How to Handle Challenging Eaters

An NPN reader asks our natural parenting mentors:

I have a question about my nine-month-old baby’s eating habits. She is fairly small for her age (approximately 16.5 pounds and 26 inches). She was exclusively breastfed for four months but then began refusing to breastfeed. We think it is due to reflux issues. I started pumping and giving her bottles of breast milk. At that point, I realized that she didn’t really like to eat very much. The most I have ever been able to get her to drink, formula or breast milk, is about 28 ounces in a day (and that was during a growth spurt).

She is now eating a variety of solids, and because she never liked taking a bottle or breastfeeding, I am attempting to feed her three solid meals per day. The problem is that she now does not seem as interested in the solids either. I am not sure if I am trying to overfeed her. I usually give her about four ounces (give or take) of pureed fruit, yogurt, vegetables, or meat per meal and then attempt to have her take four bottles with six ounces of formula or breast milk in each bottle. I feel like feeding her has become a battle. She will start out great. Then after a few bites, she starts getting fidgety, whiny, flailing her arms around, closing her mouth, etc. If I try and feed her when she does not want to eat (bottle or solids) she will vomit (she has a VERY sensitive gag reflex, to top everything off). I feel like I am dreading every time I have to feed her anything. I am wondering if:

1) Could I be trying to give her too much (24 ounces of formula or breast milk) as well as three meals (approximately four ounces/two baby cubes of solids) per day?

2) Is this a stage?

3) Should I be trying to add fats to what she is eating so that she is getting foods that are more substantial, since she is so small for her age? If so, what types of foods? I already feed her avocados, yogurt, and try to sneak either breast milk or formula into her meals.

I should probably add that, developmentally, she is doing great. She is EXTREMELY active. She is crawling and pulling herself up to standing. She is sleeping twelve hours straight through the night and takes two 1-1.5 hour naps during the day. She does poop a lot, approximately four times per day. Her poops are quite hard and dry so I try to give her prunes to soften her stools. Basically she is a wonderful little girl except when it comes to eating. I am a little worried that she is going to develop bad eating issues because of our feeding battles since birth.

Here is what our natural parenting mentors had to say:

Jennifer: I could have written this post when my daughter was nine months old. Like your daughter, mine had serious reflux issues as well as a ridiculously strong gag reflex. In fact, it was so bad that I could not feed her any purees or soft foods so she started solids rather late, around 11 months. She too was very small for her age (still is at 26 months old) but was and is just fine developmentally.

To answer your questions:

First, you might consider having your daughter checked for things like tongue-tie, sensory processing disorders, and under/overactive colon. Believe it or not, these issues greatly contribute to eating and elimination patterns and abilities in children. A good naturopath will be able to quickly and easily address any health issues.

Second, your daughter knows when she is hungry, how much and what she is physically capable of eating, and which foods agree or disagree with her. All mothers worry about their children’s eating habits. It’s what we do! However, follow her cues. If she is a small eater but thriving, then relax a little. Offer her small portions of food and breast milk often, but do not become unsettled if she eats little to nothing. At 26 months my daughter BARELY eats anything. She eats a total of about three-quarters of a cup of food on a good day. She still breastfeeds, which helps. She also drinks water, but her appetite and body’s caloric requirement are small. Still, she is healthy and thriving.

You are on target to give thought to what you are offering your daughter. Children need lots and lots of fat. You mention giving your daughter avocado. Great, great choice! Whole milk yogurt is good too. There is the possibility that cow’s milk yogurt is causing a little constipation in your daughter (the hard stools). You might want to try goat’s milk yogurt or raw milk yogurt to see if that helps. Kefir is another great option. Since it is cultured differently, it typically does not cause as much constipation as the other options. It is not as thick as yogurt, but it is fun to slurp up with a straw or eat with a spoon all the same. It is also great for smoothies. Load up the smoothies with vegetables, kefir, a little fruit (except bananas, which are constipating) to make it tasty, and a tablespoon of coconut oil to increase her fat intake.

I would also make sure that you are offering a protein source at every meal.  For example, an egg yolk cooked in real butter is such a nourishing protein. Vegetables are important, followed by fruit. Last on the list are grains. These are not only extremely difficult to digest before a child is three years of age, but they are often times too filling, leaving little room for anything else. Homemade foods are best. The preservatives and additives in packaged foods are not doing your daughter any favors.

