Comprender las dificultades alimentarias en la infancia sin caer en mitos ni culpas.

Es una escena cotidiana en miles de hogares: un niño que solo acepta unos pocos alimentos, rechaza las verduras, tarda una eternidad en terminar el plato o parece no tener hambre. Frente a esta situación, es habitual que aparezcan la preocupación, la frustración y las dudas.

¿Es simplemente una etapa? ¿Le faltarán nutrientes? ¿Estoy haciendo algo mal?

La buena noticia es que la mayoría de las dificultades alimentarias forman parte del desarrollo infantil y pueden resolverse con un adecuado acompañamiento. Sin embargo, algunas situaciones requieren una evaluación más profunda para descartar problemas médicos o nutricionales.

Las dificultades alimentarias son mucho más frecuentes de lo que imaginamos

Se estima que entre uno de cada cuatro y uno de cada tres niños sanos presenta en algún momento alguna dificultad relacionada con la alimentación. A pesar de ser tan frecuentes, alrededor del 20 % no recibe un diagnóstico adecuado, lo que puede retrasar el tratamiento cuando realmente es necesario. 

Es importante entender que «dificultades alimentarias» no significa necesariamente que el niño tenga un trastorno alimentario. Se trata de un término amplio que incluye distintos comportamientos relacionados con la alimentación y que pueden tener causas muy diferentes.

No todos los niños que comen poco tienen el mismo problema

Existen tres grandes situaciones que los pediatras suelen encontrar.

El niño selectivo

• Es el caso más frecuente.
• Acepta solamente un grupo reducido de alimentos, rechaza probar otros nuevos y muchas veces elimina alimentos que antes consumía sin problemas. Es típico entre los 2 y 6 años y suele coincidir con una etapa normal del desarrollo en la que los niños buscan mayor autonomía y muestran cierta desconfianza hacia los alimentos desconocidos.
• Esto no significa necesariamente que esté desnutrido.

El niño con poco apetito

• En este caso el problema no es la variedad sino la cantidad.
• El niño parece saciarse muy rápido, come pocas porciones y muestra escaso interés por la comida. En ocasiones puede estar relacionado con enfermedades, con etapas de crecimiento más lento o simplemente con un requerimiento energético menor.
• Lo importante es evaluar si ese apetito alcanza para mantener un crecimiento adecuado.

El niño que tiene miedo a comer

• Es una situación menos frecuente, pero requiere atención.
• Algunos niños comienzan a rechazar los alimentos después de haber vivido una experiencia desagradable, como un episodio de atragantamiento, vómitos intensos o dolor al tragar. En estos casos, el rechazo no se debe a que no tengan hambre, sino al temor que les produce volver a comer. 

¿Cuándo una etapa normal deja de ser normal?

Muchos niños atraviesan períodos de mayor selectividad que desaparecen espontáneamente con el tiempo.

Sin embargo, existen algunas señales que justifican consultar con el pediatra:

• pérdida de peso o falta de crecimiento; 
• rechazo persistente de grupos completos de alimentos; 
• comidas que duran más de 30 minutos de manera habitual; 
• atragantamientos frecuentes o dificultad para tragar; 
• vómitos repetidos durante las comidas; 
• dolor al comer; 
• necesidad permanente de distraer al niño para que coma; 
• ansiedad o conflictos familiares importantes alrededor de la alimentación. 

La presencia de estas señales obliga a una evaluación más completa para descartar problemas médicos, nutricionales o del desarrollo. 

El crecimiento cuenta más que un plato de comida

Una de las primeras preguntas que hacen los padres es:

«¿Está comiendo lo suficiente?»

La respuesta no siempre está en lo que ocurrió durante el almuerzo.

Los pediatras evalúan la alimentación considerando el crecimiento a lo largo del tiempo. El peso, la talla y su evolución en las curvas de crecimiento aportan mucha más información que una comida aislada.

Un niño puede comer menos que sus hermanos y, sin embargo, crecer perfectamente porque sus necesidades son diferentes.

