Eating Problems

‘I made her a bowl of rice pudding and she looked at it, and then at me, and then quite deliberately picked it up and emptied it on to the floor. I really shouted at her and then felt quite tearful.’

Most parents have passing worries at some stage about how much their child eats, what he eats, or how he eats it. This is quite understandable, especially in first children when parents do not have any experience of childish idiosyncrasies. Sometimes it is also hard to make the transition from dealing with an utterly dependent baby who has to be fed little, often and just the right foods to dealing with a young child whose needs are suddenly different and who can let you know when he is and is not hungry and what he wants to eat.

Many emotions are bound up in the whole business of preparing and giving food. Getting food rejected can feel like a very personal kick in the teeth for the chef, and children quickly find out how much you care, even though they may not understand exactly why.

Toddlers can do all sorts of horrific things with food, some of them innocent, and some, as they get more knowing, rather more experimentally testing. Obviously, you have to let them know what is and is not acceptable, but beware of making too much of what would otherwise simply be a passing phase in how much or what they eat because that is often how something trivial can develop into a real problem.

Children Who Won’t Eat

‘My son stopped eating anything much at fourteen months - looking back I realise now it was because the weather was hot and he’d just learnt to walk. Eating was boring and he wasn’t hungry, but at the time I couldn’t see it so clearly and wasted hours following him around with teaspoons of food trying to get him to eat. It all became an enormous game. If only I could have ignored it all the whole thing would never have become such a problem. As it was he didn’t eat normally until he was three and a half and going to nursery school.’

All children go through phases of not eating, eating very little, or eating only a few foods – commonly labelled ‘hunger strikes’. They usually begin in the second or third year and reach a peak around four years, disappearing with the start of school. If you largely ignore the problem and do nothing but offer meals without making a fuss or letting your child continually nibble in between, his hunger will ensure he takes what he needs. The more you try to encourage or force him to eat, the more he will discover how important this is to you, and what power he has to command your attention.

No healthy child will allow himself to starve, so if you have any other reasons, apart from his lack of appetite, to worry about his health, see your GP. Probably the best test to find out whether he is eating enough is to see if he is growing properly. Your health visitor will be pleased to check his height and weight against his expected growth which can be plotted on a chart. If this is all right, as it will be for most children, then exercise supreme indifference to plates of untouched food, but do not allow him to fill up on extra snacks of any kind in between meals or offer puddings instead. Sometimes, parents who complain that their child does not eat do not look realistically at what is eaten between mealtimes in the form of sweets, biscuits, crisps and other snacks.

Do not forget that drinks are food, too, and often young children who seem to eat nothing are still drinking a great deal of milk. Liquids are also filling, so drinks of any kind before meals will take away his appetite. If this is the case, cut the amount of milk he drinks to one pint of whole milk per day and do not give sweetened drinks at all, only water. Remember that although after the age of six months milk alone is not enough to meet all his requirements, such as iron, milk is nevertheless an important source of calcium and other nutrients and that a pint a day should be given.

Often parents worry that even though their child seems healthy now, eating very little will lower his resistance to illness and infection – he will get ‘low’ and not have the right reserves of vitamins and minerals. Provided your child is healthy, this is not true. You should of course, if you are worried, continue to supplement his diet with children’s vitamin drops from your local health clinic. Very delicate mechanisms operate to ensure we absorb just the right amounts of vitamins and minerals, and eating a lot or taking massive extra supplements do not mean the body is able to store more; indeed an excess of some vitamins, such as vitamin D, is toxic.

Eating and Illness

Going off food is often the first sign of illness which is usually followed by other symptoms such as a temperature, tiredness, wretched or miserable behaviour, sickness, diarrhoea, complaints about pain or a rash. As in health, the best guide as to what your child needs will probably be his appetite, but remember he will need extra drinks. If he does not want anything at all, just concentrate, especially in the case of sickness and diarrhoea, on giving him plenty of fluid to stop him becoming dehydrated. Packets of special salts and sugar are available from your GP or over the counter from the chemist to make up into a drink to rehydrate him. If his lips and mouth appear dry and/or he hasn’t passed urine for a number of hours (the number depends on the age of the child, but as a guide four to six hours for a baby under one year and eight to ten for a child from one to five years) go to see or ring your GP for advice.

