At 19 months old, Gavin’s eating habits are still somewhat questionable and recently, I’ve been receiving some heat for it.  Although he is a healthy weight and growing well, there is still a lot of concern about the fact that he doesn’t seem as interested in food as other children his age.  Let me qualify that - other children we know who are his age.

As I’ve said before, in a Chinese family, food is love - we live to eat.  The idea that a child does not like to eat deals a crushing blow and strikes fear in the heart of all those who love him.  So naturally, there are a number of people up in arms over Gavin’s lack of interest in food.  In fact, this has been a persisting issue since he started solids at six months.

Quite honestly, I feel I have tried everything I can think of.  I have also read quite extensively on toddlers who won’t eat and the advice is the same everywhere - keep offering food and try to relax.  The more anxious you are about your toddler not eating, the more likely he is to continue this pattern.  It has taken me a while to relax and just when I have started to accept my son’s eating habits, I have been accused of not trying to correct his behaviour or researching how this might be done.

I really don’t know what else I can do to encourage Gavin to eat besides forcing his mouth open and shoveling food in there and for obvious reasons, I won’t do that.  Neither will I resort to threatening him to eat.  I have heard of a mother who spanks her daughter with a cane if she refuses to eat - and I fail to see the logic behind that.  She’s just increasing the negative association that her daughter has with food.

So let’s break it down and take a look at the problem:

Gavin is 19 months old and he has eight teeth.  I’ve noticed that he tends to go off food especially when he’s sick or when he’s teething.  Since he still has quite a number of teeth to erupt, I guess it’s safe to say that the eating patterns aren’t going to improve on their own in the near future.

The times when he’s eaten well, the foods he ate were - cheese, bread, cereals, biscuits, noodles, ice cream, hot chocolate, soup, congee and rice.  However, none of these foods have consistently been a real hit with Gavin except the hot chocolate and the ice cream.  The fact that he eats ice cream with such gusto suggests to me that he doesn’t have a problem with eating but that he is just very selective about his food choices (not unlike someone we all know).  It’s just unfortunate that ice cream is hardly a staple food that we can offer him on a regular basis.

We have also noticed that Gavin eats a lot better when he is in the company of other children.  Perhaps it is the influence, perhaps it is the fear that all his food will be eaten, he seems to be more interested to eat when his friends are eating.  Aside from encouraging more outings with friends with kids, there’s probably not much else we can do about this until Gavin gets another sibling.

Other reasons for not wanting to eat - snacking too much, or consuming too much fluids.  I’ve noticed that we tend to feed him a snack after his afternoon nap - anywhere between 4pm to 5pm.  It may be a biscuit, it may be bits of bah kwa (dried sweet meat) and it can be with juice or chocolate milk.  Perhaps in our concern to make sure he eats, we have developed a habit of giving him too many snacks.  One way to keep track of how much he’s eating is to keep a food diary.

Sure, sometimes it isn’t the snacks.  Sometimes he just doesn’t like what’s offered at dinner and chooses not to eat.  So maybe what we need to do is have a consistent back-up to feed him in the event that he doesn’t like what is served at dinner.  And maybe what we need to do is take better note of the foods that he does enjoy eating and make sure we cook them more often?

You might have noticed that I have used the term “selective feeder” instead of “fussy eater” to give it a more positive spin.  They say that negative labels tend to be a self-fulfilling prophecy, such as calling a child naughty, so I’ve decided to remove this one by referring to my son as a “selective feeder”.  He’s not picky, he just knows what he wants.

If you have any other suggestions at all on feeding a selective feeder, feel free to post them in the comments below. 

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For some parents, feeding time is a breeze.  Their babies love the highchair and they eagerly open their mouths for the next mouthful.  It’s such a joy to see such babies eating.  Regrettably, though Gavin began his solid eating experience with great promise, he now displays none of the signs of being such a baby.  Feeding time requires a lot of patience, understanding and ingenuity on my part.

Although Gavin’s waning interest in food has been around for a couple of weeks now, in over the last few days, it appeared to be getting from bad to worse.  When you throw in a couple of anxious grandparents in a Chinese household, you have a recipe for disaster.

If you’re Chinese, you’ll know that the fundamental belief of the older generation is that food is love and that fat children are happy children.  Trying to convince the grandparents that it’s okay for your infant to reject food on occasion is like talking to a brick wall.  They will have all manner of suggestions for you to try on how to get baby to eat better - unfortunately, not all of which, you will approve of.  If you can’t get baby out of his food ambivalence phase and eating with relish soon, the pressure increases.

