When Eating Becomes a Battle

I know in a world that is so concerned with too much weight gain there is not a lot of talk about kids that have trouble gaining weight. My son Joseph used to be a terrible eater. Even as a baby it was a struggle to get him to take a bottle. Now at four he devours his meals (most of the time), however, this was not the case a year ago. He would often pass up cookies or candy to go play. We went to a number of specialist about Joseph's lack of weight gain and have found there was nothing medically wrong but were given great advice on how to deal with our skimpy eater. I was going to say picky eater, but Joseph is not even that, he would try just about anything and liked unusual things for a three-year-old, broccoli was his favorite food. He would rather just not eat.  The first thing that helped tremendously is having a timer and setting it for a certain amount of time, typically ten minutes. The child has to sit at the table for 10 minutes before he can get up. Now whether or not he eats in this 10 minutes is his deal. It is so very important not force kids to eat, this just creates a battle that you will NEVER win. Eating is something a child has control over, and if forced to, they will exert this control.  By allowing them to take the initiative, this builds a good relationship to food, rather then them viewing it as something negative.  Now, you have him at the table but what should be on the plate? Protein and healthy fat are the best, so meats and cheeses are great. Fruits and vegetables are important too, but they are not going to have the impact that meat and cheese does. Make sure if he does have a vegetable, put butter and cheese on it. Let him dip things in ranch and sour cream. Unlike adults and "normal kids" our skinny boys (and girls) need all the calories they can get! However, avoid fluff calories like fruit snacks, pop tarts, and fruit juice. Use these things as dessert foods, not meal foods. Only allow the child to earn dessert if he has eaten a certain amount of food. Typically 10 bites or more warrants a dessert in our house. That way when they actually are eating they are getting as many calories as they can. Another suggestion is giving the child Carnation Breakfast Essentials for breakfast and before bed. We use the powder form and mix it in with his milk (which if you really want to pack on the calories use whole milk). This stuff tastes sooo much better than pediasure and has the same nutrients as the other kinds of dietary supplements. This not only provides the child with extra protein but also provide other nutrients and vitamins they may be missing from their daily consumption (or lack thereof) of food. Over time you will see a gradual change in your child's eating habits, and your once skimpy eater will become a clean plater (ok, well at least mostly clean plater).

Here are some resources:
http://kidshealth.org/parent/nutrition_center/healthy_eating/toddler_food.html
http://kidshealth.org/parent/nutrition_center/healthy_eating/toddler_meals.html

 The following is from http://www.keepkidshealthy.com/welcome/conditions/failure_to_thrive.html

Treatment of failure to thrive is usually carried out with a team approach, with your Pediatrician, a Pediatric nutritionist, and appropriate specialist referrals as indicated. There are many Pediatric specialists that can evaluate a child with failure to thrive, depending on your Pediatrician's suspicion of the cause. Often, especially if they have gastrointestinal symptoms, such as vomiting or chronic diarrhea, a Pediatric Gastroenterologist will evaluate your child.
Treatment depends on the underlying cause. If no medical reason is found for your child's failure to thrive, then often treatment will consist of nutritional therapy to see if your child will gain weight if given an adequate amount of calories. This may be done in the hospital over a few weeks or it may begin as an outpatient. Feedings may be given orally, by a nasogastric tube (usually as overnight slow drip feedings) if your child just won't eat enough calories, or by an intravenous (IV) line as total parenteral nutrition (TPN) if your child is not able to digest and absorb oral feedings.
To make mealtimes easier and maximize the chances that your child will eat, you can:

• avoid trying to force or bribe your child to eat. Turning meals into a power struggle usually doesn't help and may make your child more resistant to eating.
• Have a schedule for meals and snacks, which should include 3 meals and 2-3 snacks each day of high calorie foods with lots of nutrients (see below).
• Allow your child to feed himself, especially finger foods, as much as possible.
• Only offer liquids, especially juice, after the meal.
• Avoid large amounts of juices, sodas, or water. Offer milk or formula, which have more calories and protein, instead.

A Pediatric nutritionist can also suggest ways that you can provide your child with more calories by offering high calorie foods that are high in protein with lots of nutrients, especially since he will need additional calories to help him catch-up with his growth, including (disclaimer: only use these suggestions for increasing the calories that you are giving your child under the guidance of your Pediatrician or a Pediatric nutritionist):

• avoid junk foods, such as candy, which may have calories, but are usually low in protein.
• for younger children, under the direction of your Pediatrician or a nutritionist, your infant's formula can be concentrated to provide more than the regular 20 calories/ounce.
• for older children, over 12 months of age, instead of milk, you can offer Pediasure, which has 30 calories/ounce (vs 20 calories/ounce for whole milk) 2-3 times a day.
• or mix whole milk with a packet of instant breakfast powder (adds 130 calories) or dry milk powder (adds 33 calories per tablespoon) to increase calories.
• when baking and cooking, substitute whole milk, half and half, evaporated milk or condensed milk mixed with dry milk powder for water or milk.
• for high calorie snacks, offer milk shakes made with a cup of whole milk, a packet of instant breakfast powder and a cup of ice cream blended together (can provide over 400 calories).
• pudding can also provide a lot of calories if you add 1/2 cup of dry milk powder to the milk and instant pudding mix.
• add cheese as a topping for sandwiches, vegetables, etc.
• use peanut butter (about 100 calories/tablespoon) as a snack and as a topping for vegetables, crackers, and fruits or blended with milk, ice cream or yogurt
• make a high calorie fruit snack using fruits canned in heavy syrup, add sugar or yogurt to fresh fruit or add a packet of instant breakfast powder to strained fruits.
• make high calorie jello by substituting fruit juice for water in its preparation
• serve meats and breads with added butter, margarine, gravy or sauces
• serve fried foods, such as fish and chicken and add breading or flour before cooking