Is Your Baby a Fussy Eater, Or Is There an Underlying Issue?

Babies and toddlers can be notoriously fussy eaters, with most toddlers going through a phase of eating a very narrow range of foods. So if mealtimes in your house have become more about tantrums and bribery than about the food itself, rest assured that many other parents are facing the same issue.

Fussy eating is a normal phase in a toddler’s development. It’s partly because of something called food neophobia, a fear of new foods that results in toddlers feeling reluctant to try the foods on their plate. It’s also got a little to do with the fact that your baby is learning their independence. They know they are their own person, but much of their daily lives is controlled by their caregivers. Food is one aspect they can gain some control of.

However, sometimes a child’s reluctance to eat a certain food is not about fussiness or assertiveness, but more about underlying issues such as allergies or tiredness. Fussiness can actually be a sign that something is wrong. It is important to consult your child’s health care professional when in doubt.

Fussy bottle feeders

Please note the following section refers to bottle feeding, and as such it is important to share the recommendations of the World Health Organisation. Please consult your healthcare professional if you require further information.

• The World Health Organisation recommends that breastfeeding is best for your baby.
• Having a balanced diet when breastfeeding is also important. Baby formulas should only be used after you’ve sought advice from a doctor or health practitioner.

• A decision not to breastfeed can be difficult to reverse and introducing partial bottle feeding will reduce the supply of breast milk. It is also wise to consider the cost of infant formula.
• If you use infant formula, all preparation and feeding instructions must be followed as per the manufacturer’s instructions. This is important for your baby’s health.

According to lactation expert and baby nurse Rowena Bennett, fussing during a bottle feed is usually a good indication that something is wrong. Troubled or concerning behaviour includes:

• Turning away from the bottle.
• Refusing to close mouth around the nipple.
• Taking a small amount and then refusing to continue.
• Crying when placed in the feeding position.
• Milk pouring out of baby’s mouth.
• Coughing and spluttering.
• Throwing up milk.

There are many different reasons for these behaviours, and these should be considered before blaming them on ‘fussiness’. Reasons include:

Misinterpreted signs

When babies are in the primary oral stages of development, many love to suck when tired, bored, uncomfortable or upset. Some simply enjoy the act of sucking, and therefore do it often. It’s not always an indicator of hunger.

If you’ve mistaken your baby’s sucking cues as hunger, your baby may just take a small amount from the bottle before refusing the rest. Because you think they’re hungry, you may be inclined to try and force feed them, but this will in turn lead to distress and further fussiness.

Tiredness

If a baby doesn’t sleep well, it can negatively impact their feeding habits. Tiredness makes a baby uncomfortable and, if you are waiting too long to feed them, they may associate the discomfort with the bottle. Without a good feed, however, babies won’t sleep well and so a vicious cycle is formed.

If you think that your baby is not feeding well due to tiredness, speaking to your paediatrician about the best way to help their sleeping patterns get back on track.

Feeding equipment

The nipple of a bottle needs to be the right size and speed for your baby’s size, age, and sucking ability. Too long, too short, too fast or too slow, and your baby may experience difficulties in feeding. It’s also important to maintain a balance in air pressure within the bottle – when the nipple ring is screwed on too tightly, air is prevented from entering the bottle. This negative pressure makes feeding uncomfortable, and the nipple risks collapsing in baby’s mouth.

The right bottle is a crucial part to successful feeding, and different bottles work for different babies. If something’s not working, try another. Breast-like bottles are the obvious choice, but some babies prefer something vastly different.

Unrealistic expectations

The guidelines suggesting how much formula the average baby should have is in place to provide a rough estimation. Babies are individuals and should be treated as such, and not all babies will drink the average amount of milk calculated for age and weight. If you are concerned about how much your baby is drinking, speak to your paediatrician about your concerns.

Position

Holding your baby in the traditional reclining position may not work for a breastfed baby, as it’s too close to the real deal and they get upset when they don’t get what they expect. Toddlers sometimes benefit from a more raised position and their own grasp on the bottle.

