Parents Beware: Toddlers Have Multiple Ways of Saying No to Food

Just Two More Bites!: Helping Picky Eaters Say Yes to Food
by Linda Piette, MS, RD,

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The "no" stage lasts about a year and moves through three stages:

Nonsense "no" is playful and experimental. It doesn't necessarily express dislike or resistance. It's more about seeing what happens with a response of "no."

Defiant "no" is a test of limits and power. Giving a child appropriate choices empowers her to express appropriate preferences and avoids potential showdowns.

Reasonable "no"; is less common, less intense, and does express personal preferences. At this stage, it's good to dig deeper. Talk to a child and find out why she said no.

With babies, handling picky eating is less straightforward. When food refusals start at an early age, immature eating skills are often to blame. In order to eat, babies first need to learn how. Some do it easily and happily while others resist and struggle. Young children vary a great deal in their readiness for solid foods.

Babies born early and those with medical complications are at risk for immature development. They often don't follow the typical schedule for such learning skills as walking, talking, and eating. Regardless of the cause, a child with a lag in eating or self-feeding skills is more likely to reject food.

Parents who realize there's a lag in a child's eating skills may be tempted to push harder to help their child catch up. Oddly enough, this often makes things worse. If a baby resists eating food from a spoon, holding down his arms in order to pry in extra spoonfuls isn't the solution. If a baby gags when eating stage three baby foods, giving these and other difficult foods won't help. In fact, it is likely to increase the gagging and may possibly lead to vomiting. When a child has immature eating skills, a gentle approach works best.

Meals are happier and more productive when parents are able to recognize typical behaviors for their child's development stage and adjust the pace of feeding to match the child's comfort level. Sometimes this means advancing food textures through smaller steps instead of big leaps. Even though timing varies, children eventually learn how to eat. In the meantime, keeping early eating experiences positive avoids negative associations with food. Chapter 3, "Feeding Skills," and chapter 8, "Food Textures and Flavors" offer suggestions.

Handling food refusals in children with developmental delays, aversions, or other special needs is also less straightforward. Parents may find that it's harder to distinguish the difference between a child who needs help and one who is testing limits. Picky eating patterns are more extreme. Instead of changeable and time-limited food jags, food preferences are narrow, fixed, and longer-lasting.

Autistic children often adopt rigid food routines, eating the same ten foods day in and day out. Chapter 12, "Feeding a Child with Special Needs," describes some of the strategies used to overcome slow food progressions or rigid food preferences.

Biology

From a medical perspective, poor growth, not poor appetite, is the classic sign that a child needs help. Although poor appetite and poor growth usually go together, there are exceptions.

Three-year-old Adam amazed everyone with his giant-size appetite, eating twice as much as other kids his age. Still, he remained the smallest in his group. The mountains of food Adam devoured did not help him. Adam's problem was digestion, the leading biological cause of poor growth in children.

The classic signs of a digestive problem are diarrhea or vomiting. It turned out that Adam had celiac disease, which caused him to have diarrhea whenever he ate food that contained the protein in wheat-gluten. That meant it was necessary to avoid a long list of common foods, including pasta, bread, and most crackers and cereals. Once he eliminated all foods that contained gluten, Adam's diarrhea stopped and he began to gain weight.

Of course, a serious condition is not always to blame. Because babies and young children have immature digestive systems, they are very susceptible to digestive problems-short bouts of diarrhea and vomiting are common. Fortunately, because of the short duration of these bouts, they rarely have a lasting effect on a child's growth or appetite.

It's long-term conditions that are more problematic. Any ongoing condition that causes a child to associate pain or discomfort with eating can eventually lead to food refusals. This can happen with mild digestive problems, such as reflux, constipation, or, in some cases, allergies, as well as with mechanical problems involving eating or swallowing. These are discussed in chapter 11, "Food Allergies and Digestion Problems."

Children with serious growth or feeding problems often have an underlying medical condition. Researchers report that a high percentage of children seen in medical specialty clinics such as pulmonary and GI (gastroenterology) have feeding problems. This is not surprising. Any number of medical conditions increase a young child's risk for problems with feeding or growth. Obvious problems such as cleft lip or cleft palate make eating more difficult. Less obvious are conditions that increase a child's calorie needs. These include prematurity, cerebral palsy, cystic fibrosis, and some congenital heart problems.

Because the number of children with feeding problems and medical risks has increased in recent years, more services are available. Human biology is complex. Understanding how much of a child's growth or feeding problem is inherent rather than acquired is always a challenge, but more so when a child has a medical condition.

Copyright © 2006 by Linda Piette.

About the Author

Linda Piette, MS, RD, is a pediatric nutritionist and registered dietitian with twenty-five years of experience. You can find out more about her at lindapiette.net.