19 month old - won't eat meat or iron rich foods. Losing weight

[howdoyoulikethemweeds]

My 19-20 month old has had been through the wars recently - cold after cold and some mild illnesses such as hand, foot and mouth and bronchiolitis. Each time she is ill she barely eats and wants only breast milk or junk food. 2-3 weeks ago, she had (I think) bronchiolititis and her appetite, which was never big, really went down and is not recovering. She now won't eat any meat or any vegetables and I am really concerned, both about the calories she is consuming (I still breastfeed her, but even that seems to have gone down) and potential vitamin deficiencies - particularly iron.

I spoke to the health visitor about 6 weeks ago about how much breastmilk she was having and that she treats breast milk as her main food and food as an optional extra, and was told her diet seemed ok and to swap breastmilk for cows milk in a cup and basically that it would probably resolve itself slowly, but at the time she would eat fish, steak, and chicken so there was little concern about iron deficiency. Now she won't.

She has a cold again this week and I've offered her roast chicken, chicken soup, lamb, turkey meatballs, steak, chicken nuggets, fish fingers. She tried the roast chicken and spat it out and ate one bite of a chicken nugget today. The rest she refused to even try. She will eat a small amount of pasta in butter, plain rice, cheese, sometimes bread. She is generally happy to eat junk food like biscuits or chocolate. She sometimes tries food but spits it out rather than swallows it, she will also sometimes eat a novel food - such as cheerios this week, but then won't eat it if I offer it again.

I weighed her today and she is 10.2kg and was 9.25 at 1 year. Her stools have never really been consistently firm, but I always took this as being that she had so much breastmilk, she currently has a small amount of movicol each day as she had been stool withholding a bit (started that this week). Her development otherwise seems fine.

I tried to get a GP appointment last week and instead was booked in to a nurse, who couldn't offer any advice other than to weigh her weekly and wait until February for a blood test to see if she is anaemic.

I am really worried and would appreciate some advice.

When she’s ill I’d offer lighter foods like boiled/scrambled egg and a bit of toast. Don’t overface her, just a quarter of a piece of toast with no crust.
or maybe a wafer thin slice of cheese and a wafer thin slice of apple. Small and often.

This is all bog standard toddler eating stuff, you really don't need to be worrying but appreciate that is easier said than done. Almost all of them go through a beige stage, it just lasts longer for some than others. Not unusual for it to go on for years. She'll be fine. Try and get a child multi vit in her every day as recommended and otherwise just keep offering a range of foods alongside stuff you know she is more likely to eat. Personally I'd wean her from the BF as it sounds like it's part of the issue but that's up to you of course. And just as a gentle reminder, no one needs to eat meat to have a well balanced diet!

I can only speak for us but when our daughter is ill most rules go out the window and it's just get whatever we can in her. If that's just 5 pieces of toast all day, so be it. Fluid is most important when they're ill, food you can just let them eat what they want but a few days with a smaller intake won't hurt.

It's not been a few days, it's been weeks.

Egg yolk is a good source of iron. You could give egg custard and add egg yolk to cheesy pasta.

As a household we used to eat less meat, but she won't eat any vegetables apart from corn on the cob, any legumes, lentils or tofu. So I increased the meat to ensure she got enough iron.

I’d be looking to stop the BF to make her hungry for food. But that’s up to you.

She won't eat eggs or cheesy pasta. Just plain pasta with butter and a little cheese on top. I can try custard again but she refused to try it when last offered.

Make smoothies with frozen banana, whatever fruit she likes and baby spinach.

Make bean dips. Dips are incredibly successful for this age. Doesn't matter what they are using for dipping, it probably won't get eaten anyway. You can purée all kinds of things with the beans, whatever flavors she likes.

Don't worry too much, toddlers don't really eat unless they're about to have a growth spurt. It comes and goes. All my kiddos ate voraciously around a period of rapid growth then ate practically nothing in between. Very healthy eaters too, no pickiness at all, just ate on demand basically. So just remember it's normal, don't try too hard (they can sense that and it will get worse lol) and just keep offering.

She won't tolerate any sauce apart from ketchup, but this has to be on the side, not on the food. She won't eat bolognaise or chilli con carne, which were lifesavers with my older daughter.

Christ why do they still peddle the swap breastmilk for cow's milk stuff, what is that supposed to help with?? At least the breastmilk has iron and other stuff in it.

Some breastfed toddlers do seem to do this. Anecdotally they seem to start eating properly by the time they are two.

I do agree with the others that not eating is par for the course when they are ill, and while it is a bit hair raising when they go through the winter that they seem to be ill non stop for weeks, they do seem to come through it OK.

I don't think that anyone is likely to refer you until she has got over the current cold.

Have you looked into ARFID?

Also are you trying to feed her or do you let her feed herself? Encourage the independent eating, don't try to intervene. Give her utensils and let her use her hands if she wants.

Buy some pediasure

There’s a possibility that she’s got more particular about what she will eat and it has just coincided with her being well. My eldest ate a big variety of food and then aged a bit younger than your one he started decreasing the range of what he ate. Concentrate on healthy sh stuff that she will eat. Consider vitamin drops. You could try speaking to your health visitor (if you are in the UK).