It is a catch 22 really.  Babies are very emotional beings and they can sense when something is up.  They can even read your attempt at a nonchalant expression when dishing out a new food for them to try out and realise that something is up.  Of course, the more times baby rejects what’s on the spoon, the more anxious everyone gets, the more baby senses something is really wrong leading to more food rejection and well, you know where that’s heading…

What concerns me is that all this pressure to eat is creating an unhealthy attitude towards food for Gavin.  Reading advice on feeding infants and toddlers from Askdrsears, Sears also advises that: 

Pressure tactics make feeding harder, not easier. Don’t force-feed food, as this could create long-term unhealthy attitudes about eating. The parent’s role is to select nutritious foods, prepare them well, and serve them creatively, matched to baby’s individual capabilities and preferences. Baby’s role is to eat the amount he wants at the time, according to his needs, moods, capabilities, and preferences…

This is also something I’ve been repeating like a broken record to the rest of the family but it appears my words are falling on deaf ears. 

Although I know that Gavin is still thriving, despite his reduced solid food intake, I have scheduled a well-baby check-up for him with the doctor tomorrow just to make sure his growth patterns are acceptable.  My peace of mind and that of Gavin’s loved ones is definitely worth more than the RM45-60 it’ll cost us to see the paediatrician.

My concern is not so much that Gavin isn’t eating solids now, but that he may have difficulties with solids when he’s older.  Between 6-12months, a baby still gets most of his nutrients from breastmilk or formula milk.  The only nutrient that a breastfed baby might need a little extra of is iron which is readily available in fortified baby cereals.  The introdution of solids between 6-12months to baby is merely for food appreciation and for baby to learn that a spoon (or hands in the case of some babies) is for conveying the yummy stuff to the mouth.

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At nine and a half months, Gavin appears to have gone on a hunger strike.  We’ve tried everything that he used to like eating and he either seems reluctant to eat them or he flatout refuses to open his mouth.  I’m confused by the sudden change that seems to have come from out of the blue.  It certainly doesn’t help that everyone is doing backflips with anxiety over his stagnating weight gain (even if he still remains in the upper range of the weight and height growth charts).

It is almost as if he fears the spoon or perhaps he fears the contents that the spoon contains?  I find that usually if I am able to get him to taste a little of what is on the spoon, he is more willing to open his mouth if he likes what he’s tasted.  However, beware if he doesn’t because he’ll angrily swipe at every spoon that moves within a half meter radius of his being. 

So far, the only thing that consistently meets with approval is his rice cereal mixed with plain water.  His temperamental tastes for the other foods is so perplexing that at times it’s a little risky to try mixing them into his rice less he rejects his rice as well.  Pumpkin was approved for a few mouthfuls and then rejected.  Broccoli and sweet potatoes that were once met with an eager mouth are now spurned.  Zucchini was approved one morning for breakfast but I haven’t dared to try it again after his favourite foods had been rejected.

We also tried the fruits.  Bananas were received with mixed reactions - one day popular, the next day discarded.  Apples - ditto.  Papaya was also received with mixed reactions, albeit more favourable than the bananas.  He ate a few spoonfuls day before yesterday then decided he had had enough.  Yesterday, he patiently sat in his highchair without complaining and swallowed spoonful after spoonful of papaya until he started to feel full.  Yesterday, he rejected his mango (which he once ate with such gusto).  This morning, he took a few mouthfuls and then pursed his lips shut.

I have read that infants before the age of one year still rely heavily upon breastmilk and formula for most of their nutrients.  At this stage, the introduction of solids are more for taste and to help them get practice eating with a spoon.  About the only additional nutrient that babies require between six to twelve months is iron which comes in fortified rice cereals so I guess we’re quite lucky that Gavin hasn’t rejected rice cereal either.  The other good news is that he still enjoys his breastmilk so we don’t have to worry about him wasting away.

Just to eliminate any possible reasons why he might not be eating, I have tested variables by process of elimination and still not come up with any identifiable patterns.  I’ve tried feeding him in the high chair, on the floor, in the Bumbo chair, on the hubby’s lap, outside - none of it produced predictable results.  Sometimes he’ll eat, sometimes he won’t.  One thing is fairly consistent more often than not is that he refuses to eat, or he eats a few mouthfuls and then balks at the rest, while in the highchair or the Bumbo.  I suspect it is his form of protesting against being restricted when he still wants to explore.  I’ve also tried new foods, more lumpy foods, the same old same old, finger foods - ditto.  Sometimes he’ll eat, sometimes he won’t and there’s no predictable pattern to it either.

A quick check on the parenting forums revealed that this behaviour of Gavin’s is not particularly out of the ordinary.  In fact, there are plenty of parents out there with children refusing to eat.  Some of these parents are experienced with more than one child and they are at a lost because their first child was a compliant eater.  And if I thought I had it bad with Gavin, I’ve read of cases far worse.  At least Gavin still eats rice cereal and he still takes his milk. 

