Is it a normal phase or a health concern?

“My child doesn't like eating.'' This is a question that is often asked during medical examinations. Although such concerns are often unwarranted, they are a source of great frustration for parents.

Dr. Marc Belaiche, a pediatrician at the Robert Debray Hospital in Paris, says: French Annual General Medical Conference (JNMG 2024) It was held in Paris last month. His presentation focused on differentiating between parental perceptions, typical childhood behaviors, and feeding problems that require intervention.

When assessing parental concerns, use the Montreal Children's Hospital Feeding Scale for children aged 6 months to 6 years and the Baby Feeding Scale for children under 6 months of age. Tools such as eating behavior questionnaires can help identify and monitor eating problems. If possible, it is also important to observe how your child eats.

Main phases and development

Bereish focused on children under the age of six because they often experience feeding problems during key developmental stages, such as when they are weaned and learning to sit.

The neophobia (interest in new foods) stage usually occurs by 12 months, followed by the neophobia (fear of new foods) stage between 1 and 3 years of age. This neophobia is a normal part of neuropsychological, sensory, and gustatory development and persists when key developmental moments are marked by choking incidents, mealtime stress, or forced feeding. It is possible. “The challenges are different for a difficult 3-year-old and a 6- or 7-year-old who still refuses new foods,” he explained.

Parental pressure and nutritional balance

Balanced nutrition is essential, but “parental pressure is often too high.” Parents are concerned because they consider the food to be a “nutritional supplement.” Dr. Belaish recommended reducing anxiety by keeping mealtimes gentle, allowing children to eat at their own pace, avoiding force-feeding, keeping meals short, and avoiding snacking. “While it is important to remain vigilant and it would be a mistake to think that children will never go hungry, in general practice most cases can be managed with parental guidance, empathy and a positive approach.”

Monitoring the growth and weight curve is very important, and a Kanawati index (ratio of arm circumference to head circumference) of less than 0.31 is a reliable indicator for referral to a specialist. A varied diet is important to maintain nutritional balance. If this is not achieved, continued intake of infant formula after age 3 can prevent iron and calcium deficiencies.

If an eating disorder is documented, health care providers should investigate for underlying organic, gastrointestinal, or extraintestinal conditions (such as neurological, heart, or kidney disease). “It's best not to rush into diagnosing a milk protein allergy,” advises Dr. Bereish. Cases are relatively rare, since unnecessary exclusion of milk can complicate a child's relationship with food. Similarly, gastroesophageal reflux disease must be objectively diagnosed to avoid unnecessary proton pump inhibitor treatment and associated side effects.

Consider evaluation for genetic syndromes in children with low birth weight, mild congenital heart disease, or suspected dysmorphic abnormalities.

Avoidant/Restrictive Food Intake Disorder (ARFID)

ARFID is characterized by a lack of interest in and avoidance of food due to sensory characteristics. ARFID is commonly observed in children with anxiety and is diagnosed in approximately 20% of children with autism spectrum disorder, where food selectivity is prevalent. This condition can stunt the child's growth and may require nutritional support.

Eating Problems Case Profile

Bereish outlined three typical cases of children who are considered “picky eaters.”

• Small eater: Often near the lower end of the growth curve, this child “grazes and does not sit still.” These children are usually active and have a family history of similar eating habits. Parents should encourage psychomotor activity, refrain from snacking outside of mealtimes, offer a variety of foods mezze-style, and consider fun family picnics on the floor.
• Children with a history of trauma: Children with trauma (e.g., intubation, nasogastric tubes, severe vomiting, force-feeding, suffocation) may develop aversions that require behavioral intervention.
• Children with high sensory sensitivities: This child hates getting his hands dirty, avoids putting things in his mouth, and resists certain textures such as grass and sand. A step-by-step behavioral approach using sensory play and visually appealing new foods can be beneficial. Guided self-directed food exploration (baby-led weaning) may also be helpful, but dairy intake is often required at this stage to prevent deficiencies.

Finally, gastroesophageal reflux disease and constipation can also contribute to loss of appetite. Research shows that treating these problems can improve appetite in people who eat little.

This story has been translated from french university We use several editing tools, including AI, as part of the process. A human editor reviewed this content before publication. ”