Tackling ‘Picky Eater’ among Breastfed Babies

by Dyah Febriyanti, MD, IBCLC

Babies aged 6-23 months need adequate complementary food and maintain direct breastfeeding.1,2 However, they often enjoy the food one day and push it away from their heads from the meals the next day or vice versa. They also might be cranky at mealtime or close their mouth when the spoon reaches them or spit out the meal. These conditions are often referred a be a ‘picky eater’.

There are many factors affecting babies’ mealtime. Refusing food or being a ‘picky’ one can be happened when babies are full, distracted, or not feeling well both physically and emotionally. 3,4 The common conditions that lead to feeding difficulties among breastfed babies are related to many aspects.4 During the complementary feeding period, the babies’ sensory system integration changes. When the babies eat, they use every physical sense (taste, smell, sight, etc.), and any disturbances, including sensory processing disorder, can lead to eating problems. Conflicting emotional or environmental aspects can also be why the baby refuses to eat. Feeding is a part of a learning process; the baby needs to be surrounded by safe, caring and comfort from reciprocal interactions with primary caregivers.

Any medical conditions can also interfere with the babies’ appetite or willingness to take their meal.4,5 Parents have to consult the paediatrician, not to self-diagnose the babies. Baby’s difficulties in chewing due to configuration or dysfunctions of the oral motor system such as ankyloglossia may result in feeding difficulties.6 For babies, the mouth is essential for survival by feeding and exploring the external environment in the early years of life. There are wide-ranged organic conditions, including underlying diseases and disorders such as food allergies and cardiorespiratory or gastrointestinal systems. Those conditions can elicit symptoms linked to negative feelings and further affect the babies’ daily activities, including mealtimes.

The difficulties in feeding the babies may consume the primary caregivers’ time and effort.7 Therefore, they might prefer the easier way to provide the babies, such as daily commercial baby food. The benefit of commercial baby food can be compensated by optimizing the cooking and preparation process of homemade baby food by increasing efficiency in cooking and preparation time, exploring affordable local food sources rich in critical nutrients, and practising clean and safe practices in cooking and preparation.8

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There are some “Do and don’t” in complementary feeding that primary caregivers should pay attention to:9,10

  Do Don’t
Seasoning Use the original taste from the food itself and some herbs, spice, and very limited amount of salt (1g/day) Added sugar, chili and spicy seasoning, or artificial sweetener/seasoning
‘snacking’ Fruit and veggies, and homemade appetizers that are nutrient-rich food Sugar-sweetened beverages, unhealthy commercial snack (especially Ultra-processed food that is low in nutrient content but high of saturated fat).
Meal time Supervise babies while giving them authority to handle the food, look and learn the texture, colour, etc.

Give immediate response to the babies’ cues.

Left the baby alone without encouraging them to eat, force the babies to eat.

Apply strict rules and timing to babies’ mealtime.

 

To tackle the problems in feeding solids in breastfed babies, we have to consider the whole aspects of the babies as an entire human being.4 The proper mother-baby relationship sets aside the parent’s view from ‘imaginary baby’ with the ‘real baby’. The mother and other primary caregivers should consider the aspects above. By seeing the babies through the ‘whole child’ perspective, the mothers and primary caregivers will be able to:

  • See if there is any sign or symptoms of health problems; thus, consult the physician timely.
  • forms emotional bond, attention and availability.
  • recognizing babies’ normal development (including emotional learning).
  • Accept babies’ skills and comfort during mealtime.
  • Find pleasant and playful strategies to bring food to the child’s routine.

There are some tips for primary caregivers:4

  • Pay attention to babies’ cues such as facial expression, crying, shaking hands, crying, hunger cues.
  • Give immediate responses to those cues. For example:
  • The baby tries to ‘escape’ from the highchair: put the baby on the mother’s lap and offer the food again.
  • Keep trying not to force the baby to eat. Make a pleasant environment instead. Make them feel comfortable and safe. Calm them if they seemed frustrated and look for anything that made them feel uncomfortable. If there’s nothing urgent, be calm, take a deep breath and try again.
  • Involve the baby in family mealtime and eat together. This activity can be a learning process for the baby to interact with the family.
  • Cope with your own emotions, beliefs and social judgements so you can tackle the baby’s emotions and other feeding difficulties even in unpleasant moments.
  • Offer the food in smaller portions but more frequent when the baby is unwell.

