AN EVIDENCE-BASED GUIDE TO TODDLER NUTRITION FOR HEALTHCARE PROFESSIONALS
Healthcare Professionals play an important part in helping parents of toddlers (1-3 years) understand and navigate fussy eating behaviours.
- While fussy eating is a common problem, it’s also a normal phase for toddlers.
- Although fussy eaters tend to be a lower weight than non-fussy eaters, this phase doesn’t appear to have significant effects on long-term growth.
- It can be a frustrating phase, but there are strategies parents can use to deal with fussy toddlers.
WHAT BEHAVIOURS CHARACTERISE ‘FUSSY EATING’?
In studies fussy eating affects between 8% and 50% of children and toddlers (picky eating during early childhood) 1. There are a number of definitions of fussy eating but it is generally characterised by:
- Eating a limited range of foods.
- Restricting the intake of vegetables, particularly.
- Being unwilling to try new foods.
- Having very strong food preferences2. These can be so strong that parents often prepare a different meal for a fussy eater.
Some experts believe that different aspects of fussy eating may be distinct issues in and of themselves:
Food fear. Neophobia is a fear of new foods. Most toddlers are likely to refuse foods at some stage, but it generally occurs at the end of the second year of life3. Neophobia may be genetically linked. Studies in twins find that food neophobia is more common in identical than fraternal twins3.
More taste buds means more taste. Some people are ‘supertasters’, which means they have more tastebuds than others. To such people, foods have stronger tastes than to everyone else. Sweet foods taste sweeter and bitter foods taste much more bitter. This can lead to children rejecting bitter foods like vegetables where antioxidants like flavonoids, are bitter-flavoured.
Texture problems. Food texture is often an issue. This is most frequently seen where the toddler was not introduced to lumpy and textured food at an early age4.
THE IMPACT OF FUSSY EATING ON HEALTH
Whatever the cause, fussy eating can present a very real difficulty for parents and, if extreme, can result in nutrition deficiencies in some toddlers.
In terms of effects on nutrition and growth, fussy eaters tend to be a lower weight than non-fussy eaters, but there does not appear to be significant effects on growth long-term2. Fussy eaters are twice as likely to be underweight5 and interestingly, show a less vigorous sucking style as infants6.
Fussy eating may also persist into adolescence and adulthood7. One study examining the duration of fussy eating found a prevalence of between 13% and 22% of children with fussy eating, and 40% continued to be fussy eaters for more than two years2.
Parents of fussy eaters report that their children:
- Consume limited varieties of foods.
- Require foods prepared in specific ways. Throw tantrums when denied certain foods.
- Have very strong likes and dislikes for foods.
Clearly, this is a common and very frustrating problem for parents but there are many day-to-day things that can be at the root of fussy eating and can be changed to help. It is not possible to change genetics, but there are strategies parents can try on their fussy toddlers.
QUICK TIP FOR PARENTS
Familiarity and persistence are both key. Don’t worry about the amount they eat when tasting a new food or texture, just ensure they try it!
SEVEN STRATEGIES TO HELP PARENTS WIN THE FUSSY EATING BATTLE
- Keep trying new things. Even toddlers who have a strong genetic trait for food neophobia will eat new foods eventually. Familiarity is key. Babies are much more open to trying new foods than older toddlers, so it is important for parents to introduce babies to as many different foods as possible – including tastes and textures. This means that more foods are familiar to a toddler, and so there are fewer tantrums.
- And keep trying the same new things! When introducing a new food to a toddler, studies show that it takes up to 16 ‘tries’ to get a toddler to try a new food – and sometimes even longer to get them to happily eat it8. Persistence is key. It is not about forcing a toddler to eat a large amount of any food, just about getting them to try even a tiny amount. Once they have tasted it a few times they are much more likely to stop being resistant to it8.
- Spot the signs. Help parents recognise the signals that indicate that their toddler has had enough food9. Toddlers are communicating that they do not want anything more to eat when they1:
- Say no to food being offered.
- Force their mouth shut.
- Turn their head away from the food being offered.
- Cry or shout when the food is presented.
- Fluid intake during the day. A common cause of fussy eating is too much milk (or other drinks) in between meals. Milk is often the main problem as parents of fussy eaters feel that their child is at least getting some good nutrition from their milk so they allow them to drink quite a bit between meals. Look at how much milk a fussy toddler is drinking and reduce it to healthier levels. This is also true of juice or other drinks that have calories. Toddlers can fill up easily on drinks and then refuse their healthy meals. It is a good idea limit drinks just before meals – even up to one hour before meals so toddlers have time to get hungry again. If a toddler insists on a beaker of milk, reducing the amount of milk can be a bit more difficult for the parent. Daytime milk feeds can be removed easiest as the toddler may be out of the house or attending a playgroup1.
QUICK TIP FOR PARENTS
Toddlers need about two beakers of milk a day (of 150-200mls/5-7oz each). Any more than that and they can be too full to eat their meals.
- Fluid intake at night. Removing the evening beaker of milk at bedtime can be more difficult for a toddler. Night-time feeding should be avoided if possible, as this will reduce a toddler’s appetite for food during the day. If a toddler wakes up habitually during the night for a beaker of milk, a parent should reduce the volume of milk offered until the toddler’s appetite has improved.
- Too many snacks? Snacking has become very popular for toddlers, and many parents give their toddlers lots of snacks between meals. This can mean that a toddler is simply not hungry when they get to dinner and so they refuse to eat. A good rule is to limit snacks to two or three snacks per day and not to have any snacks within two hours of the next meal.
QUICK TIP FOR PARENTS
Your toddler’s tummy is little bigger than their fist10. What is a tiny snack to you can really fill them up!
- Dealing with supertasters. For toddlers and adults who are supertasters, mixing bitter foods with sweet foods can help overcome resistance to the new food. Although consumers see sugar as being a very bad addition to the diet, the addition of sucrose can help children to accept bitter flavours in foods like grapefruit, broccoli and cauliflower and widen their palate11. Careful advice needs to be given to parents on using this technique. It is best if toddlers are referred to a qualified dietician for monitoring and advice.
Suitable articles for parents on this topic are available at www.toddlebox.ie/nutrition