Feeding Problems

Some young children are "difficult eaters," but in many cases the real difficulty is with a parent who expects the child to conform to an eating pattern that doesn't suit her. If you approach feeding problems with sympathy and a flexible attitude, they will usually just disappear. In some cases, there may be a genuine problem, such as intolerance of or allergy to certain foods, and you should consult your doctor. Never try to isolate a food allergy yourself; your child could suffer if you deprive her of particular foods.

Food Preferences

In the second year your child will start to show likes and dislikes for certain foods. It is very common for children to go through phases of eating only one kind of food and refusing everything else. For example, she may go for a week eating nothing but yogurt and fruit, then suddenly go off yogurt and start eating nothing but cheese and mashed potatoes. Don't get angry with your child about this, and don't insist that she eats certain foods. No one food is essential to your child, and there is always a nutritious substitute for any food she refuses to eat. As long as you offer your child a wide variety of foods, she will get a balanced diet, and it is far better for her to eat something that she likes - even if it's something you disapprove of - than to eat nothing at all. The one thing you must watch out for is your toddler refusing to eat any food from a particular group - refusing any kind of fruit or vegetables, for example. If she does, her diet will become unbalanced, so you will have to think of ways of tempting her to eat fruit and vegetables, perhaps by cooking the food in a different way or presenting it imaginatively.

If you spend time cooking food that you know your toddler doesn't want, you will feel annoyed and resentful when she doesn't eat it, so give yourself and her a break by cooking food that you know she will enjoy.

Don't try to camouflage a disliked food by mixing it with something else or bargain with your child by offering a favorite food if she eats the disliked one; she may very well end up refusing other foods as well. If you are introducing a new food, make sure your child is hungry; that way, she is more likely to take it. Never try to force her to take something she doesn't want; if she thinks it's very important to you, she will just use it as a way of manipulating you.

Refusal to Eat

Not eating is an early indication that your child may be unwell, so observe her carefully. If she looks pale, and seems fretful and more clumsy than usual, check her temperature and speak to her doctor if you're worried.

Occasionally your child may have eaten a lot of snacks or a drink of milk before her meal, and she won't show her usual appetite. As long as the snacks are nutritious, this is nothing to worry about. If your child refuses to eat for no reason that you can see, don't let yourself be bothered by it. She will always eat as much food as she really needs, and if you insist on her eating, mealtimes may become a battle that you will always lose.

Food Intolerance

The inability to digest certain foods fully has to be distinguished from a true food allergy, which is quite different and very rare. Intolerance occurs when the digestive system fails to produce essential enzymes that break down food inside the body. One of the most common forms of food intolerance in children is lactose intolerance - the inability to digest the sugars in milk. The enzyme, in this case lactase, may be absent from birth or its production may be disrupted by an intestinal disorder such as gastroenteritis. Pale­colored, bulky, smelly stools are characteristic of the disorder. Sometimes food intolerance occurs for reasons that are not known. If your child habitually has symptoms such as diarrhea, nausea, or pain after eating a particular food, intolerance may be the cause. The best remedy is to avoid the food concerned, but don't try to identify it yourself; you will need medical advice to pin down the culprit food and to eliminate other causes.

Food Allergy

Most cases of suspected food allergy turn out to be no more than intolerance, or the combination of a fussy child and a fussy mother. A true food allergy is quite rare and occurs when the body's immune system undergoes an exaggerated reaction to a protein or chemical it interprets as "foreign." It is a protective mechanism, and symptoms can include headache, nausea, profuse vomiting, diarrhea, a rash, widespread red blotches on the skin, and swelling of the mouth, tongue, face, and eyes.

At first the allergen - the substance that causes the reaction ­may produce only mild symptoms, but these may become more severe if the child is repeatedly exposed to the food concerned. Some foods that commonly cause allergic reactions are wheat, shell­fish, strawberries, chocolate, eggs, and cows' milk.

In the 1980s food allergies attracted a great deal of attention, and were blamed for behavioral disturbances in children, including hyperactivity. More recent studies have cast doubt on these claims: parents continued to report behavioral disturbance even when, unknown to them, the suspect food had been withdrawn from the child's diet. In a very small number of cases it has been proven that food was responsible for the behavior, but in very many more cases bad behavior is a way of seeking attention, love, and affection from parents and others. I feel very strongly that too many parents have been willing to blame foods for behavioral problems rather than, look to their own attitudes as a cause. Meanwhile, many children have been needlessly deprived of nutritious foods.

You should never attempt to isolate a food allergy on your own without medical advice, and never assume an allergy is present without a clear diagnosis from a pediatric allergist.