FEEDING A PICKY EATER

NEW YORK TIMES COLUMN: FAMILIES TODAY:
FEEDING A PICKY EATER
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 3-year-old son is a very picky eater. As we weaned him from baby food and bottles around age 1, he refused to eat anything other than yogurt and crackers. I assumed it was just a transition issue that would sort itself out as he grew older.
He is now almost 4 and refuses even yogurt, sticking only to Cheerios, crackers, apples, applesauce and milk. He takes a daily multivitamin. He continues to grow taller and gain weight at a normal rate.

I’ve encouraged him to try new foods but I haven’t pressured him too much because he can be very determined when he makes a decision. Am I doing the right thing to wait it out?

A. You don’t have much choice. You can’t force a child to eat.

You’re doing the right thing by giving your son a daily multivitamin (be sure it also contains iron), taking him to the pediatrician for regular growth checks – and, hardest of all, not pressuring him too much. We urge you to see if you can make the move to not pressuring him at all.

Why? Every time he senses your attention to what he’s eating, you’re giving him power over you. The power struggle may distract him from the pleasures of eating. Even a little pressure can turn the dinner table into a battlefield. Parental hovering can be counterproductive whether it’s pressure (“just one bite”) or praise (“you tried the broccoli – good job”). Cajoling and bribing may backfire.

Let eating be his issue, not yours. Holding back can be difficult when you fear you may not be fulfilling one of your most important responsibilities as a parent – making sure your child is well fed. Yet you may help him get closer to this goal when you turn it over to him.

Your job is to present him with the food, whether or not he eats it. At each meal, you can add to his standard fare a small amount of a new food he hasn’t tried, just enough so that if you have to throw it away you won’t feel frustrated or discouraged – which he’s bound to notice.

Many children need to be presented with a small amount of the same kind of food at 15 successive meals before they’ll give it a try. Children’s taste buds mature over time. Tastes that bother them at an earlier age are easier for them to accept later.
For some children, specific food textures may be troublesome. So as you pick a new food to introduce, start with ones that aren’t too different in taste and texture from those he likes.

Since milk seems to be his only source of protein, you might try adding protein-rich food to his diet – for example, ground meat, egg, beans or nuts. Perhaps you can spread a teaspoonful on the crackers he likes.

Your other job is to keep mealtimes relaxed and fun. You may need to take a deep breath and accept that your son will only eat what he decides to put in his mouth. Regular checks from a pediatrician can reassure you. A consultation with a nutritionist may help, too.

When mealtimes are sociable rather than stressful, the positive associations of being together and enjoying each other’s company are likely to make the food on his plate seem tastier – but not if he gets even the slightest inkling of your strategy.

(For more information: “Feeding: The Brazelton Way,” by T. Berry Brazelton, M.D., and Joshua Sparrow, M.D. Da Capo Press.)


Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

MULTIVITAMINS AND A BABY

NEW YORK TIMES COLUMN: FAMILIES TODAY:
MULTIVITAMINS AND A BABY
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D

Q. Is it true that a baby’s multivitamin intake should be stopped after age 3 months to prevent vitamin dependency?

A. We all depend on vitamins – molecules by which our bodies carry out chemical reactions that keep us healthy. Ordinarily the necessary vitamins come from a balanced diet and a little sunshine (five to 15 minutes three times a week) to activate vitamin D.

Some diseases and medications interfere with the absorption and metabolism of vitamins. A few rare hereditary diseases also cause vitamin deficiencies, despite a healthy diet; among the potentially affected vitamins are B6, B12 and D.

Children with these diseases may need to take regular supplements of the deficient vitamin to overcome their body’s inability to absorb or metabolize it.

We have never heard about multivitamins’ causing vitamin dependency. Multivitamin supplements aren’t necessary if a child eats a balanced diet. But many children don’t eat such a diet, especially in the first few years, and multivitamins can help them get the vitamins they need.

During the first year or two, iron and vitamin D are likely to be in short supply. In the first weeks of a baby’s life, we recommend that parents discuss iron and vitamin D supplements with their pediatrician.

Although breast milk is the best source of nutrition for babies, breast-fed infants often don’t get enough vitamin D, nor do babies who take in less than a quart a day of formula, which is usually fortified with vitamin D. The American Academy of Pediatrics recommends that infants take in 400 international units of vitamin D per day. Your pediatrician can guide you to the proper dose for your baby.

Depending on a mother’s diet, breast milk may not contain enough iron, though iron in breast milk is better absorbed than the iron in fortified formula. Your pediatrician can also determine your baby’s need for iron supplements.

Inadequate amounts can cause iron-deficiency anemia. During the first years of life, when the brain is growing faster than at any other time, inadequate iron intake has also been linked to learning disabilities that may only become evident later. Paying attention to nutritional needs from the beginning can make a big difference.

Between about 12 and 36 months, many children struggle to control what they eat and often limit their food intake to a few familiar items that may not contain the nutrients they need.

Many children take time to adjust to new tastes and textures. Often a parent may have to introduce a small amount of the same new food up to 15 times before a child will even try it. The process goes more smoothly if a parent simply places the new food on the plate without comment or pressure. Even gentle cajoling leads to more resistance. If you only offer a tiny taste each time, it will be less overwhelming for the child – and a little easier for you to put up with her refusal.

Multivitamins and regular visits to the pediatrician can reassure parents that a child’s growth is on track. Then parents may be less tempted to wage food battles with their children – which parents will surely lose.

There is no way to make a child eat something against her will. Repeated struggles over food are likely to lead to more struggles and perhaps even more serious eating problems later.


Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.