Page 42 - Today's Dietitian (February 2020)

behaviors and picky eating, but no association with poor easy-to-manage solids, such as well-cooked pieces of pasta or
13
growth. Brown and colleagues report the same finding. 2 vegetables, cut fruit, small pieces of cheese, or small pieces of
Byrne and colleagues note variability in perception among bread with a spread. 14,15,17,18
parents and caregivers and assert that studies rarely look
at actual intake but instead focus on parental perception. 1 Toddlerhood
Thus, it’s difficult to quantify how many of the 30% of per- Toddlers are curious explorers, learning to become more
ceived picky eaters are at risk of failure to thrive, require fur- autonomous and independent and navigate the world. They
ther medical investigation for organic causes of picky eating, have a greater sense of themselves as individuals and like to
or need complex medical intervention. Therefore, it’s imper- express it. 1,14,15,19 They try to push boundaries, but at the same
ative for dietitians to have a thorough understanding of time appreciate limits, as these provide structure and a sense
normal feeding development and the commonly seen issues of safety. They become more skilled at feeding themselves and
related to picky eating. are capable of progressing to a modified adult diet devoid of
choking hazards such as whole nuts, as they don’t have the
Normal Development of Eating skills to safely expel these foods. Although their skill sets are
17
From Infancy Through Childhood expanding, they experience neophobia and so may not be will-
Normal eating is the ability to recognize hunger and then eat ing to try or accept new foods. 14-16,18 Because growth rates and
enough to satiate oneself—recognizing a feeling of fullness. It appetites naturally decrease after 1 year of age, their appetites
also encompasses the ability to choose foods one likes and enjoy fluctuate day to day and sometimes even meal to meal. 1,4,17
those foods without an extreme restriction placed on the amount
eaten. 14,15 Included is the ability to eat for pleasure or for comfort Preschool Age
in amounts that aren’t excessive. In her book How to Get Your Kid As children reach preschool and school age, neophobia begins
to Eat … But Not Too Much, Ellyn Satter, MS, RD, states, “Normal to decrease and in most cases disappears almost entirely. 14,15,18
eating is flexible. It varies in response to your emotions, your sched- Children of this age have more advanced chewing and swal-
17
14
ule, your hunger, and your proximity to food.” While normal eating lowing skills and become more adept at using cutlery. They’re
varies from person to person—some people eat small, more fre- more coordinated when eating and drinking and may spill less
quent meals vs three large meals; prefer to snack or not; and differ in or be more efficient eaters and drinkers in general. Their appe-
how emotionally stimulated/comforted they are by food—it gener- tite continues to be variable, as with toddlers, but they’re much
ally encompasses a healthy attitude toward food. Healthy infants more aware of the feeding environment and easily influenced by
and children are born with an innate capacity to eat normally, one food-related attitudes around them or the environment in which
that changes based on their experiences and exposure to food. 14-16 they eat (eg, if the house is noisy or chaotic, or there’s tension or
discord between parents/guardians or family members). 14-18
Normal Feeding Development
From Infancy Into Adolescence School Age
At this age, children have all of the developmental skills required
Infancy for eating and can tolerate a regular adult diet. As they may eat one
Between birth and 4 to 5 months, sucking from the breast or more meals out of the house each day, they have more freedom
or bottle is how infants receive nutrition. They become regarding what they choose to eat. They have a basic understanding
more adept at feeding as they grow bigger and stronger of nutrition and can help with meal planning and preparation. 14,15,18
and can take in larger volumes more quickly. At around 4 They’re heavily influenced by their peers and environment and look
to 6 months of age, they’re able to hold up their torsos and to their parents and caregivers to be good role models in relation to
18
heads and have the oro-motor skills to accept food from a attitudes toward food and eating in general.
17
spoon. Many enjoy the tactile nature of playing with food
and will have no problems getting their hands and faces Adolescence
dirty. 14,16,17 They begin to develop a capacity to manage new Adolescents have much more freedom in terms of eating and
textures and their chewing skills. Gagging on new textures drinking. They may have disposable income, which they can
is extremely common and considered normal as the infant spend on snacks or meals while hanging out with friends. They
learns new skills related to eating. 14-17 However, many parents still appreciate having meals provided for them, as they see
become quite alarmed when their children gag, as they can’t this as a sign of caring. Adolescence is a period of great influ-
14
tell the difference between gagging (normal) and choking ence, and this is the time when odd eating behaviors or perhaps
(abnormal). If parents or caregivers react strongly each time even signs of eating disorders appear (although some children
this happens, children may become less willing to try new exhibit signs of eating disorders well before adolescence). 14,15,17
textures, as they may be frightened by the reaction of their While teenagers should have freedom around nutrition, par-
parents/caregivers. ents or caregivers still may provide guidance and be aware of
14
As infants approach 1 year of age, they begin to assert their any alarming behaviors or changes in eating habits.
independence. This may present as a reluctance to be spoon
fed. However, if given the spoon, these infants may be happy to Roles of Parents and Children
feed themselves (albeit clumsily), and they’re more willing to The golden rule when considering who’s responsible for what
feed themselves when presented with finger foods and small, when feeding children is as follows: “Parents are responsible

42 TODAY’S DIETITIAN • FEBRUARY 2020