Cod liver oil is another thing you may want to look into. Believe it or not, my daughter loves it and I started her on it when she was 10 months old. Cod liver oil has so many wonderful health benefits to it. A great blog post, “Why Fermented Cod Liver Oil?” has some more information you can reference.

I also encourage you to look at the article “Feeding Babies” by Sally Fallon and Mary G. Enig, PhD. It has information about how we need to be feeding our children.  Another excellent resource is “Foods to Tantalize Toddlers and Preschoolers,” an article by Jen Allbritton, CN, which discusses which foods are best to feed toddlers. It talks about fats, gluten, proper preparation of foods, and so much more.

Finally, children have an ebb and flow to their eating habits. As they grow and hit developmental milestones, you will find them eating more. When they are in plateau mode, their appetites will decrease. Again, just follow your daughter’s lead. She knows what she needs, provided there are not underlying health issues.

Acacia: Let me first encourage you not to worry and to trust your child to guide you to what she needs. With all of the information, guidelines, and recommendations for feeding infants, it is easy to forget or to never realize that your child often knows what she needs. I learned this with my second child who led me into the method of baby-led feeding or weaning. Even if you didn’t begin with this method, you may want to consider it now.

First and foremost, you are doing the best for her by breastfeeding. I want to praise you for your continued efforts in breastfeeding and bottle-feeding her breast milk. Keep it up! According to many reputable sources, including the World Health Organization (WHO) and Kellymom.com, babies can be breastfed exclusively until six months of age or more. In fact, many babies around the world thrive mostly on breast milk until 12 months of age or later. If your baby is gaining weight and developing appropriately, she is getting the nutrition she needs. Only at 12 months does an infant begin needing more zinc, iron, and other minerals that cannot be provided through breast milk alone.

In order to determine whether she needs to be gaining more weight, refer to charts and calculators for breastfed babies like the Normal Growth of Breastfed Babies charts at Kellymom.com or the WHO growth charts.  According to the World Health Organization, some pediatric growth charts suffer from a number of drawbacks, including environment, gender, race, genetics, and whether the child is breastfed or not. Your daughter may be gaining weight appropriately, despite her feeding problems. Her development and capabilities tell you that she is growing well. Her vomiting, poop, and disinterest in food tells you something that, possibly, both of you are eating is not right for her at this point in time. It may be a specific food, or it may be that she is just not ready for much solid food yet.

In trying to determine what is causing her stomach troubles, I would first look to grains and sugars. Even at a year, babies produce only a small amount of amylase, the enzyme needed to digest grains. To read more about the difficulty of digesting grains and what you can do to help, such as soaking flours or sprouting grains, you can read the FAQ section regarding grains, seed, nuts, and beans from the Weston A. Price Foundation. On the other hand, babies are well equipped to digest fats and proteins; so animal products are typically a wonderful option, aside from vegetables and fruits. In fact, breast milk contains around 50% fat because lipids (especially in the form of saturated fats) are crucial in the development of the nervous system and other parts of the body. Furthermore, if from a reliable source (grass-fed animals especially), they are very calorie and nutrient-dense so they provide a great amount of energy for growing babies.  It is recommended to continue providing a diet that is composed largely of fat until the age of two. You can provide unsaturated fats through avocados, seafood, flax seed/oil, and nut butters. You can provide saturated fats through meat, poultry, full fat dairy, eggs, cocoa butter, palm oils and coconut oil. Raw milk might be a consideration as well. It is much more nutritional than store-bought pasteurized milk and more readily digested. You can read about raw milk in the article “Is Raw Milk Safe for Babies?” and the Dairy FAQ section from the Weston A. Price Foundation.

At 13 months, my son has had a diet that looks very different from what is typical, but I know that he is very healthy so I continue to trust that he “knows” what he needs. I have researched what is most important for his diet and introduced foods to him throughout the last four to five months (since he first showed any interest in solid foods at all), but allowed him to eat what he wants of those foods. If I were you, I would arm myself with enough nutritional information to be confident and to seek the guidance of a trusted pediatrician or naturopath as you try to find a diet that is both nutritional and wanted by your daughter.

Kristin: Feeding issues and worries are just so challenging and emotional, aren’t they? More than any other issue, those concerning food stress me out, and I know how easy it is to compare and worry.

Since all babies have different nutritional needs based on genetics and metabolism, as well as eating habits, I’m not comfortable putting a number on specifically how much your daughter should be eating or drinking each day. From your description, she sounds quite healthy! She is very active (learning and burning those calories) and developmentally on track. She is also sleeping really well, which is great. If she were hungry I would expect her to be waking more at night. Babies around nine months are often getting very mobile and this often relates to a slowing down of growth or a temporary plateauing of weight gain. It’s also a classic time for them to become more distracted and less interested in sitting still for eating.