Por el contrario, un niño que aparentemente come «bien» puede presentar dificultades si deja de crecer adecuadamente.

Lo que los padres pueden hacer en casa

Muchas veces, con pequeños cambios en la dinámica familiar, la alimentación mejora considerablemente.

Las recomendaciones con mayor respaldo científico incluyen:

• mantener horarios regulares para las comidas; 
• comer en familia siempre que sea posible; 
• evitar pantallas durante las comidas; 
• ofrecer alimentos nuevos repetidamente, sin obligar al niño a comerlos; 
• permitir que participe en la preparación de los alimentos; 
• respetar las señales de hambre y saciedad; 
• evitar premios, castigos o negociaciones alrededor de la comida. 

Un aspecto muy importante es comprender que probar un alimento nuevo puede requerir entre 8 y 15 exposiciones antes de que un niño lo acepte. El rechazo inicial no significa que nunca vaya a incorporarlo a su alimentación. 

Lo que conviene evitar

Con la mejor intención, muchas familias terminan utilizando estrategias que aumentan el problema.

Entre las más frecuentes se encuentran:

• perseguir al niño por la casa con la comida; 
• obligarlo a terminar el plato; 
• cocinar un menú diferente para cada integrante de la familia; 
• ofrecer golosinas como recompensa; 
• convertir cada comida en una negociación. 

Estas conductas suelen incrementar la ansiedad tanto del niño como de los adultos y dificultan el aprendizaje de una alimentación saludable.

¿Siempre hacen falta estudios o suplementos?

No.

La mayoría de los niños con dificultades alimentarias no necesita estudios complejos.

El pediatra decidirá cuándo es necesario solicitar análisis de laboratorio o indicar suplementos nutricionales. Esto dependerá del crecimiento, la variedad de alimentos consumidos, la presencia de enfermedades asociadas y la sospecha de deficiencias nutricionales.

El objetivo siempre será lograr una alimentación adecuada por vía oral antes de recurrir a otras intervenciones. 

El trabajo en equipo marca la diferencia

Las dificultades alimentarias no siempre se resuelven únicamente con indicaciones nutricionales.

Dependiendo de cada caso, puede ser necesaria la participación de distintos profesionales, como pediatras, nutricionistas, fonoaudiólogos, terapeutas ocupacionales, psicólogos o gastroenterólogos infantiles.

Este enfoque interdisciplinario permite identificar las causas del problema y diseñar un plan individualizado para cada niño.

Un mensaje para llevar a casa

La mayoría de las dificultades alimentarias son transitorias y pueden mejorar con estrategias adecuadas, paciencia y acompañamiento.

El desafío consiste en diferenciar aquellas situaciones propias del desarrollo de las que representan un riesgo para el crecimiento, la nutrición o la salud.

Los padres no deben sentirse culpables cuando un niño atraviesa una etapa de rechazo alimentario, pero tampoco minimizar las señales de alarma. Consultar tempranamente con el pediatra permite identificar a los pocos niños que necesitan una evaluación más especializada y evitar que un problema inicialmente pequeño se transforme en una dificultad persistente.

Basado en: Saure C, Zonis LN, González Sanguineti X, Kovalskys I. Dificultades alimentarias en la infancia: una revisión narrativa. Archivos Argentinos de Pediatría. 2024;122(5):e202310200.

Every baby has its own growth rate during pregnancy. However, some are born with a lower weight than expected for their gestational age. These babies are called small for gestational age (SGA).

Although most of these babies grow and develop normally, some require closer monitoring to ensure proper growth and prevent long-term health problems.

What does it mean to be small for gestational age?

A baby is considered small for gestational age when their birth weight and/or length is below what is expected for the weeks of pregnancy. This does not always mean the baby is premature. In fact, many babies are born at term (between 37 and 42 weeks) but are smaller than usual.

It is important to differentiate between babies who are naturally small, due to family characteristics, and those whose growth during pregnancy was limited by various causes.