To make mealtime more effective, the primary caregivers can learn how to make the cooking and preparation more effective. Here are some tips:

  1. Baby food is not a meal that must be fancy or follow the current trend.
  2. Practice complementary feeding according to what the expert says. Information is essential, but keep it to the important ones, not to be overwhelmed by social media. Pick the critical, affordable, and applicable information.
  3. Make the baby food cooking process nutritious yet simple and straightforward.
    • Mother can use various cooking methods such as frying, sautéing, boiling, steam etc.
    • Put some more calories by adding a small amount of oil in the baby’s meal right before serving to the babies.
    • Use both animal and plant-based protein in one meal serving.
    • Explore affordable, local food that is easy to find11: eggs (chicken, duck, or quail eggs)12, beef and chicken liver. Beef liver is high in required micronutrients (iron, vitamin A, folate, vitamin B12, and Calcium).13
    • Use time-saving techniques:14
  • Make specially prepared food if the family food is spicy or not well-cooked.
  • Use modified family food daily: Cook family food without added sugar, salt, chilli, or monosodium glutamate, then set aside one bowl for the baby as the ‘topping’. Serve the staple food and the ‘topping’ together (adjust to the babies’ age). The rest of the family members eat similar food with a sharper taste (added salt, sugar, chilli, and hot spices).

References

  1. United Nations Children’s Fund (UNICEF). Improving Young Children’s Diets During the Complementary Feeding Period. UNICEF Programming Guidance. New York: UNICEF, 2020.
  2. Michaelsen, K. F., Grummer‐Strawn, L., & Bégin, F. (2017). Emerging issues in complementary feeding: Global aspects. Maternal & Child Nutrition, 13, e12444. https://doi.org/10.1111/mcn.12444
  3. West C. Introduction of Complementary Foods to Infants. Ann Nutr Metab. 2017;70 Suppl 2:47-54. doi: 10.1159/000457928. Epub 2017 May 19. PMID: 28521316.
  4. Miranda, V. S. G. D., & Flach, K. (2019). EMOTIONAL ASPECTS IN FOOD AVERSION IN PEDIATRIC PATIENTS: interface between Speech Therapy and Psychology. Psicologia em Estudo, 24.
  5. Dipasquale, V., Cucinotta, U., & Romano, C. (2020). Acute malnutrition in children: Pathophysiology, clinical effects and treatment. Nutrients, 12(8), 2413. https://doi.org/10.3390/nu12082413
  6. Baxter, R., & Hughes, L. (2018). Speech and Feeding Improvements in Children After Posterior Tongue-Tie Release: A Case Series. International Journal Of Clinical Pediatrics, 7(3), 29-35.
  7. Biks, G.A., Tariku, A., Wassie, M.M. et al. Mother’s Infant and Young Child Feeding (IYCF) knowledge improved timely initiation of complementary feeding of children aged 6–24 months in the rural population of northwest Ethiopia. BMC Res Notes 11, 593 (2018). https://doi.org/10.1186/s13104-018-3703-0
  8. Theresa Ryckman, Ty Beal, Stella Nordhagen, Zivai Murira, Harriet Torlesse, Affordability of nutritious foods for complementary feeding in South Asia, Nutrition Reviews, Volume 79, Issue Supplement_1, April 2021, Pages 52–68, https://doi.org/10.1093/nutrit/nuaa139
  9. Abeshu, M. A., Lelisa, A., & Geleta, B. (2016). Complementary feeding: review of recommendations, feeding practices, and adequacy of homemade complementary food preparations in developing countries–lessons from Ethiopia. Frontiers in nutrition, 3, 41. https://doi.org/10.3389/fnut.2016.00041
  10. Prell, C., & Koletzko, B. (2016). Breastfeeding and Complementary Feeding. Deutsches Arzteblatt international, 113(25), 435–444. https://doi.org/10.3238/arztebl.2016.0435
  11. Kementerian Kesehatan RI. Direktorat Jenderal Kesehatan Masyarakat. Buku Saku Pemberian Makan Bayi dan Anak Bagi Tenaga Kesehatan. Jakarta : Kementerian Kesehatan RI. 2021
  12. Ierodiakonou, D.; Larsen, V.G.; Logan, A.; Groome, A.; Cunha, S.; Chivinge, J.; Robinson, Z.; Geoghegan, N.; Jarrold, K.; Reeves, T.; et al. Timing of Allergenic Food Introduction to the Infant Diet and Risk of Allergic or Autoimmune Disease: A Systematic Review and Meta-Analysis. JAMA 2016, 316, 1181–1192.DOI: 10.1001/jama.2016.12623
  13. Jessica M White, Ty Beal, Joanne E Arsenault, Harriet Okronipa, Guy-Marino Hinnouho, Kudakwashe Chimanya, Joan Matji, Aashima Garg, Micronutrient gaps during the complementary feeding period in 6 countries in Eastern and Southern Africa: a Comprehensive Nutrient Gap Assessment, Nutrition Reviews, Volume 79, Issue Supplement_1, April 2021, Pages 16–25, https://doi.org/10.1093/nutrit/nuaa142
  14. Praborini A, Febriyanti D. 2021. Antiribet MPASI. Jakarta: Kawan Pustaka.

 

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