I believe that, just like sleeping, eating is one of those things you cannot make another person do, no matter how much you would like to. You can, however, set her up for success with a good selection of foods and a regular, frequent feeding schedule. I got a lot out of the book Child of Mine: Feeding with Love and Good Sense by Ellyn Satter, which has a whole section on challenging, slow-to-gain eaters. She stresses the importance of a “division of responsibility in feeding,” which states it is the parent’s responsibility to choose what foods you serve, and when and where they are served. Your baby chooses whether she eats, and how much. I know this is really difficult to do, but if you can let go of the power struggles and really distance your own desires and reactions from her you may see a remarkable change. Dr. Sears also has some really solid tips about feeding your picky toddler, like keeping feedings short because “most babies seldom take more than one or two tablespoons of food at any one meal.” One of my favorite tips is creating a “nibble tray” of finger foods out of an ice cube tray or a muffin tin. Take a look at the NPN article, “Making Lunchtime Fun: Muffin Tin Meals!” for some great ideas.

Good luck! I hear how frustrating your feeding times are right now, and I hope you are able to find a way to change that dynamic and make mealtime a lot less stressful and more fun for both of you.

Photo Credit: Ronny Satzke

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Statements on this website have not been evaluated by the Food and Drug Administration. Products and/or information are not intended to diagnose, cure, treat, or prevent any disease. Readers are advised to do their own research and make decisions in partnership with their healthcare provider. If you are pregnant, are nursing, have a medical condition, or are taking any medication, please consult your physician. Nothing you read here should be relied upon to determine dietary changes, a medical diagnosis, or courses of treatment.

2 Responses to How to Handle Challenging Eaters

  1. Angela

    I had a cousin who was also really small when she was a baby and she would only eat and drink small amounts often. She’s now 13, a dancer, very slim, tall for her age, very clever and she still only eats small amounts often. Some kids just have their own way of doing things.

    My daughter on the other hand was diagnosed with GORD at 8wks old. She was also really small, and because she couldn’t keep anything down because of the condition her growth got down to the bottom 5% for her age group – but she was very alert, never stopped moving and was quite clever. We started her on solids at 4mths to help with the condition, she took to solids instantly and then started getting funny about having her anti-reflux formula and dropped her breastfeeds right down. By 6mths she had stopped breastfeeding altogether (her choice) and was only having 1 bottle of anti-reflux formula a day and the rest was solids. This concerned me as I know kids are supposed to have more milk than that, so like you I gave her a diet that included avocado, yoghurt, cheese, I was also expressing breastmilk and used it to prepare all her foods. She is now 13mths, the GORD has resolved itself, she had her 12mth check up yesterday and she’s still on the small side, but she eats like there’s no tomorrow – absolutely LOVES food – and I still have a hard time getting her to drink more milk, she’d rather have a cup of water! LOL So I’m giving her milk with every meal, and that seems to be working. So try small meals often, also try a variety of foods and combinations – I used to freeze the purees in ice cube trays in the freezer, then at meal times I would grab a few different ones out and warm them up for her (my mum used to get grossed out when I’d mix roast vegetables with pureed apple – but as I pointed out, you have apple sauce when having roast pork, so what’s the difference? Besides which she loved it!), this kept things interesting for her, now she’ll eat anything, or at least give it a go. She really like cauliflower, broccoli & cheese; avocado & cucumber (minus the seeds); and roast carrot/pumpkin/potato & apple – she liked yoghurt too, but it had a tendency to make her vomit, so she didn’t get it often. Get creative and have fun! Stop stressing and follow her lead – if you are stressed at meal times she may start to think it’s not a good thing. If it helps, I used to act ridiculously excited when I was preparing her food (cause as soon as she realised I was getting food ready she’d start yelling for me to hurry up! LOL) so I’d say “Oh Bella, what are you having for breakfast/lunch/dinner/snack today? Oh yum! It’s roast veges and apple! Yum yum!” then while it was warming I’d applaud (she’s a big fan of clapping) and say “Yay” and carry on. It really made things fun for her (and me LOL) and we had good meal times. Good luck, you’re doing great :-D

  2. Charise@I Thought I Knew Mama  

    Thank you for all of this wonderful advice and for sharing these resources!

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