Introduction

Some common childhood eating behaviours happen when children begin to experiment and explore their own independence. This is part of a child’s normal psychological development and parents should not be unduly worried. Rarely is it due to serious underlying diseases.

How is food refusal defined?

Food refusal occurs when a child refuses to eat new food or whatever food that has been offered.

What types of foods are usually refused?

• Children aged 1 to 5 years may be afraid to try new foods. Some become picky eaters and will only eat certain foods. The commonest problem is children who refuse to eat any vegetable.
• Food refusal in infants as in refusing to take solid foods is a more serious problem.

What causes food refusal?

Food refusal in children is part of their normal psychological development. These children are generally healthy despite refusing certain foods and they usually do not have any disease. However, if your child has symptoms such as loss of weight, vomiting and choking, your child would need a proper evaluation by your doctor. He may have other diseases (which is beyond just food refusal) such as :

• Food aversion disorders
• Oral motor dysfunction
• Gastro-oesophageal reflux disease
• Neuromuscular disorders – e.g. cerebral palsy
• Intestinal obstruction
• Achalasia

How does food refusal manifest?

Infants show difficulty by :

• Not weaning at appropriate time
• Refusing to start taking solid food

Older children may :

• Be picky eaters – eat only certain types of food
• Refuse to try new foods
• Refuse to eat any type of vegetable
• Eat only one particular food item all the time

If your child is growing and developing normally, then the food refusal may be normal.

Danger signs:

If your child has other symptoms or signs such as the following, consult your doctor:

• Poor weight gain
• Slow development
• Coughing, choking or gagging during feeding
• Recurrent vomiting

Are there likely to be any complication associated with food refusal?

• There are usually no complication if your child is growing and developing normally.

Can food refusal be treated?

Your child needs to be properly evaluated by a doctor before any treatment. Even if your child chooses to reject one food group from his diet, there is usually no cause for concern if your child is growing normally.

If your child is growing normally despite refusing certain foods, try the following:

• Offer rejected food at another time. Keep trying. Do not give up.
• Keep introducing new types of food to your child.
• Prepare different food (include those that the child likes) at each meal.
• Present food in an interesting manner and in a variety of ways .
• Avoid sugary snacks in between meals.
• You can give your child multivitamin supplements for a period when your child refuses certain foods.
• Discourage eating meals or snacks while watching TV as it will distract your child’s attention. Make the eating environment as relaxed as possible.
• Eating with the family also encourages your child to look forward to meals. It also gives you a chance to focus on her and even teach her about the food she’s eating.
• Set a good example by eating a variety of foods and make sure she knows that you are enjoying every mouthful.

Most importantly, do not turn mealtimes into a battle.

• Learn to be less anxious as this will reinforce child’s refusal to eat and create a vicious cycle.
• Do not force or scold child to eat. You should gently encourage or persuade her to eat.
• Do not fight with your child during mealtimes.
• Do not pay attention to or punish your child for food not eaten.
• Give positive reinforcements such as a small reward if your child eats the food he/she has rejected before.

How can food refusal be prevented?

You should:

• Set good example by eating proper meals with your child.
• Introduce new foods from an early age (6 months).
• Not give too much milk or juice in between meals.