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Pediatrics/2 year girl eating problem

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Question
Sir
i am mother of 2 year old(completing on 28th Feb)girl,my problem is that she has no interest in eating any food/taking milk and start coughing(no cold and cough problem checked with ped.)when taking milk or any food,it takes around 1 to 1.5 hr to feed her.My ped has given cypon syrup for 15 days,is it safe to give this syrup or i can give any alternate medicine as you suggest?,please help.

Answer
Hi Jaya,

Cypon is strongly NOT recommended. In fact, this medicine is banned in many countries. I would like to point out that NO medicine can/ should be given to increase appetite. Medicines are only required to correct any deficiency that the doctor suspects.

It is largely a behavioral issue and it takes lot of patience to deal with this. there are no short-cuts.

Following write-up would be of help:

Most toddlers are fussy about food. Why? First, babies grow very fast in first year of life. Growth rate falls after one year of age. Thus, a 3 kg baby at birth would be close to 10 kg (3 times the birth weight) at one year of age; however, he would gain just 2 kg in 2nd and 3rd year. It is natural that their appetite decreases by the time they are one year old. This fall in appetite is Normal.

Second, toddlers have new-found ambulation and are increasingly interested in exploring the surroundings. It is futile to expect them to have "regular" time-table of eating.

Third, this is their stage of development in which they learn to adapt to various conditions of senses of smell and taste...It is futile to expect that they would gulp food as such. It is the time they are going to do all sorts of "experiments" with food rather than eating.

Here are some tips to tackle this "normal" food fussiness:

1.   Choice of food is most important. Milk should not be the main meal. Consider milk just as a supplement -- to be given not more than twice, or at the most, thrice a day. Focus more on solid food. Rather than trying various forms of milk, try different cereals and legumes. At this age, a toddler can eat anything what you cook for everyone else: his diet should just contain some extra fat (oil/butter) and less of spices.

It is often one meal of the day that a toddler eats best (either breakfast or dinner). Utilize this time well and give him enriched diet.


2.   Try to make meals fun. Never make it an “issue” if he is not eating.. that will reinforce his defiance.  One has to go by the toddler's mood and "offer" food frequently, but never, never try to force-feed. The "problem" increases in 3rd year when the toddler has increased sense of independence and is more assertive and definitely has some food-fads by now. Again, offer healthy food frequently, give more food choices (e.g. among cereals) and never force-feed. Trying to force-feeding is the most common cause of a kid developing food-aversion. If he is refusing to have some specific food item (e.g., milk) or at some specific time, just let it be. Leave the plate there and allow him to stare at it. If he gets angry and throws a fit, tell him that this all "mommy" has made for dinner in a calm and relax tone of voice. You'll be surprised that toddlers at this stage mimics every move and action you make. If you yell and scream, he'll yell, scream, and retaliate. The food he is refusing to eat should be removed from his sight not later than 30-40 minutes… and offer something else after sometime.
The best time for a toddler to eat is:  (1). When others (especially other children) are eating; (2). When he is busy in doing something else: Just offer him something and he will eat, so that he doesn’t come to know that he is being fed!!

3.   Avoid distractions while eating: Food should be eaten in  calm environment.

4.    Adopt a neutral attitude towards eating behavior: Avoid excess praise, criticism, stimulation and coercion.

5. Don't feed too frequently: The meals should be almost 3-4 hours apart and avoid snacking in between, unless the toddler asks for something himself. If you give him something to eat before he is hungry: it will suppress his appetite further. Appetite is very essential for optimum intake.

6. Always keep variety in diet. If he likes something and you give it everyday he will obviously get bored. Variety in diet prevents this. If, however, it has happened, the concerned food item should not even be shown to him for 3 weeks. You can again try after 3 weeks.

7.   Encourage independent feeding from an early age. Give him his own utensils: A toddler at 20 months tend to wants to be independent and often loves to feed himself and is often excited to have his colorful plate and starter spoon/ fork. Just let him play with food and eat a little.