Why does this happen?

The reasons can be very diverse, and in many cases, more than one factor is involved at the same time. Among the most frequent causes are:

• Alterations in placental function.
• Maternal illnesses such as high blood pressure or preeclampsia.
• Smoking, alcohol consumption or other substances during pregnancy.
• Multiple pregnancies.
• Some rare infections or genetic disorders.

In some children it is not possible to identify a specific cause.

What happens after birth?

The good news is that Between 85 and 90%, babies born small for gestational age experience catch-up growth. during the first two years of life, especially in the first 6 to 12 months.

However, some children do not achieve this recovery spontaneously and may present with persistent short stature, requiring evaluation by specialists.

The importance of nutrition

Nutrition during the first months of life plays a fundamental role.

The breastfeeding It is the best option for most PEG babies, as it provides all the necessary nutrients and offers benefits for neurological development, the immune system, and future health.

When breastfeeding is not possible or is not sufficient, the pediatrician will indicate the most appropriate alternative for each situation.

The goal is to promote healthy growth, avoiding both insufficient growth and excessively rapid recovery.

Why is it important to avoid excessively rapid weight gain?

For many years it was believed that the faster a small baby grew, the better its prognosis. Today we know that this is not always the case.

Excessively rapid weight gain, especially if it occurs during the first few months of life, can increase the future risk of developing:

• Overweight and obesity.
• Type 2 diabetes.
• High blood pressure.
• Cardiovascular diseases.

Therefore, the challenge is to achieve balanced growth, allowing for adequate development without promoting an excess of adipose tissue.

Do they need special controls?

Yes. Children born small for gestational age should be monitored regularly by their pediatrician, who may eventually consider consulting with a specialist in pediatric nutrition.

Each consultation includes the following assessments:

• Weight, length or height and head circumference.
• Growth rate.
• Neurological development.
• Feeding.
• Appearance of associated diseases.

If growth does not progress as expected, further studies may be necessary, and in some cases, consultation with a pediatric nutritionist and endocrinologist may be required.

A message for families

Being born small for gestational age does not determine a child's future. The vast majority grow and develop normally.

Pediatric monitoring, proper nutrition, and regular check-ups allow for the early detection of children who need special attention.

The goal is not for the baby to grow as quickly as possible, but to achieve healthy growth that promotes their present development and health throughout their life.

Fountain

This note was prepared based on the chapter:

Kovalskys I, Mazza CS. Infants Born Small for Gestational Age at Term. In: Koletzko B, Poindexter B, Uauy R, eds. Pediatric Nutrition in Practice. World Review of Nutrition and Dietetics. Vol. 124. Basel: Karger; 2022:338-344. doi:10.1159/000516707.

We are pleased to share the official statement announcing INUMI's partnership with InfoAlimentos, a leading national and international source of information on nutrition and health. This strategic alliance represents INUMI's direct participation within a entity whose objective is the dissemination of scientifically based information, research and academic quality, and which also reaches a representative audience: The InfoAlimentos website surpasses one million annual readers.

«"June, 2026. We are pleased to announce that the Institute of Nutrition and Metabolism for Children and Adolescents, INUMI, is joining the Editorial Board of InfoAlimentos. 

In 2025, the Institute for Scientific Cooperation in Environment and Health (ICCAS) – the civil association that was part of InfoAlimentos from our beginnings – ceased operations. This event, along with the loss of our beloved Scientific Coordinator, Dr. Silvio Schraier, led us to reorganize.

This is how INUMI joins the InfoAlimentos family today. INUMI is a leading center specializing in the nutritional health of children and adolescents, whose purpose is to provide comprehensive, evidence-based solutions to the metabolic and dietary challenges facing new generations. It is built on three strategic pillars: 

– Specialized Clinical Care
– Academy and Training
– Clinical Research

With the arrival of INUMI, we are pleased to announce that Dr. Silvio Schraier's legacy continues, that we retain the valuable participation of the professionals who were part of ICCAS (some of whom are at INUMI), and that the work generated by ICCAS (talks, studies, etc.) remains available to our followers. www.infoalimentos.org.ar, in www.inumi.ar and in the virtual library of www.argenbio.org. 

