2. •
•
•
•
Healthy Eaters
No h/o Food Intolerance
Normal Weight and Height
No parental concern about
child’s eating
No psychological and
behavioural factors

3. Eating Problems
•
•
•
Food refusal
Poor appetite
Inappropriate food
for age
• Extreme or very
limited food choices
• Poor table
behaviour

4. Picky Eaters
••
••
••
Some have past h/o. organic difficulties
Some have past h/o. organic difficulties
Have psychological based feeding problem
Have psychological based feeding problem
Failure to Thrive
Failure to Thrive

5. You
know!
My son
hardly
takes
four
gulps at
lunch.
Picky Eaters
Oh!
My
son
Eats
only
two
gulps.

6. Eating Problems
• Failure to thrive
• Developmentally
delayed
• Infantile anorexia
• Picky eaters

7. Picky Eating
Definition:
Food refusal of the
child for at least one
month that may
involve all or certain
types of foods.

8. Doctor’s Role
Solve our
problem,
Pl.

9. Picky Eaters
• What was wrong?
• Why were these kids such picky eaters?

10. Doctor’s Goals
• Identification and
management of eating
problems in childhood.
• Appropriate management
strategy.
• Provide opportunities for
early detection.
• For suggestions about
prevention and treatment
of eating problems.

11. NO
NO
NO
NO
NO
….if someone yells “no” daily at your dinner
table, you’re not alone.

12. Why toddlers are picky
Being a picky eater is part of what it means
to be a toddler.
(Between 1 and 3yrs).
• After a year of rapid growth, toddlers
gain weight more slowly. So,they need
less food.
• The fact that these little ones are
always on the go also affects their
eating patterns. They don't sit still for
anything, even food.
• Snacking their way through the day is
more compatible with these busy
explorers' lifestyle than sitting down to
a full-fledged feast.

13. Battle for Control
• Children fight with
parents for control during
mealtime
• Conflict can develop
around:
– What the child will eat
– How much they will eat
– Where they will eat it.
Parenting styles may interfere with self-regulation of children’s
feeding behaviour.

14. If you don’t eat …..
.. I
wo
tal n’
yo k to t
u!
gi ve
.. I
you
good !
g
atin
be
.. I take you
to Doctor
and get you
an Injection

15. Child’s Response
Parental Response
– Highly
controlling
– Laissez faire
– Responsible

16. Medical Assessment
• Clinical history: Exclude
organic and severe
psychological problems
• Physical examination
• Laboratory profile
• Treat and monitor medical
problems
Often a combined medical and dietary approach to the
management of constipation can be beneficial.

17. Treatment Options
• Behavioural
interventions
• Mealtime
suggestions
• Oral supplements

18. Mealtime Suggestions
for Parents
• Make meals a pleasant family time
• Eat as a family at the earliest age possible
• Serve the nonpreferred or new foods -frequently
encourage tasting new foods
• “Neophobia” – Children are vary of new foods.
• Familiarity promotes shifts in food preferences

19. Toddlers from one to three years need
between 1,000 and 1,300 calories a day, yet
they may not eat this amount every day.
Toddlers
like to binge
on one food
at a time.
They may
eat only
fruits one
day, and
vegetables
the next.
Expect your
child to eat
well one
day and eat
practically
nothing the
next.
Aim for a nutritionally-balanced week,
not a balanced day.

20. Tactics for Parents
To tempt little
taste buds
&
minimize
mealtime
hassles.

21. 1. Offer a nibble tray
Toddlers like to graze their way through
a variety of foods, so why not offer them a
customized smorgasbord?
Use an ice-cube tray, a
muffin tin, or a
compartmentalized
dish, and put bite-size
portions of colorful
and nutritious foods in
each section.
Call these finger foods
playful names that a
two-year-old can
appreciate

22. 2. Dip it
Young children
think that
immersing foods
in a tasty dip is
pure fun
(and delightfully messy).
Some possibilities to dip into:
Cottage cheese, fruit juice-sweetened
preserves, pureed fruits or vegetables, yogurt,
plain or sweetened with juice concentrate.

23. 3. Spread it
Toddlers like
spreading,
or more
accurately,
smearing.
Show them how to use a table knife to spread
cheese, peanut butter, and fruit concentrate
onto crackers, toast, or rice cakes.

24. 4. Top it
Toddlers
are into
toppings.
Putting nutritious, familiar favorites on
top of new and less-desirable foods is a
way to broaden the finicky toddler's
menu
Favorite toppings are yogurt, cream
cheese, melted cheese,tomato sauce,
applesauce, and peanut butter.

25. 5. Drink it
If your youngster would
rather drink than eat,
don't despair
Make a smoothie – together.
Milk and fruit – along with
supplements such as juice, egg
powder, wheat germ, yogurt,
honey, and peanut butter –
can be the basis of very healthy
meals.
So what if they are consumed through a straw?
One note of caution: Avoid any drinks with raw eggs
or you'll risk salmonella poisoning.

26. 6. Cut it up
How much a child will eat often depends on
how you cut it.
Cut sandwiches, pancakes, waffles, and pizza into
various shapes using cookie cutters.

