Dear David: 'My toddler is never hungry'
Clinical psychologist David Coleman addresses your parenting queries.
Question: My toddler is never hungry
I have a 21-month-old boy, who is never hungry. We had to wake him every three hours for a feed until he was five months old. He had silent reflux and we never knew. We used to force feed to a certain degree for a number of months. Now it's like he doesn't have the urge to eat or drink. He often goes several days without dinner or tea even though he must be starving. My GP isn't worried since he is rarely sick, so it's not like he's not getting his nutrients. A dietician advised us to keep trying him with food and he will eventually eat. What are your thoughts?
David answers: I assume that your GP checked your son's growth and weight in relation to the normative growth charts and is happy that he is growing too, not just that he hasn't been sick.
It is very common for children to have much smaller appetites than we expect them to have. Remember that your son's stomach is only the size of his closed fist. So, it doesn't take much to fill it.
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'However, your concern seems to be more about his appetite to eat any food rather than how much food he eats at any one sitting. From what you have described it may be that he has developed some negative associations with food.
For whatever reason, he didn't seem hungry as an infant and so you had to wake him in order to feed him. You then discovered that he may have been experiencing pain every time he drank milk due to a silent reflux.
As I understand it, silent reflux is where your baby's stomach contents (milk and acid) come back up into their throat or mouth but they show no outward signs of that discomfort, like vomiting or excessive crying during or after feeding.
You then describe that you had to force feed your son for a few months. You still continue to cajole him to eat.
I could imagine that all of this was very distressing for him. Naturally, since he was so small, he couldn't ever tell you about what was happening to him. It may be, though, that he has never had any enjoyment from his food.
Enjoying our food is a key component of the experience of eating for most people. We all have an intrinsic instinct to eat because we need the fuel from the nutrients in food. However, the tastes, smells, colours and textures of different foods can also excite or distress us.
Your son may have missed out on the desire to experience his food as something enjoyable and fun. Indeed, if anything, he may even feel food is a bad thing since it was at one time a very unpleasant cause of discomfort in his throat and mouth.
So, if you'd like to change things, I suggest you try to change your son's associations with food.
Like the dietician suggested, have lots of different foods available to him. Try to pick foods that have interesting and different colours, shapes textures and tastes. Role model for him, that each of these foods can be enjoyed.
Make the mealtimes a relaxed, family affair. Try to sit together when eating so he sees you, his dad and any siblings eating. Let him watch the way in which other people seem interested in their food.
Comment on tastes, textures, colours and smells of the different foods that you serve up. Show him that each of you may have different preferences and that you enjoy the experimentation of trying new things.
Whenever you are arranging food for him, put out very tiny amounts of the foods and avoid having any expectation that he will eat them. This may be your biggest challenge but it is vital that he is free to eat or not as he chooses. You need to move away from cajoling or coercing him to eat.
Since he is nearly two serve food in easy-to-hold sizes so that he can pick up, touch, squeeze and play with the food, even if he doesn't eat it. Understanding food in this way, using other senses than just taste is important to help him establish a new, relaxed relationship with his food.
Your son does eat. His growth to date is evidence of that. Now you just have to make his food fun, relaxed and something that can be enjoyed, not just tolerated.