Picky eater

[mmcirvin]

So, the pediatrician's advice about Jorie's diet was to... give Sam a stern lecture about the need to change Jorie's diet. Gee, thanks.

Let's review the state of play here. We have a stack of baby books a foot high telling us not to force food on our kid--she'll naturally gravitate to solid food at some point. We have a pediatrician telling us in no uncertain terms that we need to make our baby eat solid food, pronto, or serious health consequences will ensue. We have a baby who, in no uncertain terms, refuses to eat solid food in more than trivial snack quantities.

What's the out here? Do we just start force-feeding Jorie, irrespective of the tantrums and lifelong psychological issues that will ensue? Do we let her set the pace and risk serious malnutrition? Do we stop or ramp down breastfeeding to make her hungry? I don't see the solution.

(I appreciate all the suggestions in the comments to my previous post, but everything you've suggested, we've tried.)

Comments

[antikythera.livejournal.com]

Is there such a thing as a vitamin supplement, to make sure she gets nutrition even though she isn't eating a lot of food? Make sure the food is there, that she sees you eating it so that she knows it's yummy, but let her set the pace and make sure she gets the nutrition another way?

[mmcirvin.livejournal.com]

Yes; we're already giving her iron supplements and probably some vitamins will follow if she doesn't eat. We probably should have been giving her supplements for some time, but I suppose that to some extent we were paying attention to La Leche League-style advice that tended to be skeptical of those.

[pr1ss.livejournal.com]

A possible prescription would be, a new pediatrician.

[kerri9494.livejournal.com]

Amen.

After reading your last few posts, though, I wonder if Jorie just isn't sure how to 'be fed'? I wonder if modeling might work -- Daddy feeds mommy a bite, feeds Jorie a bite, feeds mommy, feeds Jorie. Mommy says MMM GOOD. Jorie says MMM GOOD. Might not be that simple, but it's certainly something to try if you're still concerned. Also, it might be fun to start out with something universally yummy (vanilla pudding?), rather than gross and disgusting rice cereal, or other nasty pureed baby foods.

One other early-eater for Spud was those big Zwieback cookies. They look like biscotti...he loved to slobber all over those. :-)

I will only take issue with one thing -- 'force' feeding her (or, really, cajoling her so much that she doesn't have a choice) is not really likely to psychologically scar her for life. If you do it with love, not with anger, I can't imagine she'd be scarred for life. :-)

As always, good luck.

[antikythera.livejournal.com]

Aw, I remember loving that rice cereal stuff. ^^;;

Apparently I went through phases when I was that age of only eating foods of certain categories. Only orange foods, only green foods, only meat... I have no idea how long that lasted, though. Should ask my mom.

[pentomino.livejournal.com]

The answer depends on what quality of baby books you're using, and the experience of the authors in questino. A doctor's direct orders generally trumps an author's published work, even if the author's a doctor.

[stacebass.livejournal.com]

Really? I've had some seriously stupid doctors. Especially the one who told me that at 5'8 and 149 pounds I was too fat.

[pentomino.livejournal.com]

you may be right, but how do you tell a stupid doctor from a smart one? Second opinion maybe?

[stacebass.livejournal.com]

I don't believe I've ever heard of a child getting seriously ill or dying from not eating solid food that was offered to her.

If her body needs it, she'll eventually cave in and eat it. Humans are built that way.

[antikythera.livejournal.com]

The only exception to that might be if a kid had an abnormally small stomach, and felt full before she'd actually taken in enough nutrition.

[thette.livejournal.com]

I have heard of babies starving, both before and after starting on solids, when I took Pediatrics. (We had case presentations every week, and feeding issues were a big thing.)

[mmcirvin.livejournal.com]

There's also the failure-to-thrive phenomenon in breastfed newborns, in which dehydration makes them sleepy and less prone to feed, leading into a death spiral. But that's little, little babies.

[stacebass.livejournal.com]

And there have been cases of vegan kids starving to death, to be sure.