Thus, InfoAlimentos is currently made up of three institutions: ArgenBio, HA Barceló Foundation e INUMI. To meet the full team, we invite you to visit https://infoalimentos.org.ar/acerca/equipo.»

Fountain: Urban Press

Experts warn that when dietary variety is limited for extended periods, the risk of essential nutrient deficiencies increases, even in children of a healthy weight.

Parents' concerns about picky eating in childhood are often minimized, as it is interpreted as a temporary phase.

However, experts warn that when this behavior persists or becomes very restrictive, it can develop into a problem with real nutritional impact. Among the less visible signs are mood changes and difficulty concentrating, which may appear before any obvious physical alterations.

Scientific evidence indicates that feeding difficulties can be associated with insufficient intakes of iron, zinc, calcium, essential fatty acids and vitamins, even in children of adequate weight.

“Food selectivity is part of development, especially between the ages of 2 and 3, but when it is prolonged or the variety of foods is significantly limited, it can compromise the supply of essential nutrients,” explained Dr. Irina Kovalskys, a pediatrician, nutrition specialist, and medical director of the Institute of Nutrition and Metabolism for Children and Adolescents (INUMI).

For this reason, experts emphasize that attention should be paid not only to how much the child eats, but especially to what he or she stops eating.

It is estimated that between 251 and 401 healthy children experience some form of feeding difficulty during their growth, with pickiness being the most common. Although in many cases it is transient, it may not be, according to studies published in the Journal of the American Dietetic Association and the International Journal of Eating Disorders.

A diverse diet is associated with adequate levels of micro and macronutrients, stable blood biomarkers, and expected evolution in terms of weight and height; however, weight and height alone do not necessarily reflect internal nutritional status.

Warning signs that indicate you should see a doctor

Distinguishing between a transitory stage and a persistent difficulty is key.

Some warning signs include a duration of pickiness longer than three months, fewer than 10 to 15 accepted foods, systematic rejection due to texture, color or smell, excessive eating times or frequent conflicts at the table, and negative impact on family dynamics.

“Rejection based on sensory characteristics, such as texture or color, can be a sign of greater complexity, even associated with difficulties in sensory processing,” Kovalskys adds.

Up to 201% of children with feeding difficulties do not receive an adequate diagnosis, which reinforces the importance of consulting with a pediatrician or nutritionist to promote early detection and take preventive measures, according to the narrative review published in Archivos Argentinos de Pediatría.

Children with feeding difficulties do not meet established recommendations and are at risk of nutritional deficiencies because they do not incorporate adequate amounts of food and beverages, exclude entire food groups, and maintain low diversity in their diets.

A recent meta-analysis published in BMC Nutrition indicates a significant association between lower dietary diversity and a higher likelihood of anemia in children and adolescents, confirming the relevance of dietary variety as a protective factor.

Strategies and a comprehensive approach to addressing selectivity

Overcoming food selectivity requires a progressive and sustained approach, based on repeated exposure to new foods, the gradual incorporation of changes in already accepted preparations, and the building of clear routines around meals.

“It is also helpful to involve the child in the purchase and preparation of food, and to adapt sensory aspects such as texture or presentation to facilitate acceptance. In cases where the variety of the diet is very limited or there is a risk of nutritional deficiencies, a professional evaluation may indicate the use of nutritional supplements as a support tool, while continuing to work on expanding the diet,” suggests Lucía De Nobili, a licensed nutritionist with a master's degree in Maternal and Child Nutrition and a nutritionist at the Ramón Carrillo Hospital.

Infant feeding involves a combination of biological, behavioral, and emotional factors. The approach requires a holistic perspective: growth assessment, dietary history, observation of behavior during meals, and, if necessary, additional testing.