Can you get a blood test for iron levels? There's a illness which causes excessive iron levels called Heamochratosis so it'd be worth checking

Our toddler (2.5 yrs) is the same but not had any illness. She hates nuggets, won’t eat any kind of chicken now. Won’t really eat meat. Won’t eat sandwiches.

she’s going through a phase where she will only eat plain pasta with peas and a little grated cheese, apple, broccoli (occasionally), baby bells or pizza. She will eat a multi grain cereal and yogurts but only the tube yogurts which I’m sure are full of sugar. She used to be a really good eater.

i think part of the problem is her snacking. So we have cut it down and the eating has improved. Children won’t starve themselves but sometimes you just have to let them eat what they will eat if it’s a phase.

i would say stop the breastfeeding as that could be contributing to the eating less as she will be fuller

You can take iron tablets and that will increase iron in your breast milk. They also make gummy bear vitamin supplements for toddlers with iron.
https://www.hollandandbarrett.com/shop/product/bioglan-smartkids-iron-with-vitamin-c-strawberry-flavour-gummies-60033656?skuid=033656

I can understand how hard it is when they have been ill with one thing after another. As others have said get a good multivitamin in her.

My daughter is 5 now. She has never liked or eaten meat. She also went through the dreaded beige stage from 2.5 to 4 and it was so hard to get anything other than pasta with butter and parmesan, cereal and yoghurt into her. Now she is back to happily eating eggs and (occasionally) white fish again. Broccoli, peas and carrots are easy wins too again where for a while she wouldn't touch them. She breastfed to 4.5 and I was always so glad that she was getting at least some nutrients that way so I let her keep going as long as she wanted. Top tip - dried apricots are iron rich if you can get her to eat those. Iron absorption is aided by vitamin C too, so if you can get her to drink some fresh orange juice or eat an apple alongside the dried apricots, even better. Likewise if you can hide green veg in a blended soup.

I would say if you can get a multivitamin, breast milk and some pasta into her then don't panic yet. You could maybe ask her health visitor for a referral to a dietician if she carries on this way.

Strange. My post was hidden. I did post a link to Holland and Barret gummy vitamins with iron for kids aged 6mos and up.

You can also take iron tablets which will increase the iron in your breastmilk.

My ds is really picky. We did get an appointment with a dietician but tbh they just said let him eat whatever he will eat and continue to offer other food without pressure. It was only by phone they never even saw him. He doesn't eat any veg or fresh fruits or meat. Our relatively recent win is fish fingers and even then it's hit and Miss.

French toast is a good one. I can get 3 eggs soaked into 2 rounds of bread. We served with whipped cream and a few sprinkles on top - cream helps with weight gain.

Smoothies and milkshakes are great.

A chewy multivitamin every day.

Honestly the only dinners he really eats is fish fingers and chips, plain noodles or pasta with butter, margarita pizza (homemade) and egg fried rice but more often than not it's tiny portions and a fair amount of encouragement.

(Dd is 2.5 years younger and she eats everything and anything. She much prefers a "proper" dinner - meat, potatoes and veg etc - she's 2. I think it just depends on the child)

ARFID is super extreme as far as I know - I knew a young boy who had it and he would only eat frozen food - as in frozen undefrosted peas.

I'm really hoping this settles down as other posters say it will.

@howdoyoulikethemweeds you don't need to worry about iron levels. She will be fine. Do you usually worry excessively? I don't mean to be rude but you are making a drama out of something that is such a common place toddler behaviour. Plenty of children live on bread, pasta and cereal for years and turn out absolutely fine. Worrying about it is probably just going to stress her out and make it worse. I'd really try to relax and go with the flow more. My Child Won't Eat is a good book for reassurance.

ARFID is avoidant/restrictive food intake, so would include diets that restrict entire food groups or only eating a couple of specific items in any food group.

I wouldn't jump to ARFID yet anyway because as you say, she keeps getting viruses and that is normal to disrupt eating/appetite. It was just what you said about her basically only eating corn on the cob and buttered pasta, ketchup not being allowed to touch, no meat/fish, spitting things out instead of swallowing, only rarely trying novel foods. If that is a pattern which continues then it might be worth asking for referral to a dietician.

However do not stop breastfeeding. It is unlikely to help. People suggest this because they think it is like formula, it isn't.

What she will eat has really narrowed, over say 2-3 weeks since having bronchiolitis. My elder daughter and her have always had really different tastes in foods, so its been difficult to get the balance right in terms of pleasing them both, especially as my 4 year old is alot more vocal - this has probably played a part in her restricted diet - I remember my 19 month old eating omelette and risotto and potatoes sometimes at a year - but my 4 year old doesn't like them so we just don't normally eat them at home.

I think you are right that it is not ARFID but will monitor. She doesn't show signs of anxiety over food that I'm aware of. When I say ketchup can't touch the food, I mean that she won't be enticed to eat a food if it has ketchup on.

She struggled with swallowing at weaning too, but this gradually improved and her speech is fine, so wasn't too concerned and never sought a referral.