Jorie is a kibologist. Jorie needs some Pez.

[jmkelly.livejournal.com]

You're going to be dealing with your pediatrician a long time -- seventeen more years, ideally. A stern lecture about the need to change Jorie's diet with no concrete suggestions as to how to do so is strike one, in my book -- and I don't know if I'd wait for any more strikes. His job is to help, not lecture.

You might look at things from a behavioral point of view: what does Jorie get from nursing that she doesn't get from eating regular food? Can feeding be set up so she gets the same rewards?

Children tend to be conservative; once they've got a good thing going, like nursing when they're hungry/thirsty/in need of cuddling, they tend to stick with it and resist change fiercely. If you always give in and nurse her because she needs to eat, she's got you in a corner.

It might work to start limiting nursing to certain times of the day. Jorie won't get malnourished that way, but she'll have more incentive to try the strained peas. It's also important to establish that Mom's breasts belong to Mom, not Jorie. Most kids have to have that one explained to them!

[smashingstars.livejournal.com]

That's very good advice.

As for the doctor, well, Matt should know how I feel about doctors. I do think many doctors forget that patients are individuals with different situations and needs and, quite often, assume patients are idiots who must be scolded and lectured. Is the pediatrician making good points but just being a jerk about it? Or is he yammering and ranting without any focus? Also, I would think the litmus test with your pediatrician should be how he responds to direct questions. When Sam explained the difficulties with feeding Jorie, did the doctor say "Then FORCE her to eat solid foods"? If so, did Sam question the possible harm of force feeding? What did the doctor say to that?

If the doctor was dismissive or copped one of those "stupid new parents who worry about the wrong things" attitudes, I'd suggest trying another doctor for at least a second opinion.

[samantha2074.livejournal.com]

See my response below. The doctor wasn't a jerk and did offer a couple of suggestions, one that I've already tried, another that we haven't used in a while and will go back. I was feeling really frustrated today, and that colored the way I related the conversation to Matt. Force-feeding was never suggested. The issue is more of the impression I get from the pediatrician.

[samantha2074.livejournal.com]

I have mixed feelings about this. Yes, I can and should set limits as to what I'm comfortable with. On the other hand, I suspect that some of the issue with children not giving up a good thing is not that they won't do it, but that they won't do it on the parents' timetable. For example, my understanding is that when left to wean on their own, children tend to completely go off the breast some time between 2.5 and 7 years of age. Admittedly, by that point they're only nursing maybe a couple of times a day, but not many mothers are willing to nurse for that long. Similarly, my mom and dad co-slept with all three of us kids. My mom claims that we all transitioned easily to our own beds, but that was when we were 3-3.5 years old. Again, that just doesn't work for most people. Everyone's got to find their own balance between the kid's needs and their own. I don't think, however, that just because Jorie's behaving in one way now, that means she'll also do so unless we force her not to.

I also think that Jorie will come to eat solids in her own time. It's just that the anemia issue has put a lot of pressure on the situation. To be honest, I think that the breastfeeding isn't the real issue. The problem is that when she first showed her reluctance to go on solids, we should have put her on iron supplements. Now we're playing catch-up. We'll work it out in time, though.

[mmcirvin.livejournal.com]

And it's not as if she doesn't eat solids at all now. Just now I got her to eat a few Cheerios and some bran flakes. She just doesn't seem to use them as a major part of her diet.

reality check

[notr.livejournal.com]

The anemia issue doesn't put pressure on her to fit your imaginary timetable. It puts pressure on her to do what her own body wants. It's not a matter of performing for others like pressure to walk or talk early, or social conformity like how you dress her.

Don't let the inferred message of "You people shouldn't breastfeed your babies so much" get in the way of the real message of "You're breastfeeding this baby more than is good for her body." Yes, children in general judge pretty well when it's time to stop breastfeeding, or they wouldn't have survived to continue our species for so long. But that's a matter of averages. You're dealing with an individual.

