Everyday Feeding problems

Young children are usually determined to show their independence. This can be frustrating for carers. The children want to do things for themselves yet do not have the skills to succeed. Approaches such as letting young children attempt spoon-feeding whilst their carers feed them unobtrusively from other spoons are 'feeding skills' parents and carers develop. Young children are also easily distracted. It is wise to feed them away from active television sets and brothers and sisters at play if the family is not eating together. At family meals young children are likely to be slow eaters. They may eat in 'fits and starts' and continue to eat even when food has gone cold and is no longer palatable to adult tastes. Removing food as soon as a young child stops eating may be inappropriate since stopping eating is sometimes a temporary respite and not a sign that the child has had 'enough.' After a pause, eating may continue. Telling children to 'eat up,' nagging them to 'hurry up', or trying to force them to eat are not helpful and can lead to mealtime defiance, frantic carers, and impaired nutrition. Most parents become skilled at anticipating and forestalling mealtime problems in diverse ways.

If children refuse food at mealtimes or show no intention of finishing their meals, they probably do not need the food. This is particularly likely if they have recently had a snack. Small children are readily sated by amounts of food that seem very small to adults. Snacks should be timed closer to previous meals than to following meals - perhaps 2 h before the next meal. Children who eat poorly at one meal often eat much better at the next meal because by then they are hungry. Offering biscuits or confectionery in exchange for an unfinished meal ('because they have not had enough') is neither helpful nor usually necessary. Children learn very quickly that if they do not eat meals they may get foods that are, to them, more enjoyable. Mealtime organization begins to collapse. However, very young children have slight risk of hypo-glycemia if they go for prolonged periods without food so it is advisable to feed them before bed if they have exhibited persistent food refusal earlier in the day.

The appetites of young children are very variable. Low intakes on one day are usually compensated by excellent intakes on other days. Carers should adopt organized, but relaxed, approaches to meals and eating. Mealtimes should be enjoyable occasions for positive parent-child interaction, not the battles that sometimes develop from parents' understandable anxieties because their children 'don't eat.'

Nutrient needs that are easily met in healthy children may be more difficult to achieve if children are offered, or accept, only a limited variety of foods or have poor appetites because of illness. Vegetarian diets for young children can provide adequate nutrition but some nutritional knowledge is advisable for those managing children on such diets. Plant proteins do not individually contain all the amino acids so mixing of protein sources is important for the provision of the amino acids needed for optimal nutrition and growth. Provided breast-feeding continues, or children take significant amounts of other milk or formula (cows' milk-based or soy-based infant formulas or, after 1 year, neat cows' milk), amino acid requirements can be met from milk or formula and little other protein is needed from plant or animal sources.

WHO recommends that breast-feeding continues as part of a mixed diet into the second year of life. Milk in some form is recommended for young children. It provides a ready source of calcium throughout childhood. Before 1 year of age, European Union (EU) recommendations are for infant formula rather than neat cows' milk. After the first year of life whole cows' milk is appropriate. In the UK National Diet and Nutrition Survey 1992/3, 83% of children aged 1=2-4=2 years were taking some whole cows' milk and for 68% of children this was as a drink. Twenty-six per cent of food energy, on average, came from milk and milk products whereas in the 3 =2-4 =2 years age group this figure was only 16%. In a similar study by Gregory and Lowe, 7- 1 0-year-old children were still consuming, on average, close to 1 l of whole milk a week providing around 12% of total daily energy. Fat-reduced milks should only be used as drinks in children under 5 years if the rest of the diet is varied and 'balanced' with other sources of fat-soluble micronutrients, in which case semi-skimmed milk may be used as a drink from the age of 2 years onwards.

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