Recognizing the problem and consulting with professionals allows families to be supported with appropriate strategies and to prevent nutritional deficiencies. In this process, the goal is not for the child to eat 'perfectly,' but to build, step by step, a more varied, sufficient, and healthy relationship with food.

Fountain: https://www.infobae.com/salud/

Valeria Chavez – Infoae

Wellness rhetoric sometimes masks a return to unhealthy body standards, according to experts. How to promote a healthy relationship with food and the body from childhood.

There was a time when beauty stereotypes stopped presenting thin bodies as hegemonic and gave rise to what we know as the acceptance of "real bodies".

“You don’t judge other people’s bodies,” adults were supposed to learn, and that’s how new generations began to be raised. However, under the guise of healthy lifestyles, the cult of physical exercise, and the pursuit of well-being, specialists warn that new forms of body obsession are lurking today.

The phenomenon, which permeates social media, the fashion industry, and the medicalization of obesity, is causing concern in consulting rooms, where specialists are increasingly reporting how the discourse has changed from "I want to be thin" to "I want to reduce inflammation," "optimize my metabolism," or "eat clean.".

A return to the cult of thinness disguised as health?

According to pediatrician Marisa Armeno (MN 108.583), a specialist in child and adolescent nutrition and member of the Argentine Society of Nutrition (SAN), “today extreme thinness is no longer presented as an explicit aesthetic ideal, but as a supposed health objective.”.

When consulted by Infobae, the specialist described what she observes in her daily practice: “Unnecessary restrictions on food groups, an irrational fear of carbohydrates, prolonged fasting without medical advice, or ever-growing lists of 'forbidden foods'.‘ According to her, all of this ’is legitimized with pseudo-scientific language. The problem isn't the pursuit of health itself, but when that pursuit becomes rigid, obsessive, and disconnected from the evidence.”.

From the perspective of psychiatrist and member of the Academy of Eating Disorders, Juana Poulisis (MN 97.898), “there is a reconfiguration of the cult of thinness, and it is presented under the guise of well-being and a healthy lifestyle.” Poulisis noted that in clinical practice, “everything is hyper-focused on body composition: whether there is a sufficient percentage of fat, muscle mass, and very rigid behaviors, such as eliminating food groups like carbohydrates. Extremely thin, but fit, bodies are idealized.”.

For her part, pediatrician and nutrition specialist Irina Kovalskys (MN 80.503), a member of the SAN and medical director of the Institute of Child and Adolescent Nutrition and Metabolism, stated that "the cult of thinness has persisted, especially in areas such as fashion, advertising and certain social environments," although she acknowledged that there is also greater awareness of body diversity and the recognition of eating disorders.

Behaviors and warning signs: where is the limit?

The rise of the fitness lifestyle can serve as a socially validated mask for eating disorders. Armeno warned: “The fitness lifestyle can be a perfect mask for an eating disorder because it’s socially validated. No one questions someone who works out every day, weighs their food, or avoids certain foods, even when those behaviors are extreme.” The specialist clarifies: “Eating healthy is not the same as being afraid to eat. Working out is not the same as feeling guilty if you don’t.”.

Kovalskys pointed out that “obsessions can manifest in many ways, but in the case of food, there is a clear line between self-care behaviors and rigid, extreme patterns.” She elaborated: “This ceases to be healthy when behaviors such as systematically avoiding social situations due to an inability to control eating, feeling intense guilt for not adhering to the plan, or dedicating an excessive amount of time and thought to food and exercise appear.”.

Poulisis agreed with them, stating that "the fitness lifestyle is totally validated and not criticized, but the limit lies in the degree of rigidity, how much anguish, how much dissatisfaction there is, how much time this type of healthy life takes the person, how much it impacts their social and emotional life.".

The use of drugs to treat obesity is generating debate due to their off-label use within the context of these new ideals. Poulisis emphasized that these medications "have a perfectly legitimate role in the treatment of obesity, which is a metabolic disease, and the truth is that they are wonderful for this when properly indicated." However, he warned about off-label use: "The problem is when patients go directly and buy them because a prescription isn't required, or when they are injected at a cosmetic clinic. Their use has become completely trivialized.".

