Sunday 24 June 2018

Dear Dr Jennifer: 'My daughter will only eat chicken nuggets, cereal and cheese. What can I do?'

Dr Jennifer Grant, a GP with the Beacon HealthCheck screening programme at Beacon Hospital.
Dr Jennifer Grant, a GP with the Beacon HealthCheck screening programme at Beacon Hospital.

Dr Jennifer Grant

Dear Doctor,

My six-year-old has become fussier and fussier about what she eats - her diet is so limited now that I'm getting worried. She won't eat any fruit or vegetables. Things like chicken nuggets, cereal and cheese are the sum total of what she'll tolerate. I'm at the end of my tether and I'm so worried about her development.

A This is a very common complaint with children nowadays. In general 'Western children' do not starve, however they may show signs of failure to thrive and iron deficiency anaemia. If you are concerned you should take her to your GP to have her weight and height plotted on a growth chart.

All children are plotted on a growth chart at birth and at every check up with the public health nurse or doctor. It is important to know whether she is on the same percentile line since birth or if she is falling below her expected targets.

For example if she were to fall below two or three percentile lines on her growth chart then your GP would know to refer her to a paediatrician for multidisciplinary team support including a dietician, counsellor and social worker.

It's back to positive reinforcement with your six-year-old. You need to incentivise eating good food, consider using a blender to ensure she gets the required fruit and vegetables. Of course if no one else at home eats any fruit or vegetables you can hardly expect a child to, so please ensure everyone in the house is on board. Start with one vegetable at a time and encourage her to try it in different ways on different days - such as a raw carrot with hummus, or mashed/puréed carrot another day. Encourage her to understand that healthy food tastes good and gives you good energy.

One last word of caution. Research would suggest that early fussy eaters may have a higher chance of developing an eating disorder later in life. This is not meant to cause any alarm as fussy eating in young children is extremely common. Nevertheless if your daughter has clinically significant weight loss, a nutritional deficiency, impaired psychosocial functioning or if it is decided that she needs nutritional supplements in order to achieve adequate growth then a level of cautious awareness is required.

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