Not just picky about his food

  • Family
  • Thursday, 12 Dec 2013

When a child is highly selective about his food, it’s more than just a behavioural woe.

MANY parents believe that a child who is a picky eater will eventually outgrow his behaviour. This is not always true, however. Sometimes, the unwillingness to eat new food is a sign of a serious feeding difficulty, highly selective intake, which can affect a child’s growth and development.

Four-year-old Adam’s highly selective intake started when his parents Asree and Atie tried to introduce him to solid food. He refused to eat anything other than milk, mushroom soup and cereal. He would even vomit at the sight of certain food such as rice.

“At first, we thought that Adam just needed more time to learn how to eat solid food. But when he turned three and still refused to eat solid food, we decided to seek medical help,” said Atie.

Asree and Atie consulted some doctors, and eventually they were referred to paediatrician Dr Nazrul Neezam.

“Preliminary tests showed that there was nothing wrong with Adam’s digestive system or his ability to swallow food,” said Dr Nazrul. Further investigation suggested that Adam had highly selective intake.

Highly selective intake is one of the feeding difficulties commonly affecting children. Diagnosis and management of these conditions were difficult in the past because of a lack of official diagnostic framework for healthcare professionals. Things are starting to change, however. In 2012, the Malaysian Paediatric Association, in collaboration with Abbott Nutrition, introduced Identification and Management of Feeding Difficulties (IMFeD), a tool that allows for accurate diagnosis of childhood feeding difficulties.

According to Dr Nazrul, who uses IMFeD in his practice, the recommended intervention measures in IMFeD are useful for children like Adam.

“In this situation, the parents should eat with the child at least once a day,” said Dr Nazrul. Parents should eat normally in front of their child, and offer a small portion only after the child asks for a taste.

“Forcing the child to eat may make him more reluctant to try new food,” Dr Nazrul explained.

If the child’s growth is significantly affected by his feeding difficulty, a nutritional supplement may be necessary.

Asree said it took a while for Adam to get used to eating at the dining table. He and Atie practised the “time out method” recommended by IMFeD. When Adam misbehaved, they sent the boy to sit in a corner for a few minutes. Eventually the boy became used to eating with his parents and the tears stopped.

Today, Adam could finish a scoop of rice all on his own. He has also developed a liking for noodles and a few other dishes, much to his parents’ joy.

“I would say that Adam is now 70% on the road to recovery,” said Atie.

Asree advised parents to seek medical help if their child has a feeding difficulty. Atie added that patience is very important when it comes to helping the child.

“There were many times when I broke down and cried, but I refused to give up on Adam,” she said.

* Identification and Management of Feeding Difficulties (IMFeD) is a tool that allows for efficient and effective diagnosis of childhood feeding difficulties. Since 2012, the Malaysian Paediatric Association has collaborated with Abbott Nutrition Malaysia to promote the use of IMFeD among healthcare professionals in Malaysia. For more information, visit This article is contributed by the IMFeD programme, spearheaded by the Malaysian Paediatric Association in collaboration with Abbott Nutrition Malaysia.

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