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150 5.2 Common Nutritional Problems in Preschool Children
poo’. They will be unable to bring themselves to
eat a food that reminds them of something
disgusting.
●● A liked food may be contaminated with a
disliked food or a food they are wary of. If a
disliked food is touching or even just on the
same plate as food usually eaten all the food,
including the liked foods, may be rejected.
Toddlers who are much slower to grow out of this
phase of food neophobia and eat very selectively
and consequently cause more parental anxiety
include:
●● those who during infancy had little experience
of different food textures and family foods
●● toddlers who, as infants, were mainly fed on
commercial baby foods and who did not eat
many family foods during weaning
●● those fed on a narrow range of foods during
infancy because they were only offered a narrow
range
●● those who were not offered food with lumps by
9 months of age
●● those who were tube-fed for medical reasons.
Some toddlers lack experience of food because they
were not allowed to touch and play with food or to
develop their self-feeding skills. Some parents
prefer to do all the spoon feeding themselves and
do not offer finger foods. Sometimes this is to
minimize mess but it may be because they prefer to
retain full control.
Negative experiences at mealtimes may result
from pain with reflux, coercion and force feeding
or poor interaction with parent or carer. Sometimes
toddlers have had negative experiences around
their mouth during infancy, for example preterm
infants who had tubes inserted in their mouth and
medication via syringe.
Stubborn, strong-willed children are less likely
to copy what parents, siblings and others are
doing.
Occasionally, children have high oral sensitivity,
which may have been noticed when lumpy foods
were first introduced and infants took much longer
to accept them and move onto more complex food
textures. These children may be also be sensitive to
sound, touch or smells. They may dislike getting
their hands and face dirty. It is especially important
that these children are not forced to eat foods that
they dislike as it may lead to vomiting.
Poor oromotor development may or may not be
associated with other developmental delay or
cerebral palsy. These children may prefer puréed
food and may choke or gag on other textures which
make the feeding process uncomfortable or
frightening.
Underlying medical problems, such as
constipation, anaemia, gastro-oesophageal reflux
and delayed gastric emptying, can all cause toddlers
to limit the quantity or type of food they will eat.
Medical treatments to resolve these conditions need
to be implemented before helping parents with other
interventions to change mealtime behaviours.
When young children do not eat as well as
expected, parents can become very anxious. Their
concerns that their child may become
malnourished and not grow and develop normally
may lead to management strategies that exacerbate
the situation. This includes:
●● expecting their child to eat more than is needed
●● having unrealistic expectations of growth rates
which are lower in 1–4 year olds than in infants
●● becoming very anxious at mealtimes
●● mismanaging mealtimes.
Mismanagement of mealtimes can include the
following:
●● Giving frequent drinks of milk or juice: many
young children prefer drinking to eating and
readily fill themselves up with drinks (Smith
and Lifshitz 1994, Houlihane and Rolls 1995).
Useful advice is that drinks should be limited to
water in between meals. Cups should replace
any bottles still being given as this will help to
reduce fluid intake.
●● Frequent snacking: Some children end up
eating most of their food between meals and the
snack food often tends to be high in fat and
sugar. There is often little or no incentive for the
child to eat an appropriate meal if they are
allowed to fill up on confectionery, biscuits and