parents so they tend to exercise that control by being temperamental with food. Melanie Potock, a pediatric speech-language pathologist, feeding specialist, and author of Adventures in Veggieland, adds, "At this age, a child learns that he has a lot of control over his parents' behavior, and that can be fun!"

So don't panic don't show any signs of anxiety, simply ask them to sit with you during meal time, serve them small quantity of what everyone is eating (make sure its not too spicy or has chilies) and let them eat (or not), don't pressurize them, simply remove the plate whenever they say they are done.

Type #3

At times our little one may be content with eating bland, plain food and refuse to let the flavoursome food enter their tiny mouths. Although normal, it may not be a good idea to keep feeding them their choice of bland food items as this seldom leads to expansion of their limited range of flavour and we don't want that for them. Aversion to strongly flavoured food especially the bold bitter flavours in the green vegetables is actually an evolutionary advantage in children who have become more mobile.

In such cases instead of introducing one strong flavour everyday make inclusions and changes in their liked items. For example if they prefer plain paranthas or rotis, try kneading the dough with spinach or fenugreek leaves or if they love cottage cheese try sautéing it with boiled peas or carrots. Eating this colourful food can be a fun activity (even more fun if you create an art piece with the colourful food - nothing fancy just a face or a kite) thereby piquing their interest. Make sure to make one change at a time thereby gradually introducing flavours and keep the salt to minimum in the food you serve them. Also eating the same food item with them helps as not all kids attempt the new flavours at once. Kids learn by imitating hence they are reassured when they see their parents eating the same food as them. Give them time and keep introducing the changes, don't give up just because the little one didn't eat it the first time.

Type #4

Sometimes our kids can be really finicky about the texture of the food, porridge being too gooey, veggies being too crunchy and so on. This happens because of the discomfort with the different textures due to the still developing teeth, jaws and surrounding muscles, and the little ones may not feel much in control of the food in their mouth while trying to chew or swallow it, so they simply reject them.

First make sure they are seated comfortably with their feet resting on a stool or simply sitting on the floor on a mat while eating (remember the good old days when in India we mostly preferred sitting on floor cross legged while eating , it is known to enhance digestion according to some studies). Secondly, make sure the food they are eating is neither under cooked nor over cooked. Overcooked food loses its nutrition and may feel too gooey and under-cooked food is no good either (remember too crunchy, so don't try to feed them too much salads at this stage, if they don't relish it). Place the food item on their molars to chew and not on their tongue (where the taste buds are), once they are able to chew a certain food item they are more likely to take another bite.

Don't make the food too dry either which makes it difficult to chew and swallow, in this stage make sure they have enough water content left in the cooked food they are given (especially in daal-rice and daal-chapati combo or stuffed rotis or paranthas must have enough ghee in it not too much but enough to keep it from turning dry).

Type #5

Imagine this, your child is happily eating these handful of food items now (you feel a win) but now every time you introduce a new item they have started to gag. Trust me it is a very unpleasant experience for both you and your child.

What's going on there is that eating is becoming a stressful activity for the child. And they may be having a dramatic reaction to all efforts of "getting" them to eat. Dr. Rowell says, "If he has had difficult, unpleasant, or painful experiences related to food, such as severe reflux, constipation, a scary choking episode, or coercive and forceful feeding, that can be a factor too." There could be another serious reason for that frequent gag, that your child has oral-motor or sensory issues. Oral-motor skills refer to a child's ability to move their lips, jaw, tongue, and facial muscles in an age-appropriate manner. This issue needs to be dealt with by giving a visit to your child's paediatrician and getting it diagnosed first and doing as advised by the paediatrician there after.

Once the oral motor or sensory issue is ruled out the problem remains of dealing with the stress related to eating. For that, change your strategy by trying to involve your child with the food at the table without any pressure of eating it. Let them serve every family member the food item you want them to eat, or involve them (with safety) into the cooking process by letting them wash the veggies or other small chores related with meal time. Such activities will expose them to the food items through their eyes, nose and hands before tasting it. This kind of involvement & added sensory exposure will interest them into eating what they have served or helped cook.

Well, these are all the types I have come across and successfully helped mothers manage them. Now there might be other types out there, (do not forget to mention in your comment below if you have a 6th or a 7th type or so on) and I am sure there are ways to manage them all. Just remember to get help before it becomes too stressful for your family and remember if your kid's weight, height and overall health status is good (do take them for regular visits to their paediatricians to make sure) there is nothing to worry about. Hope the above methods will help you with your Fussy eater! Ciao till next time!