Feeding Problems in Children

                                                                Author: Worawan Jongsangawittayalert
 Feeding for children aimed to give them sufficient nutrients for their growth and brain development. Babies cannot help themselves with food, hence; they need to depend on the caretakers until they learn how to eat once grow up. The importance of feeding in kids is not only to concern with the nutrition intake, but also the relationship among family members during meals. 
Feeding problems that often found in Thailand are food pickiness, food refusal, lack of appetite, keeping food in the mouth, slow eating, etc. These problems deeply rooted in Thailand due to the lack of understanding in children’s development and their eating habits. Nowadays, these problems have intensified causing stress to both parents and children. If parents can’t solve problem, they’ll become more severe and could possibly lead to a relationship problem or other behavior problems. Thus, good prevention and early intervention should be in place.
Prevalence
 Feeding problems in children are common. The incidence rate in normal children and children with developmental delay is ranging from 20-50 percent to 70-89 percent, but the incidence varies depend on the sample population and definitions of feeding problems.
Development of Eating in Children
 Parents should understand about the development of eating in children at different ages and how to train a good eating habit for their child. Eating development in children is associated with both physical and social development of each age range as shown in Table 1, children age 12-36 months start to eat food with different textures, also have effective chewing and drinking water from a glass. After 36 months, they will eat solid food and drinking water like adults. Parents have a role in determining the rules for eating, for instance, when to eat, where and how much time to take for a meal, the amount of food required for their child. Feeding recommendations for parents are displayed in Table 2.

Table 2:  Feeding recommendations for parents

Prevention of Feeding Problems in Children
 Feeding problems in childhood can be prevented by practicing healthy eating habits in early childhood.  Train children to have eating disciplines, help themselves gradually against their age and to be responsible for feeding themselves which can also lead to responsibilities in other areas. Finney (1986) has provided a guide for parents to practice eating disciplines for their children. It can be introduced to the children aged 15-18 months as follows.
1) Arrange mealtime for all family members to spend a meal time together and do not turn on a television during meals.
2) Set appropriate time to eat, not more than 30 minutes.
3) Establish dining rules for children to follow such as sitting on a chair until finish eating, taking food by spoon, no spitting food, etc.
4) Tell children to be aware of rules in a gentle voice every time until they are able to follow them consistently.
5) Take a suitable amount of food for each child. Do not force them to eat up the whole dish.
6) Allow children to participate in topics of discussions during mealtimes. Appreciate the good things they have done. Be careful not to rebuke or reprimand them while eating.
7) Praise them when they can follow the rules set forth.
8) When a child does not follow the rules, remind him about the rules. But if he is doing against regulations for the 3rd time, leave him alone without paying attention to for a moment.
9) When the mealtime is over, keep a table without any concern that a child eats it up or not. No need to say anything else, except saying that the time is over.
10) If children do not eat out, no foods or snacks but water is served prior to the next meal.
11) Even if the child is eating normally, not too many snacks should be set. Snacks for children should have nutritional facts. Too much of snacks may cause poor appetite for food in children.
12) If children can follow the rules well, there is not necessary to tell them the rules anymore. But the best way to review or make sure that they do not forget the rules is consistent compliments when the children follow the rules.

Factors associated with feeding problems in children

Common Feeding problems and management
1. Food Refusal
 This feeding problem is most common in children before the age of 1 year and is clearly visible in the second year when a child is developing a style of his own by showing resistance to adults and less attention to feeding. As a result, he will eat slowly, chew slowly or keep food in his mouth for a long time, refusing to eat, crying, spitting or vomiting. Most children with these problems will have normal weight and height. And when being asked about their history it is found that they have received an adequate amount of foods each day.  If their growth below a standard scale or getting a smaller amount of foods than usual, doctor’s visit should be made to determine physical causes.
 Management
1. Parents should train their children to be responsible for self feeding. Do not be too anxious about their eating habits. But parents have the duty to provide foods and discipline them according to the feeding guides given.
2. Parents must be patient and take serious and regular practices.
3. Get children involved with food preparation.
4. Feed a child with a small amount of foods. Admire him if he can finish it. Avoid blaming him when he cannot eat out.
5. Multivitamin supplements may be provided for children who weigh less than normal or parents are concerned that children are malnourished. Nevertheless, do not use drugs to stimulate appetite.
2.  Food picking
 This problem is common in children with normal growth but choose not to eat certain food that parents feel they should take such as vegetables. 
Management
1. Avoid forcing children to eat since it will not work then. It may also entirely make children hate that kind of food.
2. Should get them trained to gradually familiarize with foods by preparing foods in various forms or frequently place that food on the table. Then persuade children to gradually try without forcing.
3. Adults should behave as a good model by eating food with the attitude that shows favor.
4. Multivitamin supplements may be provided for children if parents are concerned.
 According to all of the contents mentioned above, it is found that feeding problems are common in children. Moreover, prevention and management to such problem require understanding of the child development together with training their good eating habits. Children’s good eating habits will help them grow according to their age, caregivers have confident to feed their child and further a good relationship with them.

References
1. Witharn Boonyasit. Eating Problems in Children. Psychiatric Textbook for Children (Revised Version), BE2538: p104-109
2. Barnchuen Suwanthep. Feeding Development for Children. Child Developmental and Behavioral Textbook, Vol. 3, BE2556: p139-155
3. Nida Limsuwan. Eating Problems in Children. http.//www.ramamental.com/non/ Eating Problems in Children