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Ron Chapple studios

The question: I have a four-year-old daughter who is a terribly fussy eater. She won't touch meat, cheese, pasta, rice – not to mention vegetables. She's rarely hungry and almost never thinks about food. To look at her, she's thriving. She has lots of energy, is very bright; she's smallish for her age, but she is growing. She also gets a daily multivitamin which is higher in iron than the other kids' vitamin options. Any suggestions?

The answer: I am reassured by many aspects of this story including the fact this child is thriving and has lots of energy. Physicians use special growth charts to plot a child's height and weight to determine whether "smallish" children are growing normally for their age. There are many children who are small but otherwise healthy and this is not necessarily cause for concern.

In my experience preschool children who are growing well but have poor appetites almost always fall into one of two categories, "drinkers" or "snackers." The drinkers consume large amounts of milk or juice or other calorie-containing liquid throughout the day and may also awaken at night for a drink. Classically, these fluids are consumed by bottle or sippy cup. Because the toddler is ingesting so many calories in liquid form, they are not hungry for solid foods at mealtime.

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Similarly, the snacking child will constantly consume what appears to be small amounts of snack food, such as crackers, throughout the day. Although each snack may appear insignificant, over the course of the day the calories add up and can diminish the child's appetite at mealtime.

Many parents find themselves in the vicious cycle of giving their child drinks or a snack in order to make up for their infant's poor eating habits at mealtime. This strategy, of course, only makes things worse.

If your child has a generous intake of liquids, dispose of the bottles and sippy cups immediately and only offer drinks in a regular cup. High-calorie drinks such as milk and juice should be offered no more than three times a day, typically at mealtime. In between meals, if a child is thirsty, he or she should be offered water. If your child likes to snack, create a meal and snack schedule so that your little one will be eating only at predetermined times. In between these times, consider the restaurant closed!

For the record, there isn't necessarily anything wrong with frequent small meals throughout the day, as long as the food choices include options from multiple food groups. If you are worried about your child's growth, visit your physician and ask to have your child's weight and height measured and plotted on a growth chart.

Send pediatrician Michael Dickinson your questions at pediatrician@globeandmail.com. He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail website. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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