My 18-month-old son rarely sleeps through the night and eats little in the day.
My son only sleeps through the night (he will wake at approx 6am) when he is about to experience a cold or virus (usually 2 days prior). The doctor has stated he is prone to allergies etc, minor illness appears to be quite common approx every 5 weeks.
He wakes on average 3 times per night (Until recently it could be 6/7). He eats very little although quite often. He refuses meat, eats little fruit and veg [I have therefore introduced Innocent smoothies] and has little interest in food in general.
He is an extremely active child, ‘a hard work baby’ as his grandma calls him, rarely sits still, always on the go. He attends nursery 3 afternoons per week (1.30pm – 6pm) and is regarded as the most active child there; others appear sedate in comparison. I work 30 hours per week, childcare is shared with grandma. I always put him down for his morning nap, although two nights per week, grandma completes the bedtime routine: bath, change, bottle, bed approx 7.30pm (this appears to make no difference to his waking night).
On a typical day he will eat a slice of apple,1/4 piece of toast, few mouthfuls of yoghurt, 1/2 slice of bread, 1/2 oz cheese, 4 grapes, 10 organic puffs, slices of orange, sausage roll, raisins, 1/2 slice bread, 1/4 cereal bar, 6 grapes.
He will have an Innocent smoothie made with 4ozs juice at 8am, 10.30am 4ozs cows milk diluted to 10oz with water, 12.30pm Innocent smoothie, 2pm water, 4.15pm diluted juice, 6pm water, 7.30pm 10ozs full fat organic milk, 10.30pm 2ozs organic milk diluted to 10ozs, 3am the same, 6am the same.
I would be grateful for any advice you may be able to offer with regard to increasing his solid food intake and improving his sleeping pattern. I assume, perhaps wrongly, that his lack of unbroken sleep during the night results from this.
In order to increase your son’s appetite for solid food he will need to decrease his fluid intake. As his milk is watered down, the amount of fluid he is receiving in the course of the day and the night is around 58 fluid ozs. He will not be hungry whilst he takes in this much fluid.
There are two case studies of Gina’s which would be worth looking at to see how excessive fluid and/or milk intake affects appetite and the range of foods a child will accept. P54 Benjamin 23 months in The Contented Childs Food Bible and p135 Rachel 17 months The Complete Sleep Guide.
Obviously you are aware that your son does not eat much and so give him milk and Smoothies to help this. Cutting back will take time and patience. The amount of fluid which he is drinking throughout the night is affecting his appetite throughout the day. Cut back on the amount of fluid he receives in the day first as this should help to increase his interest in food.
Begin by offering him his first drink of cows milk at 10.30am diluted only to 8ozs and over a period of days reduce this down until he is receiving 4ozs of milk undiluted. This should be from a cup and he could be offered a piece of fruit to have with it as a healthy snack. Before offering a smoothie at lunchtime prepare a small healthy meal of cheese pieces, slice of bread and grapes. If he eats these then offer the smoothie or begin to replace it with a small amount of yogurt.
To begin with keep the portions small as too much on a plate will overwhelm a small child. Once you feel he is hungrier at mealtimes begin to widen the range of foods. Try easy things such as pasta and rice which can be made colourful with small diced pieces of vegetables, or sauces made from vegetables and offered with grated cheese. It will take time and thought to find things to tempt him. Make each meal as attractive as possible and keep the portions small. It is very tempting once a reluctant eater shows interest, to start giving bigger portions or to keep offering more. Don’t push him too hard, but once he says he has had enough and wants to leave the table don’t give him anything else until his next meal or snack time. If possible eat one meal a day with him and offer him the same food as yourself. The social aspect of meals is important. Your son may be more willing to try different foods if he sees yourself and grandma enjoying them.
Decide when your son is to have his main meals and snacks. He should have set times rather than eating small amounts throughout the day. If he refuses what is offered to him then remove it and do not give him an alternative. Tell him he can have something to eat at his next meal or snack time. You may well meet with resistance from him to this change in his routine but it will help him be hungry at mealtimes, especially once his fluid intake has decreased. Although it will take time to widen his tastes he will begin to eat more at mealtimes when he is not so full from fluid.
Once you begin to see an improvement in his daytime eating and reduced the amount of fluid he takes begin to do the same with the fluids given at night. Cut back on both the milk and the water used to dilute it until he is being given 1 oz of milk diluted with 1-2 ozs of water. Again you may have some disturbed nights as he will no longer be settling himself with a large drink. If this is being given in a bottle it needs to be replaced with a cup once down to a small amount. To get him to settle without any drink at all you will probably have to put some controlled crying into place and have a few more disturbed nights until he learns how to settle back to sleep without the need of a drink. When you have managed to eliminate the night feeds replace his bedtime bottle with a cup. This will bring his daily fluid intake more in line with a child of his age who needs 2 pints. This amount includes all milk, juice, soups, jellies, ice-cream, fruit and vegetables.
You may find that once his appetite improves his active behaviour may begin to settle as well. Children who are missing vital nutrients from their diet can display signs of hyperactivity.