When the time came for Sebastien Geniaux to progress from eating porridge to consuming more lumpy and textured food at 11/2 years old, he did not make the leap.
His mother, Ms Serene Lim, 48, recalls: "If he found any lumps of meat in his porridge, he would spit them out. The more I coaxed him to eat them, the more anxious and teary he became, so I just left it at that."
A stay-at-home mum, she continued to prepare soft porridge - with some vegetables, fish or well-blended meat - for him till he was about four years old.
As he was growing well - in fact, he was slightly above average in weight and height - she did not think much about the matter until a friend suggested that he could have sensory issues and encouraged her to see an occupational therapist. That was in 2013.
After attending a parenting talk which covered picky eating, she also took Sebastien to a multi- disciplinary team at the Paediatric Feeding and Nutrition Clinic at the National University Hospital, who diagnosed him with selective food aversion, a more severe type of picky eating.
The team, which included a paediatrician, a dietitian, a psychologist and a speech therapist, encouraged Sebastien to use his molars to chew tougher food such as meat chunks. He was also given less milk in between meals to build up his appetite before a meal.
Since then, Sebastien, who turns six in August, has doubled the variety of food he eats, says a happy Ms Lim.
She says: "He is now willing to eat rice, pasta, pizza crust and also small pieces of meat. We are making small but steady progress."
Dr Chan Poh Chong, a senior consultant at the Paediatric Feeding and Nutrition Clinic, says that a multidisciplinary approach is needed in Sebastien's case as his aversion to food types was more severe than many other children's.
He says: "Sebastien was getting his calories and proteins mainly from milk; the variety of food he was taking was quite narrow.
"They were not age-appropriate and may lead to nutritional deficiency and other social issues, such as feeling left out during school mealtimes. He may also not develop good chewing skills."
Most cases of picky eating in children are milder and children tend to outgrow the phase, say experts.
According to Ms Pauline Xie, a senior dietitian at the National Healthcare Group Polyclinics, studies show that 25 to 40 per cent of toddlers aged between one and three years have picky eating behaviour. But the numbers plummet by two-thirds by the ages of six and seven.
Dr Janice Wong, a consultant paediatrician at Thomson Paediatric Centre, says there is a slow-down in food intake for a child after the growth spurt at one year old. Moreover, toddlers tend to get distracted by play and entertainment during mealtimes.
She says: "They start to exert some independence and want to do things their way."
To help toddlers through this transitional phase more easily, Ms Xie says parents can adopt some good practices such as exposing the child to a wide variety of food from an early age. Above all, encourage and not force them to eat, she adds.
She says: "Praise a child for trying even if he spits the food out. Do not insist that he finishes everything on the plate. Respect that he has eaten enough, especially if mealtimes drag past 30 to 45 minutes."
Ms Sharifah Nurshida Syed Yahya, 35, learnt the hard way that forcing children to finish their food may backfire.
Soon after her daughter Ariana was started on pureed food at seven months, her mother-in-law insisted that she finished what was on the plate, even if Ariana turned away to indicate she was already full.
Over the next few months, the child would eat only pureed fruit, which had to be apple, pear or banana flavoured. She refused any other food.
Says Ms Sharifah, a stay-at-home mum: "She would push it away, spit it out or throw a big tantrum."
This went on until Ariana was about a year old. Worried that it may affect her growth, Ms Sharifah took her daughter to a paediatrician and he advised her to encourage Ariana to eat on her own and not force her to finish her meal.
Since then, the girl has become more willing to try new food and the 23-month-old now eats what the adults eat, but with less or no salt.
For another mother, Ms Chng Yean Leng, 39, her son's fussy stage came later. Her four-year-old, Gareth, started to reject "anything green" on his plate only last year.
Ms Chng, an account executive, says: "If he sees even a bit of green vegetable, he would ask me to take it out."
But recently, she stumbled on a way to get him to eat his greens.
In March, she attended a cooking demonstration held by dietitians at her son's childcare centre. Gareth tried his hand at wrapping a quesadilla, a tortilla filled with a savoury mixture which included lettuce. To her surprise, he gobbled it up, lettuce and all.
Since then, she has repeated the recipe about five times at home and Gareth was involved in the food preparation each time.
Ms Xie, the dietitian from the polyclinics group, says it is a good idea to rope in children in food shopping and preparation.
She says: "They become more interested and curious about a dish on the table if they are involved in seeing how it is transformed from the supermarket to the dining table. This is in stark contrast to if they were to be just presented with a dish and asked to eat it."
Ms Xie, herself a mother of three, would often get her 21/2-year-old toddler to pluck vegetables. Her six-year-old would do simple mixing and marinating while her nine-year-old does simple cutting and cooking.
She says: "I try to make it interesting for them. If they are handling lemon, I would get them to take photos of one another tasting lemon. If they are handling potatoes, I would give them cookie cutters to press shapes out of them."
TIPS FOR HAPPY MEALTIMES
Dr Janice Wong, a consultant paediatrician, sees about two to three picky eaters at her clinic at Thomson Paediatric Centre every week. These are her tips on what parents can do to encourage healthy eating in their children.
- Eat meals at the table as a family, with no games, toys or walking around. If a child still insists on doing these things, do not feed him. Mealtimes are for eating and interacting with the family.
- Be a role model. A child will eat better and be more willing to try new food if he sees others at the table eating the same food.
- Offer three meals and up to three snacks at regular times each day. Offer only water between meals and snacks. This will keep a child hydrated and also make sure his stomach does not fill up before mealtime. This way, he will come to the table hungry.
- Prepare one meal for the family. Be sure to offer food in the correct texture and cut sizes for a child. Remember it is the caregiver’s job to offer the food and it is up to the child to decide whether he wants to eat it or not. The child will be more willing to try new food if he knows he will not get his favourite food when he refuses dinner.
- Continue to offer new food on different days, at different meals and in different recipes, even if a child has said no to them before. It can take as many as 10 times for a child to try a food and like it.
- Limit meal times. Allow a child a maximum of 30 minutes to eat the meal. After this time, put the food away and let him leave the table. Offer food again at the next scheduled meal or snack time. Extending meal times will not make the child more likely to eat and does not create a healthy and happy eating environment.
- Promote happy mealtimes. Do not pressure or force them to eat. Do not punish poor eaters. A child will eat when he is hungry.
- Listen to the child. Trust that he knows when he is hungry and full.