QUESTION: Dr. my daughter is 3 yrs old and weigh only 10.8 kgs. Although she is an active child .She is very fussy eater.She eats grinded food till date that i feed her by distracting her otherwise she doesnt eat it by herself. She takes lot of time to chew chapati or rice and swallow it slowly.That is the reason i have to give her mashed food, to feed her a decent amount daily.She hardly eats anything on her own /ask for something to eat.
I got her checked multiple times by different doctors but all of them have said that she is a normal active baby.I dont know what to do as giving her a proper diet has become very difficult for me.She doesnt even drink milk (only while she is asleep that to @ 120ml 2 times.
PLEASE SUGGEST SOMETHING...
ANSWER: Hi Sheetal,
Before answering, I would like to ask some questions that you need to answer to yourself, HONESTLY:
1. Why would she need to ask for food if you keep on offering her food before she is hungry?
2. Why would she love food of feeding is a "ritual" for her which appears like "punishment" given several times a day?
3. Why would she chew food, if she gets mashed food just to feed her a "decent" amount as per YOUR expectations and not as per her hunger?
When you answer these questions, you would realize that the problem is not in her, but the way she is being fed. That needs to change.
Her weight is on the lower side of normal range. Hence, although she might be smaller than many children of her age, but is WITHIN NORMAL RANGE. Don't try to push her to higher range, as it would be "overload" on her system. She should gain roughly 1 kg in 6 months. If that is so and she remains active, she is NORMAL, as all of other doctors have rightly said.
Since her weight is less, her requirement is also less. Please don't go overboard in trying to feed her.
First, your duty is just to OFFER her a variety of food (cereals, pulses, fruits, vegetables, milk and daily products, poultry, etc.): But how much to eat and when to eat is HER CHOICE. You have to respect that, if you want her to ask for food and eat herself. Don't ask her about food at least 6-7 hours after her meal. No snacking in between. At most, you can OFFER fruit in between.
Second, she should be taught to chew food. How? Simply by offering her food to eat. This is going to be very very very difficult since she has been on mashed food all these years unfortunately. Research has shown that best time to learn chewing is BEFORE age of 10-11 months. It becomes increasingly difficult to teach chewing after 1 year. Thus, you need to be patient, gradually move from mashed food to semi-formed food and then gradually to normal food. You can take professional help (from occupational therapists and speech therapists) to help her learn.
Third, Please don't go for unnecessary tonics/ appetizers/ supplements. That is NOT going to solve the problem.
Her milk intake is OK. Just try to give that before she goes off to sleep. Taing milkwhile sleep increases chances of dental caries, especially in front teeth.
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India
---------- FOLLOW-UP ----------
QUESTION: Hello Dr. Thanks for the reply.U had been a great help in solving my queries.
But i have tried that thing also.On a doctor's advice ,For 3 days continuously i didnt force feed her but have kept many food items before her so that she eats on her own.But she ate only 2.5 biscuits in @ 3 days.Then i had no option but to feed her mashed food by distracting her.Even when she goes to birthday party or somewhere else she hardly eats anything..
I have few doubts -
1. Is it possible that she is not able to relate hunger with food. Bcoz she gets cranky when i dont feed her,n she doent eat anything by herself.
2. How can she go without food/very little food for 2-3 days.
3. She thinks a lot or take very much time holding any food in her hand before putting it into her mouth.
4. Even if there is a table full of food she hardly picks anything to eat.
Will it be beneficial to send her to day care for 3-4 hours so that she might learn to eat along with other children.I am not able to decide bcoz she goes to playschool for 2 hrs but hardly eat anything there.Also for how long a 3 yr kid go without having food and yet be active .
Thanks for the follow up.
As I informed you in my last reply also, the change over is going to be "very very very difficult", as she has been used to this routine for a very very long time.
You have to persist with it for a few weeks, not just 2 days. Just make her sit when you eat and place a colourful, attractive plate with small pieces of HEALTHY FOOD (bits of roti/idli/fruits etc.), NOT BISCUITS, in front of her...and tell her she just has to sit for sometime with you, parents. Let her PLAY with food. Talk about daytime activities, don't insist too much on food.
Research has shown that meal times should not be more than 30-40 minutes. Beyond this period, her resistance to food will increase. Hence, if she eats and eats slowly, don't attempt beyond this period. TAKE the PLATE AWAY from her sight after this, as sight of food will make her angry. Please note that this 30-40 minutes is just for child who is eating slowly; IN case she has not taken even single bite, don't try for more than 15 minutes in one sitting. Try after at least one hour.
Whether to eat or not depends on the sight (NOT taste) of food: Hence keep changing the presentation of food. Add green vegetables in dough to make it green; on some other day, cut roti in different shapes: triangle, square etc to give it a different look.
She must be learning about names of fruits and vegetables. USE THAT also: Let her be aroound when you buy and cook vegetables. Tell her what you are buying/ cooking/ cutting etc: That would make her SLIGHTLY MORE interested.
Reagrding your question regarding her not relating to hunger and not eating by herself(Q. no. 1), its simply because she has never learned it; she DOESN"T KNOW what is hunger: so she WOULD become cranky when hungry: she might not be able to explain: At that time, do offer something that is healthy, crunchy (so that she chews; You can even FORCE first 1-2 bites, but NEVER whole meal.
How she remains happy without food? Simply as adults loose their hunger/ sleep when they are in love: She LOVES aazadi (freedom) from being asked about food so much that she would be happier when not asked about food: But as you said, she would be cranky after a while when she is hungry, but does not know what to do then: All this she has to learn and it will take weeks to months, not days..
Ya, sending to play school can help as she MIGHT copy other children who are eating. But again, don't expect magical results. Don't expect that she would start eating from day-1. You need to wait for a month at least.
Also get her screened for worm infestation, iron deficiency that might add to the issues and need to be addressed separately but simultaneously with behavioral training, that is most important. Hence do consult a pediatrician in your area again to ask specifically about it.
And as I informed earlier also, if you fail to succeed after at least 3-4 weeks of trying, do take professional help: She might need it.
Bottom line and KEY ingredient would remain: PATIENCE, loads of it.
Feel free to ask for any further clarification.
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India