The ‘picky eater’: The toddler or preschooler who does not eat

Question 1

What percentage of toddlers and preschoolers are described by their parents as picky eaters?

Answer 1

25-35%

Question 2

Why does picky eating occur in young children?

Answer 2

1. Growth reduced during 2-5yo
2. Toddlers appetites are erratic
3. Toddlers are developing a sense of autonomy
4. Do not like new foods initially
5. Excessive intake of beverages reduces a child’s appetite
6. Grazing between planned meals and snacks will also interfere with a child’s appetite
7. Inappropriate feeding techniques
8. Poor role models
9. Poor mealtime atmosphere

Question 3

What clinical evaluation should occur?

Answer 3

1. Three-seven dietary history
2. Complete history and physical examination
3. Accurate measurements of weight and height, plot on curve and compare to previous values

Question 4

What are the recommendations regarding picky eaters?

Answer 4

1. Reassure parents that decrease in appetite is normal 2-5yo
2. Parents are responsible for when and where children eat and children are responsible for how much they eat
3. 1tsp/year of age of each food initially on the plate and add more if needed
4. Snacks should only be offered mid-way between meals
5. Limit milk and do not offer juice
6. Nutrient dense snack foods should be chosen
7. Children should not be allowed to graze
8. Eating should be enjoyable
9. Limit toddler’s time at the table to 20min, then remove all food and do not offer again until the next meal
10. Toddlers need to exercise and play
11. 10-15min notice before meals to help settle and prepare children
12. No books, toys, or TV during mealtimes
13. Table manners only that are appropriate to the child’s age and stage
14. Families should eat together whenever possible
15. Appetite stimulants (e.g. cyproheptadine) generally not indicated
16. Vitamin or mineral supplements can be used
17. If child is growing well there is no indication for special toddler formulas