Re: reality check

[mmcirvin.livejournal.com]

Just to be clear, neither of those messages were what the doctor actually literally said, and it's by no means clear that withholding milk would actually cause her to eat more solids--it might just mean she'd eat less overall.

I do think that feeding Jorie solids first when she gets hungry is going to be a large part of the solution.

[samantha2074.livejournal.com]

In fairness, Matt's overstating what the pediatrician said. She basically said that ultimately we have to address the iron deficiency by changing Jorie's diet, not by giving her drops, and suggested cereal mixed with breastmilk. Okay, it's been a while since we tried that, so we can go back to it. The problem with the pediatrician is that, though she's been nice about it, I think her philosophical approach is different from ours, and I don't feel like I'm getting support from her. For example, early on she told me that she wasn't happy about the fact we were co-sleeping with Jorie, although she respected our decision. In contrast, my OB, who was a family practice doctor and would have been Jorie's doctor if we hadn't moved, fully supported that.

At our most recent visit, the doctor said that Jorie's rate of growth was flattening and that she wanted to see another growth spurt in the next 3-6 months. She acknowledged that breastfed babies grow really fast in the first months (which Jorie did), but still wanted to see Jorie have another uptick. However, according to the chart in my book, Jorie's right where she should be weight-wise given her birth weight. She's maybe a little short (29.25" as opposed to 30"), but essentially she's 50th percentile now in height and weight. While this is a decline from 80-90th percentile in the early months, it's in line with her birth height/weight. In addition, from what I've read, at about one year, babies start to reduce their caloric intake and their growth slows. So where's this growth spurt supposed to come from? I feel like the hidden message is really "you shouldn't be breastfeeding your baby so much," and, while I'm concerned about Jorie's iron deficiency, I'm not sure that otherwise Jorie's breastmilk diet is really so bad.

Ultimately, I think it's time to find a new pediatrician.

[smashingstars.livejournal.com]

Well, I'm glad the doctor wasn't a jerk, but if your gut tells you there's a hidden message there, then go with your gut. From what you and Matt have said it does sound like this doctor doesn't have a lot of respect for parenting methods unless they're her suggested methods, and that doesn't bode well for a good relationship in the long run.

[youxu.livejournal.com]

First of all, sorry about the frustrating situation. I'm sure that things will get better, but it sucks when you are stuck. I can't help forcing my two-cents on you and Matt if you don't mind. When we were looking for pedi the first time, an old wife-tale says "get a pediatrician who is also a parent", and we did, and it's been working for us. So I'm passing it along.

What I remember about introducing solid food (from 6 yrs ago) is the timing and fashion. Timing is a small window when the baby can sit up without much support. Fashion is to introduce rice cereal (avoid allergy), followed by barley cereal and others, mixed with breast milk or water. The critical point is to train baby to overcome the reflex to push things outward with their tongue and learn to swallow things thicker than milk. It sounds like Jorie knows how to swallow, but she doesn't favor to do it often. I'd restart the swallow training as you planned to do, but in the meantime, maybe have some pedi-ENT specialist to take a look and make sure there is nothing in her mouth that causes discomfort or interference when she swallows solids.

Personally I don't favor infants take vitamin pills, 'cause I am just not sure dumping a load of artificial chemicals into their little body would be beneficial. At least it should not be a long term solution.

I hope things will work out for you three and work out sooner than later.

[2wanda.livejournal.com]

She has a few teeth. She's one year old now. How much of her food are you trying to feed her with a spoon? How much is she able to eat on her own, finger food style? My kids were gumming finger foods even before they had teeth. They really enjoyed feeding themselves. Yes, they made horrendous messes, but it sure was fun!

Jarred baby foods taste terrible. I wouldn't eat them, and I rarely gave them to my kids. I know it's not really convenient to make your own baby food, but really, if the food tastes better, the kids is more likely to eat it.

My advice is to make eating as fun and delicious as possible. Also, try to duplicate the closeness she gets when nursing with eating solids. Let her sit on your lap and play with her soft steamed peas and little bits of soft chicken.