Armeno added that “drugs are not the problem in themselves. When properly prescribed, they are a valuable therapeutic tool for a chronic disease like obesity. The problem is their off-label use and the message surrounding it. Today they are used as a cosmetic shortcut, not as a medical treatment. And that reinforces the idea that the body can be quickly modified, pharmacologically, to meet a certain standard.”.

Along the same lines, Kovalskys clarified that “the problem is not scientific advancement, but its inappropriate use. Patients who use these medications without a clinical indication could not only appear thinner, but also become malnourished, lose lean mass, and experience unnecessary health complications.”.

Social media and digital culture as amplifiers of the body ideal

Social media and the fashion industry amplify and rapidly disseminate these body ideals. According to Kovalskys, “social media can be especially harmful during adolescence, a highly vulnerable stage, due to exposure to unrealistic beauty ideals that impact self-esteem.” Armeno added that “algorithms tend to reinforce extreme content, not nuance. Restrictive diets, very thin bodies, intense routines; that gets more visibility than a balanced approach, which is what we specialists advocate in our practice.”.

Poulisis defined social media as “an echo chamber that constantly amplifies the ideal body image. It's constantly making us feel like our self-esteem is terrible, constantly generating comparisons.” Although she acknowledged that the fashion industry is showing some progress in size range, she considered that “we haven't yet achieved what we see, for example, in the United States, where there is truly a wide range of sizes.”.

Was there real progress towards body acceptance?

Regarding the acceptance of diverse bodies, Poulisis recalled that “there was indeed a great deal of visibility about it on social media, but it wasn't achieved. This concept was somehow reabsorbed by new ideals such as the fit body, being strong but thin.”.

“The reality is that the scope of body diversity has ceased to be visible, I would say especially this year,” the psychiatrist reinforced.

Armeno agreed and pointed out that “there was a moment—mainly driven by movements like 'body positivity'—where body representation expanded. But I think it was more discursive than structural. What we are seeing now is a reaction, a digital culture that is once again rewarding extremely thin bodies, but now with a narrative of 'well-being'.‘.

Kovalskys added that “knowledge about the impact of extreme thinness on health has increased in recent years, as have initiatives to reduce body stigma. These transformations are not linear and coexist with reappearing trends.”.

Keys to promoting a healthy relationship with food and the body in children and adolescents

The role of adults is fundamental in preventing and addressing eating disorders in childhood and adolescence. Kovalskys pointed out that “a healthy relationship with food is built gradually, with adults as role models and organizers of the food environment.” She maintained that “factors such as a healthy weight, respectful environments, and enjoying one's body for its function act as protective factors.”.

Armeno emphasized that “children learn from what they see, not from what we tell them. Comments about body image, diets at home, classifying foods as 'good' or 'bad'—all of that has an impact. Children aren't born with prejudices about food: they learn them.‘ Among the key elements she mentioned (for promoting a healthy relationship with food and the body from childhood) are ’offering structured but flexible meals, avoiding focusing the conversation on weight or appearance, and encouraging internal awareness of hunger, satiety, and enjoyment.‘.

In turn, Poulisis recommended that “you don’t talk about other people’s bodies, don’t talk about other people’s plates,” since all these comments “are predisposing factors for an eating disorder.” The psychiatrist emphasized the importance of “helping children understand the signs of hunger and satiety, encouraging them to exercise as something enjoyable and not as an obligation, and being very attentive to red flags when rigid, restrictive, or extremely anxious behaviors toward food begin to appear.”.

In closing, the specialists agreed that critical education and psychoeducation are key tools to counteract the influence of networks and media, and to build a sustainable and respectful relationship with food and the body from childhood.

Fountain: Chavez, V. (2026, April 13). The obsession with thinness takes on new forms: "Eating disorders can be hidden within fitness culture"«. Infobae.