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Extreme fussy eating in children

In this video, accredited dietician Inger Neylon discusses fussy eating in infants, what causes it and practical strategies for addressing it.
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INGER NEYLON: Growing babies learn many things across their first year of life. Learning to eat is a big thing. Hello, I’m Inger Neylon. I’m an accredited practicing dietitian and fussy eating specialist. The learning process for a baby moving from their liquid diet of milk to purees to lumpy food is easy for some babies, but a struggle for others. In addition to getting used to many changes in textures, babies will also be exposed to all the other sensory elements of eating– what it looks like, how it feels to touch, the smell, the taste, and finally the noise it makes when they chew.
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Learning to accept the new food, but to also like all the sensory elements requires lots of patience and practise. Many babies begin eating enthusiastically. Over the early months, many parents will begin to feel that their baby or child becomes less willing to try new foods. This is commonly termed fussy eating. Most children go through a stage of fussiness around trying new foods. And for most children, this can usually be overcome with repeatedly offering family foods in a positive and calm environment. For a small group of children, food refusal is persistent, and becomes highly restrictive in nature. For example, a child may progressively limit their intake to only white foods, such as white bread, potatoes, and plain rice.
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This extreme fussy eating may be due to an underlying physical or neurological issue. If the underlying cause of food refusal is not addressed by a professional, over time food fussiness can get worse as the negative association attached with meal times and with food increases. There can be a number of underlying issues that may lead a child to present as an extremely fussy eater. Both sensory and mechanical issues need to be considered. As discussed previously, the task of trying a new food involves all of our sensory skills. Children with sensory processing difficulties can find any of these sensory elements an obstacle when it comes to new foods.
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To overcome this, it is important to help babies and children feel safe to explore the sensory elements of new foods. One therapeutic approach found to be effective is a gradual and repeated step-by-step process of exposing the child to new food. The steps would be to first get the child to look at it, hold it, then smell it, lick it, and finally, taste it. This process could be done all in one sitting or could take weeks depending on the child. In addition to sensory considerations, we also need to be aware that children need a set of mechanical or motor skills for safe eating. The absence or delay in development of these motor skills can interfere with eating.
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For example, if a child lacks jaw strength or stability to chew foods, then they may refuse meats and vegetables and only consume foods that can be sucked and dissolved in their mouth such as breads and crackers. Other causes of oral feeding problems may include premature birth, developmental issues, and cerebral palsy. It’s important to remember that some fussiness will not automatically subside as a child ages, and professional assistance may be required. Studies show that the longer fussy eating persists, the greater the food struggle becomes. If this becomes your experience, keep in mind that every child is different, and some children will respond to treatment faster than others.

For some children, fussy eating is a persistent struggle that can lead to health concerns for parents and carers.

Understanding the reasons behind the fussiness and when to seek professional advice are key to maintaining optimal nutrition, health and happiness for both child and family.

Extreme fussy eating is often a behavioural expression of something that is going on behind the scenes, making eating and trying new foods uncomfortable for the child.

Causes of fussy eating

While approaches for treating fussy eating are often the same, understanding the underlying cause for this behaviour is imperative for parents, carers and professionals.

This means empathising with the child and trying to understand what they’re experiencing and why. For example:

  • was there a traumatic gagging experience that led the child to only eat smooth textures?
  • is there too much background noise that may be creating too much sensory stimulation and quietness is needed for the child at mealtimes?
  • is the child experiencing anxiety related to food when pressured to eat?

When to seek professional support

Extreme fussy eating in babies and very young children can be distressing for parents. It’s also difficult for them to know what normal fussiness is and when to seek professional support.

If parents demonstrate significant anxiety despite initial advice from their general healthcare provider, speciality services should be sought to explore the underlying cause and what the most effective treatment might be.

These services may include support from a mix of paediatric dietitians, psychologists, feeding clinics, gastroenterologists, and occupational, speech or language therapists.

A referral is especially important for children who:

  • fail to meet appropriate nutritional or energy requirements
  • follow a limited diet, such as in the treatment of allergies
  • have a chronic disease such as cystic fibrosis or diabetes
  • have parents who demonstrate high levels of distress around food
  • have a sensory processing related problem (see below).

According to Thompson et al (2009), feeding-related problems due to possible sensory processing preferences may be indicated by the following:

Inadequate eating, eg:

    • repeated food refusal
    • not swallowing food
    • the tendency for regurgitation, choking, retching or coughing
    • accepting only minimal amounts of food
    • intensely limited range of food, including difficulty advancing to solids
    • limited movement of food around the mouth as the infant develops.

Difficult mealtimes, eg:

      • excessively lengthy feeding periods (eg 30–45 minutes)
      • problem behaviour, such as screaming or throwing food
      • the expression of extreme distress at mealtimes.

Inadequate weight gain due to lack of nutrition.

In this video, Inger Neylon, a family dietitian, outlines some of the underlying causes that can manifest in extreme fussy eating and food refusal, and why – for some children – professional support is needed to address this.

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Infant Nutrition: from Breastfeeding to Baby's First Solids

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