27. 7. Package it
Our kids enjoy the unexpected and fanciful when it comes to
serving dishes – anything from plastic measuring cups to
ice-cream cones.

28. 8. Become a veggie vendor
"Doctor, he won't eat his vegetables"
So if you aren't the proud parent of a veggie lover, try
the following tricks
•Plant a garden with your child.
•Slip grated or diced vegetables
into favorite foods
•Use vegetables as finger foods
and dip them in a favorite sauce or
dip.
•Concoct creative camouflages.
•Cut the vegetables into
interesting shapes (Make veggie
art).

29. 9. Share it
If your child is going
through a picky-eater
stage, invite over a
friend who is the
same age or slightly
older whom you
know “likes to eat.”
Your child will
catch on. Group
feeding lets the
other kids set
the example.

30. 10. Respect tiny tummies
Dole out small
portions at first
and refill the
plate when your
child asks for
more.
This less-is-more meal plan is not only more
successful with picky eaters, it also has the
added benefit of stabilizing blood-sugar
levels, which in turn minimizes mood
swings.

31. 11. Make it accessible
Give your toddler shelf space.
Reserve a low shelf in
the refrigerator for a
variety of your
toddler's favorite
(nutritious) foods and
drinks.
This tactic also enables
children to eat when
they are hungry, an
important step in
acquiring a healthy
attitude about food.

32. 12. Use sit-still strategies
One reason why toddlers
don't like to sit still at the
family table is that their
feet dangle. Try sitting on
a stool while eating.
Children are likely to sit and
eat longer at a child-size
table and chair where
their feet touch the
ground.

33. 13. Turn meals upside down.
The distinctions between
breakfast, lunch, and
dinner have little meaning
to a child.
If your youngster insists on
eating pizza in the morning
or fruit and cereal in the
evening, go with it – better
than her not eating at all.
This is not to say that you
should become a short-order
cook, filling lots of special
requests,
but why not let your toddler
set the menu sometimes?

34. 14. Let them cook.
Let your child help
prepare the food.
Use cookie cutters to
create edible designs
out of foods.
Give your assistant
such jobs as tearing
and washing lettuce,
scrubbing potatoes,
or stirring batter.

35. 15. Make every calorie count.
Offer your child foods that pack lots of nutrition into
small doses.
Nutrient-dense foods
that most children
are willing to eat
include:
•Pasta,Brown rice
and other grains,
Potatoes,Cheese,
Poultry, Eggs,
Squash, Fish, Sweet
potatoes, Kidney
beans,Yogurt, etc.

36. 16. Count on inconsistency
What and how much they are willing to eat may vary daily.
Don't be surprised if
•your child eats a
heaping plateful of
food one day and
practically nothing
the next,
•adores spinach on
Tuesday and refuses
it on Thursday
• wants to feed
herself at one meal
and be totally
catered to at
another.
"The only thing consistent about toddler feeding is
inconsistency."

37. 17. Relax
"Try to make mealtime a really relaxed atmosphere talking about
the day. Don't bribe and reward your child with things like 'eat your
peas and you'll get your desert'.
- Breton
•
•
•
•
It's not easy to reason with
an opinionated two-yearold.
Better to learn to make the
sandwich the child's way.
Don't interpret this as being
stubborn. Toddlers have a
mindset about the order of
things in their world.
Any alternative is
unacceptable.
This is a passing
stage.

38. Golden Rules
No child has ever died of starvation when
presented with an array of healthy food choices.
Kids often simply
don't want to be
bothered with having
to eat. For them, meal
times often represent an
unwelcome interruption in
their playtime.
When children are truly
hungry, they will eat.

39. Golden Rules
Enforcing meal times and/or requiring kids to
eat a certain amount of food at mealtimes only
serves to frustrate both child and adult, and can
also lead to the development of life-long eating
disorders.
Children come to associate food with conflict,
and may turn down an offering of their favorite
foods just to avoid this situation
• DON'T force kids to eat. Instead, offer children
the opportunity to sample a variety of healthy
food choices at all meal times.
• Don't expect a complete turn-around over night.
• Don't expect your kids to like every new recipe
the first time they try it.
• Don't give up!

40. Why Children Should Grow Healthy?
• Child under-nutrition or failure off children to
grow properly in early childhood ,, results in greatly
increased child mortality..
• At more than 3000 infants a day,, the death toll
from under-nutrition by far exceeds even the
Tsunami or Bhuj..
• Those children that survive do so with a greatly
reduced capacity to lead productive and healthy
lives..

41. Causes of Infant Mortality
Malnutrition 55%
S
I
L
E
N
T
K
I
L
L
E
R

43. Danger of Picky Eating
• Prolonged
eating
problems can
seriously
affect a
child’s
growth and
development
Role of Oral Supplements

44. Role of Supplements
For any child, it is important to get some food from each
of the food pyramid groups every day. That's because,
for the most part, nutrients aren't shared between
them.

45. Pickiness is a
Challenge
Yes,
but one that is
worth meeting.