Healthy Spaces

When the dinner table is a battlefield

Family physician Angelia Chua says parents should encourage self-feeding in their kids when they are around nine to 12 months old. As children learn by touching and feeling objects, exploring food with the senses may encourage their appetite.
Family physician Angelia Chua says parents should encourage self-feeding in their kids when they are around nine to 12 months old. As children learn by touching and feeling objects, exploring food with the senses may encourage their appetite.PHOTO: ISTOCKPHOTO

Some parents believe in getting young picky eaters dewormed and fed with appetite stimulants, but experts tell Joyce Teo that a change in kids' eating habits is more effective

Food and pickiness about food are right at the top of many parents' list of what they worry about most in a young child.

It is not uncommon to see maids running after their charges to spoon-feed them, or for parents to be on the receiving end of all kinds of advice on how to get a child to eat.

Parents ply their children with all sorts of vitamin supplements in the hope that these will help them get stronger.

We asked the experts to weigh in.

Are these necessary?

1. DEWORMING TREATMENT

Some people - especially those of the older generation - may conclude that intestinal worms are the reason for a child's poor appetite and recommend treatment with a deworming syrup that can be bought off the shelf.

But it is not advisable to give kids deworming syrup without a doctor's assessment, said Dr Angelia Chua, a family physician and consultant at Yishun Polyclinic.

"Malnutrition, stomach ache, vomiting, diarrhoea and perennial itch are the common symptoms that the child might have if he has a parasitic infestation," she said.

If the doctor confirms the infestation, he will prescribe medication in a syrup form, she said.

There are simple and more important steps that parents can take to prevent their children from getting intestinal worms, she added.

These include:

•Maintaining proper hygiene at home and frequently washing the child's hands with soap and water.

•Monitoring what the child is touching or putting into his mouth.

•Ensuring that the child wears shoes when he is outside the house, especially in muddy areas.

•Making sure the child does not eat undercooked meat or unwashed fruit and vegetables.

2. APPETITE STIMULANTS

Some parents believe that lysine, an essential amino acid that can be found in some multivitamins for kids, can help boost appetites.

However, there is insufficient evidence to show that it works as an appetite stimulant, said Ms Jenette Yee, a dietitian at the nutrition and dietetics department at KK Women's and Children's Hospital.

"Besides, the responses may vary from child to child."

Often, it is more important to address the underlying reasons for the lack of appetite before parents turn to supplements, she said.

The child could be snacking too much between meals, or simply be disinterested because he is being forced to finish his meals.

3. MULTIVITAMINS

Many parents give these to their children in the belief that the supplements will help them grow stronger. But multivitamins are generally unnecessary for a healthy child who is growing normally, said Dr Chua.

"Most kids should get their vitamins from a balanced, healthy diet that includes milk and dairy products, fruit and vegetables, as well as proteins like chicken, fish, meat and eggs, and whole grains."

Many common food products are also fortified with vital nutrients, such as B vitamins, vitamin D, calcium and iron, she added.

Ms Yee agreed: "Children do not typically need large amounts of vitamins and minerals."

A multivitamin may be helpful only if the child does not eat regularly, is extremely fussy about food or takes a restricted variety of foods due to, for instance, food allergies or chronic diseases that require lifelong dietary avoidance, she said.

What can parents do?

A child's appetite may be affected by many factors, including their level of physical activity, fatigue and emotional instability.

Or he could just be a picky eater, said Dr Chua.

As long as the child's growth is normal and he is eating a balanced diet, there is no need to be concerned. "Appetite fluctuation is often transient and will not harm the child's overall health," Dr Chua said.

She shares the following tips.

1. ENCOURAGE SELF-FEEDING

As children learn by touching and feeling objects, exploring food with the senses may encourage their appetite.

The child will also develop the motor skills and confidence required to eat with a fork or spoon.

Parents should encourage a child to feed himself when he is around nine to 12 months old.

"Encourage the child to pick up bite-sized pieces between his index finger and thumb as he attempts to take the food to his mouth," Dr Chua said.

Applaud every attempt and supervise the child closely to watch out for signs of choking.

2. KEEP TABS ON SNACKS

Limit snacking to twice daily, and only if your child asks for a snack.

Do not give a child too much milk either, as this can reduce their appetite at mealtimes.

Infants and toddlers who drink much more than 470ml to 710ml of milk a day may not want to eat other nutritious foods as they are full.

They can then become underweight. But if they are still eating well, they can become overweight from the extra calories.

3. MAKE MEALTIMES ENJOYABLE

Refrain from having food battles with your child, like forcing him to eat everything on his plate.

Pleasant, stress-free mealtimes can encourage a healthy appetite.

Offer small portions. If he wants more, let him ask you for it. This will help him feel more in control, said Dr Chua.

In some cases, a child is not simply a fussy eater, but could be a "problem feeder".

Ms Yee said a fussy eater usually accepts 30 types of foods or more, while a problem feeder usually accepts 20 types of foods or fewer.

Parents whose children are underweight or are problem feeders should consult a doctor or dietitian, she said.

Problem feeders likely require help from a speech therapist and an occupational therapist, as they may have oral hypersensitivity or sensory issues that make it hard for them to accept new foods, she said.

A version of this article appeared in the print edition of The Straits Times on November 03, 2015, with the headline 'When the dinner table is a battlefield'. Print Edition | Subscribe