Life Health & Wellbeing

Thursday 17 October 2019

Dear Doctor: How can we coax our fussy eater to broaden her taste buds?

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.

Dear Doctor, my five-year-old is a picky eater and doesn't eat any vegetables. She only really eats chicken goujons, pasta, pizza and a few other things that aren't the most healthy. I try to give her some other meals, but she always kicks up a fuss, and after a stand-off, I usually give in. Is there an easier way to mix up her diet and get her eating healthier?

A This is a very common complaint with children nowadays. Let's be honest, 'Western' or 'First World' children do not starve to death, 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 centile line since birth or if she is falling below her expected targets. For example, if she were to fall below two or three centile 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 good old 'positive reinforcement' with your five-year-old daughter. You need to incentivise eating good food and even consider using a blender to ensure she gets the required fruit and vegetables. Examine what the rest of the family are doing. 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 with modelling good behaviour.

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 carrot another day. Encourage her to understand that healthy food tastes good, gives you good energy and helps you to grow.

For all parents beginning the weaning process with their infants, try to include a wide variety and small portion sizes of vegetable, such as spinach, kale, mushrooms, peppers, courgettes, aubergines and onions, and not just the usual high-sugar carrot, sweet potatoes mixed with white potatoes or apple puree.

You need to expose young children to as much nutritious food as possible from an early age in order to try prevent the fussy eaters. And remember to keep persisting. Just because your infant refused one particular vegetable 10 times last year, doesn't mean he/she will always refuse to eat it.

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.

Dear Doctor,

I'm 30-years old and am having trouble falling asleep recently. I can't see an obvious reason for this happening and don't really want to rake medication. Is there something you would recommend?

A A sleep disorder, or insomnia, is defined as a dissatisfaction with sleep quality or quantity (difficulty initiating 30-plus minutes, or maintaining sleep), despite adequate sleep hygiene measures. It must occur at least three times per week for at least three months in order to be deemed a chronic sleep disorder. Most importantly, this disturbance in sleep must cause clinically significant distress or impairment in functioning.

I assume you are not on any medication (known to disturb sleep) or taking any illicit substances. Medical conditions associated with insomnia include diabetes, obesity, heart disease and hypertension.

There are predisposing, precipitating and perpetuating factors leading to insomnia. Maintaining your natural circadian rhythm is imperative. You can help to achieve this by having regular sleep and wake-up times seven days a week, by going to bed when you feel sleepy and not spending excessive time in bed (over-sleeping), as this is counterproductive. Simple things like monitoring your daily caffeine intake (ie. in drinks and chocolate) and even going 'decaff' after 1pm can help improve sleep. Similarly, nicotine is also a stimulant.

I do not recommend hypnotic and sedating medication for the treatment of chronic insomnia as they require long-term use, are often not effective in this setting due to tolerance, and have the potential for side effects. Cognitive behavioural therapy for insomnia (CBTi) has better long-term outcomes and is the gold standard of treatment.

CBTi begins by reviewing your health status and any factors likely related to your insomnia, as well as education about sleep and good sleep hygiene. It can be delivered in a group or on one-to-one sessions with a therapist over a course of four weeks.

'I can't sleep but doN't want to take medication'

'I'm young but our family heart history is a worry'

Dear Doctor,

I'm 28 and have a history of heart disease in my family. I try to eat healthy and exercise, but am wondering if there are any precautions I should be taking to keep my heart healthy?

A A strong family history of ischaemic heart disease is suggested by having at least one first-degree relative suffering a heart attack, heart failure, angina pectoris or coronary death before 55 years of age. Family history is one thing you cannot change, but there are nine well-known modifiable risk factors for cardiovascular disease.

The first five are known as the leading five causes: smoking, hypercholesterolaemia, hypertension, diabetes, abdominal obesity. The remaining four risk factors are psychosocial factors: daily consumption of fruit and vegetables, regular alcohol consumption and regular physical activity. Few cardiovascular events occur in patients with no elevated or borderline risk factors.

Based on the above evidence, I can certainly make a few suggestions for you. If you smoke, consider switching to e-cigarettes or, ideally, stop altogether. Look up and try to achieve the American Heart Association guidelines for recommended duration, intensity and frequency of weekly cardiovascular exercise.

Get your blood pressure and blood tests for diabetes and cholesterol - every year or two in your age group would be acceptable. In terms of your cholesterol, most people know there is a good form, called low-density lipoprotein (LDL), and a bad form, called high-density lipoprotein (HDL). It is very important to get your good LDL cholesterol as high as possible by exercising and eating plenty of nuts, avocado and extra-virgin olive oil.

The last two suggestions are to maintain your body mass index (BMI) between 18.5-25 if you are female and 20-25 if you are male, and try to eat a healthy balanced diet with at least five portions of fruit and veg per day. Simply really!

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