Majority of toddlers are described by their parents as poor eaters (picky) and poor gainers (weight). Parental efforts to make them eat more may have an opposing effect and mealtime becomes battle grounds which may lead to parent child (inappropriate threats /punishments) and at times parent pediatrician conflicts (doctor shopping). Parents will ask for some appetizers and also will request you to rule out primary complex?.Many children are investigated for tuberculosis since they have not gained weight and poor appetite.
What is the cause of this picky eating & poor weight gain in these toddlers? Toddlers are busy trying out new achievements and they hate to sit & eat. In the first year of life an average infant weight gains 7 kgs, during the second year growth is about 2.3kgs and it slows down further between 2-5 years. Since the growth is slow, the requirement is low and so as the appetite and this is aptly called as PHYSIOLOGICAL ANOREXIA (doctors children will definitely have?). Some parents and at times doctors mistake the average weight (the 50th percentile) for normal weight and it is not unusual to find that childs weight are within the normal range (3rd to 97th percentile.).
A detailed history and physical examination to determine whether the refusal to eat is due to physiological anorexia/organic cause.if the child looks well and above 3rd percentile (not 50th percentile) no need to investigate further.
Reassure and counsel the parents about the normal growth and development of children at this age. After 1st birthday ask them to anticipate that their child is going to have poor weight gain and appetite which is appropriate for that age.
Ask them to follow family pot feeding method. Because most children like to copy others the family and child peers are effective role models for the development of food preferences and eating habits.. If a family member refuses a specific food, the toddler may imitate the same. Let your child eat with you.