And sometimes, the person holding them too can make all the difference. If your baby doesn’t want to drink milk from a secondary source when mum is nearby, it may be worth stepping out of the house for a moment and letting someone else take over until your child is used to it.

Too much solid food

In the early stages of solid foods, the focus should be to add value to your baby’s nutritional intake and provide a new learning experience. It’s not to be used to fill their tummies. As very young children experience difficulty in self-regulating their dietary intake, they may continue to eat solid food as long as it is offered even after they are full. This in turn will reduce the appetite for milk feeds.

Aversion

If milk feeds are associated with an unpleasant, stressful or painful stimulus, a feeding aversion can be the result. An aversion is a conditioned response that tells baby not to drink or it will cause displeasure. Acid reflux, food allergies and chronic constipation are common causes of feeding aversion, and should be addressed with your paediatrician.

The most common food allergy or sensitivity among babies is to cow’s milk protein, found in most formula. For those that are sensitive, 50% of those will also show some sensitivity to soy-based formulas. Signs of sensitivity include: rash, hives, eczema and vomiting.

Fussy solid feeds

The signs of a fussy eater can seem pretty obvious. They include:

• Pushing food away
• Turning their head from food
• Clamping mouth shut
• Spitting food out
• Crying
• Getting cranky
• Tiredness
• Throwing food on the floor.

There are many reasons for food fussiness and, before getting frustrated with your uncooperative child, these should be considered:

Allergies

An average one in twenty children are allergic to at least one food. The good news is that except for peanuts and tree nuts, most children outgrow food allergies.

Most food allergies are caused by triggers such as:

• Peanuts
• Tree nuts
• Fish
• Shellfish
• Milk
• Eggs
• Soy
• Wheat.

Signs of a food allergy usually come on quickly and can be triggered by just a small amount of food. An intolerance generally comes on gradually, so results in fussiness after a feed. If you suspect an allergy or food intolerance, keep a diary of the foods you give during mealtimes, and consult your paediatrician.

Sensory processing problems

Toddlers with highly sensitive sensory processing may object strongly to certain textures, smells or tastes of food. In the case of textures, offering the same food but in a different form could help. For example, if they’re not liking pureed carrot and sweet potato, try sticks of cooked carrot and potato instead.

Playing with food is also a very important part of feeding, as it gives the brain more information about the food before it is put in the mouth. Not rushing your child to eat can make a big difference in relaxing them.

Preference

When a toddler has been exposed to lots of sweet foods, encouraging healthy, nutritious food can be a challenge. When parents are too afraid to say no to sugary treats or enjoy spoiling their children too much, negative food habits are set up and can be hard to break.

It’s important to remember that everything is ok in moderation, and that the moderate amount of sweets and treats for your toddler is much smaller than it is for yourself. Save things like cake and lollies for special occasions, and for the everyday stick to healthy, wholesome foods.

Oral motor difficulty

An underlying oral motor difficulty can affect how a child handles food once in their mouth. Essentially, your child might not know how to move the food around the mouth, bite or chew. Signs of poor oral motor skills include frequent drooling or gagging, and speech and language delays.

Lack of inspiration

As toddlers get older, they can be greatly influenced by what others are doing around them. Eating well at mealtimes can simply be achieved by sitting down and enjoying a meal together. With no one to watch and aspire to, your toddler has no idea of how enjoyable food can be. Show them you’re enjoying it, and they’ll follow suit.

Fear/anxiousness

If too many foods are introduced all at once, it can be pretty overwhelming to a child. Instead, try limiting the options on the plate and including at least one thing you know they like to eat. You could also try getting them to choose what goes on their plate, so that they are more in control and engaged with their food.

This information has been provided as general advice only. If you are concerned about your child’s nutrition or eating habits, please always speak with your paediatrician, GP, or a registered medical health professional about your concerns.

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