One thing that comes up regularly when I speak to parents is advice to supplement their fussy eater’s diet with formula or Pediasure. This advice is generally to increase calories or nutritional intake, or both.
If a child is young and not eating well parents may be told to add in some formula. For reference, children over one year old do not generally need milk in their diet as all the nutrients and calories can be found in the foods we eat.
Formula is an easy way to supply extra calories. It is also very easy to consume and contains all those lovely connections to babyhood, particularly when served in a bottle.
If the child is older the recommendation is more likely to be Pediasure. Again, the philosophy is the same, a child is not gaining weight or missing out on nutrient so Pediasure steps in to cover that gap.
There are of course situations where a medical need necessitates supplementary feeding. For children with very low weight or who are struggling to grow as they are not taking in enough calories this could be absolutely necessary.
I am certainly not advocating going against the advice of your medical professional. However, I seem to be coming across a growing number of families who have a child whose food challenges have not improved – even across several years – and who is reliant on drink supplements.
Supplementing as a short-term solution for weight gain seems different to long-term reliance. Long term use of drinks or formula feel as though they are treating the symptom rather than the cause – unless there is an underlying medical need which makes it essential.
Here we will be discussing children without underlying medical needs that make supplementary drinks essential. It is also focused on ‘picky eaters’, those children who for whatever reason are unable to eat a wide variety of nutrient-dense foods.
Why supplementary drinks may not be the only solution
Supplementing with calorie-rich drinks can be reassuring for parents. Many parents tell me they don’t feel stressed because although their 4, 6, 10-year-old is not really eating dinner, they know they are getting nutrition though their drinks.
Unfortunately, sometimes this can become like headache pills for ongoing headaches. Yes, they help with the symptoms, but they don’t fix the underlying cause. Why someone is getting ongoing headaches in the first place is a key part of finding solutions.
We are also a time poor society and quick fixes can easily become long-term solutions. We keep meaning to reduce the reliance on something but over time it becomes harder and harder to do.
Now I’m absolutely not recommending that anyone immediately drop the formula or Pediasure, but it is good to periodically question how long this has been necessary to do. If it’s been a long time, have other strategies to increase calorific and nutrient intake been evaluated and tested?
I have spoken to families where a 6-year-old is having 6 bottles of formula per day (endorsed by the paediatrican) or a 14 year old is drinking multiple Pediasures.
Unfortunately, in these circ*mstances it’s likely that the reliance on the drinks has either exacerbated the problem or meant eating normally has become more difficult.
If your child is over one year old and is having multiple glasses of milk and you are using it like a supplement, then the same problem can arise. They are replacing learning to like food with a reliance on something fatty, filling, and easy to consume.
With supplement drinks it’s often a question of degree
The more reliant we become on them the less other foods may be added.
There are also many children who don’t particularly like drinks like Pediasure. This can mean parents resort to bribing or cajoling their child to drink them. Pushing our child to eat or drink anything is never a good strategy. It can also mean an already food hesitant child becomes less and less enthusiastic about meals.
Filling the tummy with drinks leaves less room for food and means a child is often less likely to eat widely and well. If children like drinking them it can also mean they ‘hold out’ on dinner or other meals as the drink will be coming.
Or a child may drink them before a meal and so have no interest in eating.
What can we do?
If your child is not severely underweight, then working on the underlying eating challenges is important:
1. Can drinks be offered after food? – prioritise food first. Where we put attention, attention flows! Having set mealtimes with gaps between so a child is allowed to get hungry and then offering drinks after eating can be helpful.
2. Focus on option A – option A is breakfast, dinner, or lunch. Option B is anything that is easier/more enjoyable than those meals. Our focus and our child’s focus needs to be on eating widely and well at these meals.
If eating Option A well is difficult, it’s a process to get to a point where they are able to do this. However, what can make it more difficult is a child knowing Option B is always coming if the meal is ignored.
3. Bulk up on calories – there are other ways to increase calorific intake and if drinks rock then that may be a good place to start. Smoothies can be calorie and nutrient dense.
Moving from a processed drink to a home-made one is not always easy and may take time and effort to achieve. Perhaps an interim step is a drink from the supermarket that is different but a step towards a smoothie.
Introducing new drinks can take time, especially if our child is anxious or rigid around foods. Perhaps it may mean combining a tiny portion of a new drink with the accepted drink, for example.
Over time smoothies can be a great way to introduce both calories and nutrients. Depending on how challenged a child is around food, it may be possible to gradually add fruit, veg, fibre, omega 3’s and a range of nutrients to the drink.
4. New drinks – if drinking is easier than eating, perhaps introducing new drinks is a good place to start. Perhaps it’s hot chocolate or a drinking yoghurt, for example.
Moving to different drinks with different tastes/textures can help a child learn to accept new foods. It’s also great for children who have multiple supplementary drinks a day. Instead of having the same thing they are getting different nutrients.
There are many ways to boost nutrients, even in a very limited diet. I will put some ideas together in a blog shortly.
If you feel stuck in a cycle of supplementing just to keep the head above water in the feeding sphere, feel free to reach out: judith@theconfidenteater.com Having someone walk the path with you can be very reassuring.
Judith, MA Cantab (Cambridge University), Post Grad Dip Psychology (Massey University), is an AOTA accredited picky eating advisor and internationally certified nutritional therapist. She works with 100+ families every year resolving fussy eating and returning pleasure and joy to the meal table.
She is also mum to two boys and the author of Creating Confident Eaters and Winner Winner I Eat Dinner. Her dream is that every child is able to approach food from a place of safety and joy, not fear.
Learn more about Judith here: https://theconfidenteater.com/about/