And she might be more receptive to eating solid foods with Daddy. Mommy is for milk. She might be having a hard time separating that in her little mind.

I totally agree with the way you are approaching food, in that you are trying to allow her to transition over on her time. But there are probably some creative things you can do to encourage, not force, her to eat more.

[samantha2074.livejournal.com]

I've actually wondered if the Mommy=milk association isn't a problem when I try to feed, although Matt says she won't eat for him, either. We'll try having her sit on our laps -- haven't done that yet. Early on she indicated a reluctance to be spoon-fed, so what we give her is diced food from our plates so she can feed herself. We do offer some goopy stuff - applesauce, yogurt, cereal. She enjoys making a mess and playing with the spoon. She loves to feed me, so she obviously understands the concept of the spoon -- she just doesn't want it in her mouth.

[adw3345.livejournal.com]

I agree, baby food from a jar loses its popularity once Baby gets a clue. Zhanna's been cooking baby food at home. Simple things like mashed yams, applesauce, chicken bullion, pureed rice. Baby eats it all up, along with overlooked Easter candy she found this morning from who knows when, covered with dirt and ants.

-Derrick

[dr-strych9.livejournal.com]

Jarred baby foods taste terrible. I wouldn't eat them, and I rarely gave them to my kids.

Leopold didn't like very many of them, but we found some he would eat. There was much fussing.

Gee and I didn't have as much trouble introducing him to solid food as I think you've had with Jorie. He took to the rice cereal mixed with breast milk without a fight. He transitioned to cow milk and multigrain cereal just fine. We fed him baby food from jars for a short time. At about twelve months, we started feeding him this stuff (http://www.plumorganics.com/), which he really likes and we seem to find only in the frozen section. He's 19 months old, and has all but his back molars now. We did exactly what our pediatrician told us to do, and it worked out okay. I suppose what I'm trying to say is that I don't think my experience compares to yours, so I feel uncomfortable offering suggestions.

It's possible Leo took to solid foods so easily because all the breast milk he ever got came in a bottle. I'll bet that made weaning less difficult. I don't know how to turn that observation into a constructive suggestion. Alas.

[aderack.livejournal.com]

Well. For what it's worth, I was just reading an article -- I think maybe in the Bay Guardian -- claiming that a lot of health problems can be traced back to weening a kid off breast milk too early, and that this is mostly a problem in the U.S., where there's pressure from every corner to switch off as soon as possible.

If I had a URL, I'm sure that would be far more useful.

[jmkelly.livejournal.com]

Wow, what a mob of comments!

I would like to add a couple of things:

Our kids presented both ends of the weaning spectrum. The first had to be weaned as she approached her third birthday; her reward for giving up nursing was a pink rug. The second lost all interest in nursing at about nine months; far from feeling a need to reward him, Mom felt a little rejected. Your mileage may vary. Your mileage, in fact, will probably vary more than you thought it ever could.

There really is a kind of ownership/control issue in parenting, and it's especially acute for the mother, who has been intimately involved with the child's physical survival for all the child's life. At birth, in all normal cases, it'd be fair to say those breasts belong to the child. Some time later -- a year? two years? -- they are Mom's again, and I think (I hasten to add that I'm not a doctor or psychologist, only a father) that it's vital to the future relationship, and the formation of the child's personality, that Mom assert this gently, lovingly, and firmly. It helps that the emotional and spiritual quality of nursing changes over time; it starts out as a practically mystical communion between the mother and newborn babe; a couple of years later, you see the same kid walking over to Mom and opening up her blouse like a NASCAR dad going to the refrigerator for a beer.

And here's a practical suggestion: if you don't have one already, get a baby-food grinder (we used to call it a "baby-grinder", but we're kind of sick that way). Here's an example. (http://http://www.happybabyproducts.com/kidcofoodmill.html) Instant baby food that doesn't suck, made right at the table when baby's interested!

Don't slack off, but don't worry. She'll figure it out.