7 steps to help the child who won't eat

Nutrition4Kids is privileged to have Bailey Koch on our advisory board and as the author of several blogposts and informative tables that help to clarify very important points in childhood nutrition. And as an Atlanta-based registered dietitian and a certified specialist in pediatrics, she has much to teach us about how to best feed children, even those who don't want to eat. --Dr. Stan

When we see so many children that are overweight, it's almost a surprise to know that there are a host of children who don't eat well. Some are filling themselves up through the day so they have little room for actual meals; others are too busy to eat, while another group lacks an appetite or has developed an actual fear of eating (food aversion). There are a number of things parents can try, no matter the cause:

CONSISTENT FEEDING SCHEDULE:

3 meals + snacks. All meals and snacks should be separated by 2-4 hours. NO GRAZING (allowing them to eat small amounts whenever they want)!

Children who are constantly munching or drinking don't take in much (and that's usually junk food, with little nutritional value) and all of that food keeps them satisfied enough that they rarely want their meals.

DURATION:

Meals should last between 10-30 minutes, generally. Children with physical impairments can spend up to 45 minutes. Set a timer if needed.

Lingering longer seems to lessen their interest in eating, not increase it--and only a little extra is consumed -- or it turns into food play. On the flip side, kids need to know the difference between meal time and play time. Five minutes is not long enough for meal time.

ENVIRONMENT:

Consistent eating area, devoid of distractions, restricted to people that are eating.

It's best if the television and screens are turned off. If that seems boring by comparison to their constant activity, strike up an interesting conversation the children can participate in.

DECREASE EMPHASIS ON EATING:

No coaching, begging, bargaining or force feeding.

It's OK to lightly praise child for trying new foods or eating more than usual. You can also insist that there's no room for cookies/snacks, etc. if there's no room for their vegetables or main course.

SOLIDS:

Offer 3-4 food groups per meal plus 1-2 food groups per snack. Keep the portion size of each appropriate for age (1 portion = size of 1 of child’s fist). Do not offer alternatives or more of favorite food if the child refuses certain of the offered items. If the child does refuse any or all of their meal or snack, then they must wait until the next scheduled meal or snack.

Of course, this has to be the same for everyone at the table (parents included). A child won't be able to understand why its important for him eat his broccoli if Dad doesn't eat his and gets more mashed potatoes instead. Also, if you give a large portion of the child’s favorite food then there will be no reasonfor them to try the other foods.

CLEAR LIQUIDS:

No liquids during 30-60 minute windows before and after solids are offered. Limit juice to 4 ounces per day of 100% juice (and that can be diluted with water).

Allowing the windows before and after solids helps ensure the liquids don't depress the child's appetite. When we want to help people lose weight, we often suggest they drink water or vegetable juice before a meal to cut their appetite and intake at the meal.

MILK:

Offer with meals/snacks--towards the end, after the majority of the meal. Too often children will drink so much of their milk, they don't have any need to eat the other foods.

You can also offer water, but water has no calories, so it's not appropriate when encouraging weight gain.

Bailey Koch, RD, CSP, LD 07 July 2014

Bailey Koch is the President of Atlanta Pediatric Nutrition, Inc., which provides nutrition services to pediatric physicians’ practices and provides consulting services to food companies and researchers. Bailey serves on our Read More

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