Clinical summary
The starting point of any nutritional assessment is the growth curve. Poor appetite, constipation and iron deficiency frequently influence one another. Diagnosis and treatment are guided by feeding history, examination and, where needed, laboratory tests.
Complementary feeding
Breast milk is the only recommended nutrition for the first 6 months. From around 6 months, complementary foods are introduced after assessing the infant's developmental readiness (sitting with support, head control, interest in food).
New foods are introduced one at a time, a few days apart, so that any reactions can be identified. Including iron-rich foods early in the plan is particularly important. Cow's milk should not be given as the main drink and honey should not be used before one year of age.
Poor appetite and picky eating
After the first year, appetite often decreases as growth velocity slows — this can be physiological. Picky eating behaviour is common at this stage.
What matters in assessment is the trajectory of the growth curve, daily variety of foods, meal structure, the amount of milk or sweetened drinks between meals, and the duration of meals. If the growth curve is progressing appropriately, the approach is usually behavioural.
Questions we ask in the clinic
- How much milk or dairy is consumed per day?
- What is the gap between meals, and what is the snacking pattern?
- Do meals last longer than 20–30 minutes?
- Is there screen use at mealtimes?
- Is there accompanying constipation or abdominal pain?
Iron deficiency and anemia
Iron deficiency is the most common nutrition-related deficiency of childhood. It can affect not only blood values but also growth, attention and general energy levels.
Risk increases with preterm birth, low birth weight, excessive cow's milk intake, an iron-poor diet and periods of rapid growth. Symptoms can be insidious: pallor, tiring easily, poor appetite, irritability or reduced attention span. Some children have no symptoms at all, which is why screening tests may be performed at routine visits.
Treatment is planned by the physician; dose and duration are individual. Response to treatment is confirmed with follow-up blood tests. Taking iron supplements haphazardly or for longer than needed is not recommended.
Constipation
Constipation is common in children and usually functional. Painful defecation leads a child to withhold stool, which in turn hardens it, creating a vicious cycle.
The approach combines adjusting fluid and fibre intake, structuring toilet habits (particularly sitting attempts after meals), and medication support where advised by a physician. Blood in the stool, weight loss, abdominal distension or severe constipation starting in early infancy require further assessment.
Growth problems
Poor weight gain, slower-than-expected height growth or a marked drop in the percentile curve may relate not only to nutrition but also to chronic illness, absorption problems or hormonal causes. Assessment therefore relies on the trajectory of the curve over time rather than a single measurement.
Well-child visits, growth and development
When is assessment needed?
Situations where medical assessment is recommended
- A marked drop in the percentile curve or weight loss
- Marked pallor, tiring easily, reduced activity
- Persistent constipation, painful or bloody defecation
- Difficulty swallowing, gagging, recurrent vomiting
- Rash, swelling or breathing difficulty after food
- Refusal to feed in an infant under one year
Related content
- Newborn and infant follow-up
- Well-child visits and development
- Parent Health Guide
- Frequently asked questions
Frequently asked questions
When should complementary feeding begin?
The general approach is to start at around 6 months, also taking developmental readiness into account. Timing may differ depending on gestational age, growth curve, allergy risk and the individual situation.
How can I tell if my child has iron deficiency?
Iron deficiency can be insidious. Pallor, tiring easily, poor appetite, irritability and reduced attention span may occur; some children have no symptoms. Diagnosis is made with blood tests and treatment is planned under medical supervision.
Is fibre enough for my child's constipation?
Fibre and fluid intake matter but may not be sufficient alone. Painful defecation leads to withholding, creating a vicious cycle. Treatment usually combines diet, toilet habits and, where needed, medication.
My child eats very little — should I give vitamins?
Vitamin and mineral supplementation is not routinely recommended without an identified deficiency or risk. Whether it is needed is determined from feeding history, growth curve and, where necessary, laboratory results. Vitamin D supplementation is routinely recommended by age.
This content is provided for general information purposes and does not replace individual medical assessment, diagnosis or treatment.