8.   Involve him when buying/ cooking food: At 20 months, you should start involving him more when you are buying grocery, fruit and vegetables. Let him choose one or two vegetables and let him observe you when you are cooking (especially the vegetable he had chosen): Utilize his curiosity to encourage him have his meal.

9.   Don’t let him control you: There is no need to ask him what he wants for dinner. You have to maintain your parent figure. If you keep asking him, it will be chaotic in the near future because if you don't give him what he wants, he will throw a tantrum.

10.   Avoid “junk food”: It is a common mistake to replace healthy food with "junk food" (biscuits, pastries, etc.) when the child is not "eating well". A common dictum to remember is that what you offer is your choice, but when and how much to eat should be left to the child. Many parents argue that this way, he would not eat anything.. I always reassure that this is not the case, just try it!!... A toddler will never starve himself when access to food is assured.

11.   Do remember that there is no benefit of unnecessary supplements: Another common mistake is to load the child with supplements when the child is not "feeding well". This just gives a false sense of security, and may deter parents from real focus on child's nutrition. "Supplements are "supplements" and should never replace food. Which supplement is required depends more on your child's need. For example, if there are signs of iron deficiency, he may need iron supplementation.



Best wishes,
Dr. Puneet Kumar,
Kumar Child Clinic, Dwarka,
New Delhi, India

www.KumarChildClinic.com

+91-9818356846

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Dr. Puneet Kumar

Expertise

I would be happy to answer general queries on prevention and treatment of ailments in newborn, infant, toddler, child or an adolescent. Needless to say, it will not be possible to answer any query requiring specific diagnosis of a particular subject.

Experience

I have worked in various capacities (medical officer, resident, senior resident, consultant) in public as well as private sector in Pediatrics and Neonatology. Today, I have over 15 years of experience in the field.

Organizations
Currently, I am running my own clinic (Kumar Child Clinic) in Dwarka, New Delhi and am attached to Lifeline Hospital, Dwarka as consultant pediatrics and neonatology. I am also developing my clinic website into a comprehensive child health/ parenting website (http://www.kumarchildclinic.com)

Publications
(a) Chapter "National Immunization Schedule" in Frontiers of Social Pediatrics, Jaypee Publishers: 2nd edition, 2016. (b) Article, "All about Pertussis vaccines" in special issue of Indian Journal of Practical Pediatrics, July-Sept 2015 (c) Three chapters (DTP vaccines, Pneumococcal vaccines and Poliovirus vaccines) in "Textbook of Pediatrics for Post-graduates" First edition: 2015. (c) Chapter: "Alternative delivery methods of vaccines" in IAP textbook of Vaccines, First edition, 2014 (published by IAP/ Jaypee Brothers) (d) Special Article: "50 years of Immunization in India: Progress and Future" in January 2013 issue of Indian Pediatrics (e) Four chapters in "FAQ: Book on Vaccines and Immunization Practices" First edition, 2011 AND 2nd edition, 2015 published by Jaypee Brothers. (f) Three articles in special issue of Journal of Pediatric Sciences on “Controversies and Challenges in Pediatric Vaccination Today" in Sept, 2010. Co-edited the series also. http://www.pediatricsciences.com/issue/view/1050000010 (f) Regular column, “How do I treat” in Pediascene (www.pediascene.com) (g) Review article, “Role of Anti-Poliovirus Agents in Polio eradication and beyond” in Polio Pulse, April, 2008. (h) Chapter on “Acute Infectious Diarrhea” in Textbook of Infectious Diseases in Children. (An IAP Publication), 2007. 2nd edition in 2011. (i) Book-Review (IAP Pediatric Drug Formulary, 2004) in Pediascene, March 2005 (http://www.pediascene.com/page.php?cid=6&catid=9&id=132 ) (j) Case-report on Osteopetrosis. Jharkhand Journal of Pediatrics, Dec-2002.

Education/Credentials
After MBBS, I have done DNB residency in Pediatrics.

Awards and Honors
Winner of IAP practising pediatrician's quiz in 2001.

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