Approximately 25 percent of otherwise normally developing young children experience feeding difficulties. These may not only be disruptive to the child's physical and emotional development, they also may affect the whole family. In When Your Child Won't Eat or Eats Too Much, author Dr. Irene Chatoor teaches parents how to navigate the challenges of early feeding development and help their children establish healthy eating habits. Based on clinical experiences and research studies, Chatoor helps you understand your child's specific feeding problems-whether your child has difficulty feeling hunger, has difficulty determining fullness, refuses to eat certain foods, or is just plain scared to eat. When Your Child Won't Eat or Eats Too Much presents specific suggestions and practical tips on how to understand and manage each of these feeding problems while promoting a healthy eating environment for the whole family. It also describes how feeding difficulties can be prevented and how discipline can be established without resorting to coercive measures. Chatoor, a pediatric psychiatrist who has made fundamental contributions in her field, helps parents better understand and deal with the challenges of early feeding development and the special feeding issues of their children.

When Your Child Won't Eat or Eats Too Much

A Parents' Guide for the Prevention and Treatment of Feeding Problems in Young ChildrenBy Irene Chatoor

iUniverse, Inc.

Copyright © 2012 Irene Chatoor, MD
All right reserved.
ISBN: 978-1-4759-1245-6

Contents

Foreword.................................................................................................xiAcknowledgments..........................................................................................xiiiIntroduction.............................................................................................xvHow to Use This Book.....................................................................................xixChapter 1 The Challenges of Early Feeding Development....................................................1Chapter 2 Facilitating Healthy Eating Habits.............................................................14Chapter 3 The Two-Year-Old Executive in the Family.......................................................26Chapter 4 The Child Who Rarely Shows Signs of Hunger: Infantile Anorexia.................................40Chapter 5 Selective Eaters...............................................................................58Chapter 6 The Child Who Is Afraid to Eat: A Posttraumatic Feeding or Eating Disorder.....................96Chapter 7 Children Who Have More than One Feeding Disorder...............................................107Chapter 8 Children Who Eat Too Much......................................................................116Chapter 9 Get Everybody on Board!........................................................................135References...............................................................................................143

Chapter One

The Challenges of Early Feeding Development

During the first few years of life, infants and young children have to learn to transition from drinking milk only to eating solid food. They also have to learn to feed themselves and to recognize signals within their body, such as when they are hungry or full. Additionally, they have to learn how to deal with their emotions.

Whereas for most young children these early developmental functions seem to evolve without problems, others have more difficulty in mastering these new experiences. Actually, 25 to 50 percent of parents of young children report encountering difficulties feeding their children.

The Introduction of Solid Food

In general, pediatricians recommend that parents gradually introduce their infants to baby cereal around six months of age and then add baby purees, fruits, and vegetables to the infant's diet. By the age of ten months, many infants are introduced to the thickened type of purees with a meaty taste and with lumps in it. This transition to baby foods can become a very challenging experience for some infants and their parents.

It is generally recommended that parents introduce only one new baby food at a time and wait for a few days or a week before starting to expose the infant to another type of food. This will allow you to observe whether your infant has any allergic reaction to the new food, such as a rash or loose stools, but it will also allow your infant to get used to the new taste of the food. Some infants may be cautious with new tastes and textures of baby foods. They may not like some types of baby purees on first exposure and not open their mouths for the second spoon filled with the new food, but the next time, they may be willing to take the new food again and gradually get used to it and even like it. It may take up to ten or more exposures on different days until your infant begins to like the new food.

However, there are some infants who are very sensitive to the taste, texture, temperature, or smell of certain foods, and they may experience strong aversive reactions when first exposed to certain foods. If your infant grimaces and turns her face away from the spoon, you may try the food at another time in a small amount and follow it with one of your infant's favorite foods. Gradually, you can increase the amount of the new food until your infant can tolerate it without grimacing. Eventually, after several exposures, your infant may even like the new food.

On the other hand, if your infant spits out the food, gags on it, or even vomits, I recommend that you do not offer that food again. In my experience, young infants seem to retain feeling memories, and they become scared when they see the food again or any other food that reminds them of it. Infants and young children seem to generalize by the color or appearance of the food. If your infant had an aversive reaction to a green vegetable puree, she may not want to eat any more green foods.

Some infants are especially sensitive to the texture of food and show strong reactions, such as gagging and vomiting, when you introduce them to purees with lumps of other food mixed in it. I have seen so many young children whose feeding disorders started with the introduction of these mixed-texture baby foods that I strongly recommend that you skip them altogether and advance your child to soft table foods if your child has any aversive reaction such as gagging or vomiting.

The Transition to Self-Feeding

Variations in temperament and culture

In the first year of life, infants and parents learn to establish a mutual communication system by which the parents learn to read their infants' signals of hunger and fullness and feed the infants accordingly. As early as eight to nine months of age, infants become more competent. They learn to sit up independently and begin to use the pincer grasp to pick up little things with their thumb and index finger. At this age, many become interested in the feeding process. They may grab the spoon and other feeding utensils, play with them, throw them, and generally get in the way of the parents' feeding efforts. This is the beginning of a challenging period when during each meal, parent and child need to negotiate who is going to place the spoon into the child's mouth.

During this transition to self-feeding, I have seen big variations among individual children and among parents from different cultures. In the North American culture, most children are transitioned to self-feeding between nine and eighteen months of age. However, there are strong individual differences among children with different temperaments. There are those who grab the spoon at nine months of age and refuse to open their little mouths when their mothers try to feed them, and there are those who still like to be fed when they are two years of age or older.

The following is an example of a child who insisted on feeding herself early, at only nine months of age, and how her mother dealt with it.

A friend and colleague of mine brought in a videotape of her nine-month-old daughter who screamed at the top of her lungs when her mother approached her with the spoon, and my friend said to me, "You would think that I had a weapon in my hand, the way she screams." She told me that it was impossible for her to continue feeding her daughter with the spoon because her nine-month-old wanted to do it herself. My friend gave her daughter finger food and bottles with milk while she practiced holding the spoon in a way she could get some of the purees in her mouth. It took three months before her daughter was able to manipulate the spoon successfully. During this time, her daughter did not gain any weight. However, once she was able to feed herself successfully, her growth picked up and...