I guess the take home message is that some parents are just blessed with babies who love to eat and others aren’t.  I guess it is sort of like the bathtime example I gave in an earlier post - some babies love water, others don’t.  And just like some hydrophobic babies grow into toddlers that love water, some food-aversed babies can also grow into toddlers that love to eat.  With so many changes going on in their lives, especially during the first few years, we can expect that no habit is necessarily permanent.

Below:  During the early days when Gavin first started solids.  Hubby’s description of this facial expression, “It’s like you’re trying to feed him fecal matter!”  (Note: the original words have been adapted for this family friendly blog).

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Last night, hubby and I attended our third class at Pantai Hospital. The two hour session was split to cover two topics:

1. Nutrition during pregnancy, confinement and lactation
2. Pain Management options during labour (I’ll write about this topic in the next post)

The senior dietition took us on a speed course through the topic of “nutrition during pregnancy” since all of us, save one person, were in our third trimester and the person that was not was already in her second trimester. Again, there was very little that hubby and I had not already read about. By the end of the session, hubby was starting to complain whether any of this was useful to us. Perhaps it would have been if we had had the course while I was still in first trimester before we got all those books to read…

What was news to me was that the recommended weight gain for a regular pregnant woman should be about 9-13kgs. What I had heard was a recommended weight gain between 12-18kgs. I wonder - no, I hoped she was using the old guidelines which had stipulated a lower allowance for weight gain during pregnancy. Looking at my 14kgs of excess mass, it’s a little too late for me to rectify the problem.

The pregnancy diet isn’t really any different from a regular healthy diet, save a little more focus on the nutrients that the baby needs. The main ones are folate, iron and calcium - which I’m being supplemented for. She also was of the opinion that cravings don’t have any significance to any lack in your diet (specifically because most women crave sweets, chocolates, ice cream and other unhealthy foods). While it is okay to indulge in such cravings every so often, the dangerous cravings are called “pica” - when you start to crave for things like chalk, sand, and other non-food items.

An interesting point to note is that calcium from milk is more readily absorbed by the body compared to calcium in the form of tablets. Likewise calcium from animal products (e.g. milk, cheese, fish with edible bones) are also more easily absorbed than the calcium from vegetable products (e.g. toufu, soy milk). Failure to obtain sufficient calcium means that the baby will rob Mum of her own calcium stores, leaving her with brittle bones and a higher risk of developing osteoporosis later in life.

Regarding iron intake, some good take home points to note are:

1. Iron is better absorbed if the meal contains Vitamin C (so I guess that bowl of Vietnamese beef noodles I with a glass of orange juice certainly went down well…)
2. Iron supplementation can also lead to constipation (a common pregnancy problem)
3. Chinese tea should be aboided because the tanins inhibit absorption of iron

Folate is usually present in food such as green leafy vegetables, citrus fruits and juices, and fortified cereals. Since it is easily destroyed during the cooking process, supplementation of folate is often a good idea.

Other noteworthy points:

• Avoidance of raw, uncooked, potentially unhygienically prepared food. This includes half boiled eggs, medium rare beef, sashimi, soft cheeses. Cheesecakes are acceptable if they are baked. That means tiramisu is also out because it contains mascapone cheese that is not cooked. I ought to add a qualifier here since the locally produced tiramisu also includes coffee flavoured cakes that have no mascapone cheese. When in doubt, err on the side of caution.
• Limit/avoid foods with no nutritional value, such as your cravings for sweets, sugars, etc. as these are empty calories that contribute to weight gain but provide no additional benefits to you or the baby
• Fish oils provide Omega-3 fatty acids are good for the development of baby’s brain, eyes and nervous system. The recommendation is to consume fatty fish (such as cod and salmon) twice a week.
• Make sure you don’t forget to eat your carbohydrates, like rice, pasta, noodles (more specifically complex carbohydrates rather than the refined carbohydrates) because you need energy and carbohydrates are your best source of energy.
• Fiber from fruits, vegetables, grains, cereals will help prevent constipation. Generally your meal portion should be one bowl of vegetables to one bowl of rice (refering to the chinese rice bowl size).
• About 8-10 glasses of fluids for adequate hydration and to facilitate the function of your fiber (fiber without water is totally useless for treating constipation). I was somewhat surprised to see that coffee and tea were included since they are diuretics. Generally, for every cup of coffee that is consumed, an additional cup of water should be taken to replace the lost fluids.

The part that was more important to me was the section on confinement diet. The dietition debunked a lot of the usual superstitions associated with confinement, such as not being able to drink cold drinks, but I guess I’m still going to get nagged on this one regardless of who says it’s okay. On the question of alcohol, try not to consume, but if you have to, take small quantities with plenty of water immediately after breastfeeding so that the alcohol is no longer in your system when it is time to feed the baby two hours later.

Interesting that I sat through all that just to listen to one short paragraph…

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