My 4 year old won't eat solids after the addition of a new baby. She's always been a terrible eater but is reaching for new heights. Problem is, she needs to gain 2 pounds in three months for another growth hormone test. I'm having problems with her receiving negative attention because of the weight she needs to gain. My kid's are all drug exposed and are adopted. What are some ways to add calories that don't break your bank account (nutritional drinks) and vitamins? I'm using canned milk and a nutritionist (for another child) suggested adding canola oil to creamed soups.
Dear "Refusing Solids",
It is common for siblings to have a difficult time adjusting to a new baby. Siblings frequently experience jealous feelings of displacement which causes them a lot of stress. (1) A young child does not have the developmental or communication skills to understand or communicate their feelings and as a result may develop physical symptoms and negative behavior. This stress that a sibling experiences can also manifest itself in regressive or attention getting behaviors. Some children may start to go to the bathroom in their pants again; some may start waking at night. It seems like your 4 year old daughter is having a difficult time with the arrival of the new baby and may be using eating as a tool to get your attention. Since you mentioned that she has a history of not gaining weight, she may have learned that eating or not eating gets her the attention that she needs.
As a parent it can be extremely frustrating to deal with a child that is acting out, especially when there is a new baby in the house that takes up all of your time and energy. My first suggestion would be to recruit the help of family and friends and have someone treat your 4 year old to a visit to the library or the park. This will make her feel special and give you a break so that you can regain the mental energy that is needed to deal with a child that won’t eat.
The next step is to try to take the focus away from eating. This is very difficult to institute when you have a child who has problems gaining weight especially when a lot of time and energy is spent at doctor’s offices addressing the issue. Try to avoid coaxing your child to eat, threatening or even talking about eating no matter how hard it may be. Simply put food in front of her three times per day at the table with the family at breakfast, lunch and dinner. Offer snacks in between. When the family is finished eating clear the plates and do not mention anything about how much she did or didn’t eat. If your daughter perceives that you are not paying attention to her diet, she may stop using her diet as a tool.
Try to make eating an enjoyable time, talk about fun things, play games and be an example by enjoying your food when you eat. It is from adult role models that children can learn what to eat, how much to eat and how to eat. (1) Soon your daughter will associate feeding with a happy time and will realize that she will not gain anything from withholding food.
While your daughter is going through this transition it will take an extra effort to provide her with nutrition and calories since she will not eat solids. Some suggestions include liquefying her meals. You can put vegetables in the blender and add seasonings to make them taste better. For example you can add some brown sugar and maple syrup to squash, sweet potatoes or carrots. This will not only add calories, but will make the food more palatable. Cooked Broccoli pureed in the blender with melted cheese sauce is another idea. Adding melted cheese to crème soups also adds calories and is a good source of calcium.
Foods that are high in calories include bananas ( 22 calories per ounce), avocados (25 calories per ounce), olives (30 calories per ounce), prunes (46 calories per ounce), mushrooms (62 calories per ounce), and cheddar cheese (120 calories per ounce). Although your daughter may not eat or like any of these foods by themselves, you can puree them and add them to soups or dishes in order to add calories to her meal. You probably will not be able to get your daughter to eat olives, but you can add a tablespoon of olive oil to her meals in order to add calories. From my experience, if a child doesn’t see the chunks or pieces of food, they will not notice that they are eating something different.
For snacks you can offer puddings, chocolate mouse, ice cream and custard which will all add calories to your daughter’s diet. These items will melt down to a liquid if she won’t try them with a spoon. Once your daughter develops a favorite dish, you can try to alter the consistency of the item by making it thicker or adding it to another dish. If she likes pureed avocados, the next time you feed her; give her guacamole dip with tortilla chips which is a thicker form of avocados. If she likes cheese sauce, serve melted cheese over very soft, cooked cauliflower or very thin mashed potatoes. For an after dinner treat you can make the whole family milkshakes made from ice cream and bananas. Give everyone a “silly straw” so the children can not only enjoy the snack but have fun. On an alternate night, serve a spoonful of chocolate mouse or pudding over a slice of cake or muffin. If your daughter does not eat the solid food, do not bring it up, but instead continue to enjoy the snack with the rest of the family. The hope is that your daughter will eventually try the new variety because she wants to have fun with the rest of the family.
You can add Ovaltine to your daughter’s milk or milk shake in order to ensure she gets the vitamins that she needs on a daily basis. Supplements such as Pediasure and Boost can also be added to a child’s diet when they won’t eat in order to provide nutrition, but as you mentioned these supplements can be expensive. If you contact your insurance company you may find that you are eligible for reimbursement for these products. Although it is not the norm, in some circumstances an insurance plan may cover the cost of supplements if a child has a medical diagnosis, a prescription and letter from her doctor.
Although the most obvious cause of your daughter’s refusal of food is behavioral, an organic cause should be considered if the symptoms persist. Since you mentioned that eating and growth have been an issue in the past, you may want to consider Gastroesophageal Reflux (GERD) as a contributing factor. Symptoms of GERD include vomiting, heartburn, difficulty swallowing, chronic cough, recurrent pneumonia, sore throat, hoarseness, wheezing, bad breath, sinusitis, dental erosions, feeding problems, poor weight gain and weight loss. (2,3,4) In particular children over 2 years old with GERD most often have symptoms related to heartburn as well as abdominal pain, vomiting and cough. (4,5)
From my experiences many children with GERD present with poor weight gain, disinterest in eating and abdominal pain. Those same symptoms resolve with initiation of treatment for GERD. Since the recent addition of the new baby to the family seems to have caused your daughter emotional stress you may want to consider an exacerbation of an underlying condition such as GERD. You can ask your doctor if GERD is a factor in your daughter’s case or contact a Pediatric Gastrointestinal specialist for more information if necessary.
In addition, including your 4 year old in the care of your newborn may help her adjust to the changes in your family.(1) If your 4 year old helps with the feeding, dressing and playing with the new baby it can help her feel involved and part of the infant’s life. In time your 4 year old can develop empathy towards the infant’s needs, and sensitivity to the infant’s cues. Don’t lose heart, positive sibling behavior takes time and can be cultivated with your guidance and support.
Congratulations on your new baby, and I hope your 4 year old daughter feels better soon.
(1)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:111,257.
(2) Waring JP, Feiler MJ, Junter JG. Childhood Gastroesophageal reflux symptoms in adult patients. J Pediatr Gastroenterl Nutr. 2002; 35:334-348.
(3) Christensen m, Gold B. Clinical Management of Infants and Children with Gastroesophageal Reflux Disease: Disease Recognition and Therapeutic Options. Presented at: The Exhibitor’s Theatre Session at the 2002 ASHP Midyear Clinical Meeting, the Georgia World Congress Center; Dec 9, 2002:Atlanta.
(4)Hassall E. Decisions in diagnosing and managing chronic Gastroesophageal reflux disease in children. J Pediatr. 2005;146:S3-S12.
(5)Suwandhi E, Ton M, Schwarz M. Gastroesophageal Reflux in Infancy and Childhood. Pediatric Annals. 2006;35(4):259-266.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice For Parents