Generally, though, as appetite returns, illness is a time to relax some aspects of eating rules, so try to tempt him with milky drinks or sweetened drinks and interesting but nourishing snacks. Eating problems can often follow an illness when fads have been indulged, and you need to assess carefully when to go back to the ‘rules’ by gradually re-introducing normal eating. This may mean weaning a child who has gone back to having mainly breast- or bottle-feeds on to solids all over again, or re-establishing a pattern of regular mealtimes for a child who has been having odd snacks as and when he wants.

Frequently children are temporarily ravenous after a bout of illness and eat anything and everything. However, although they will need extra drinks and snacks, they sometimes cling to eating habits they were allowed when ill. Parents who have been worried about their child and nursed him through an illness are naturally more anxious and do not want to upset him. However, the same rules apply as at other times – keep him busy and distracted between meals so that he forgets about asking for in-between treats: offer such treats at mealtimes sometimes if you think he will like them, as well as two or three extra drinks or snacks for a week or two. Do not make too much fuss or comment if he does not seem hungry.

Children Who Want Food All the Time

Fridge raiders are not as common as hunger-strikers, but this can be a passing phase which develops into a habit because it gets so much reaction from you. Taking food without asking, especially in other people’s houses, usually acts as a sure way of getting your attention. It can be a sign of jealousy, for example, about a new baby. Make sure you give your child plenty of attention at other times and keep him busy and occupied in order to take his mind off food. Offer foods and drinks he likes at meal or snack times, but explain that extras are not permitted, except water. Play down your reactions to his eating habits generally – often children who seem obsessed with food can also be very fussy and refuse food at mealtimes. This may be another way of gaining your attention or the result of nibbling in between meals. If you think the problem has become serious or your child is getting fat, discuss the problem at your health clinic (Fat children).

Is Food Too Important?

‘My mother never cuddled or played with us but spent all her time in the kitchen preparing meals. She would take it as the most personal affront if you weren’t hungry or didn’t like something she served, and to this day I still can’t leave anything on my plate and both I and my brothers have weight problems. She also had a very martyred attitude to it all – serving up wonderful children’s teas at parties but with a stony face that defied us not to enjoy every mouthful after we had caused her so much work.’

When long-term battles about food become established, it can often be that the whole relationship between parent and child has come to rest on food and eating alone. If you seem to be at this stage, think about how much of your attention your child gets in other areas of his life. Do you play games or join in activities with him? Do you read stories to him, go for walks together or just sit him on your knee and talk about what he is watching on television? It may be that food is very important to you in some way, or that you find it hard to show affection to your children in other ways and feeding them becomes either the only way to show affection or a substitute for love. Children may make more and more out of what they will and will not eat if it is the only way they can get your individual attention and a genuine response – the fact that you get cross and angry does not make any difference.

Try to take the emphasis off food and concentrate on sharing other aspects of your child’s life. If you find this difficult, then talking to your partner, a good friend or a professional you trust, such as health visitor or GP, may be helpful.

Using Food as Punishment or Reward

Once children are old enough to understand, it is reasonable to say ‘no pudding’ until they have eaten some of the first course – though there is no need to insist on a clean plate. This is a straightforward reward system and probably what you have been practising when they were younger. It is also reasonable to deprive a child of an edible treat if it is set in context – for example, if they behave badly in a shop or supermarket and you are buying them a lolly or crisps then forgoing the expected treat is an obvious punishment. However, banning sweets or puddings for bad behaviour in a situation that has nothing to do with the food in question, or handing out sweets and other treats for good behaviour, just puts too much emphasis on food and eating all the time.