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Managing Meal Times

Approximately 25 to 35% of toddlers and preschoolers are described as ‘picky eaters’ by their parents or caregivers.1 Challenges in feeding children are often a cause of parental stress and conflict between child and parents. Parents are frequently concerned that their children are not eating enough to support healthy growth and development. This concern is often unfounded and healthcare providers can help parents/caregivers establish a healthy eating environment for children to promote proper growth and development. 

 

What causes ‘picky eating’

The first two years of life are a time of rapid physical growth in children. After two years of age, growth begins to slow and accordingly so does a child’s appetite; however, many parents view this as a cause for concern that their child is a poor or picky eater. In turn, they may try to bribe, coerce or force their child to eat more, which often causes a child to eat less.1 In reality, the majority of children consume adequate amounts to support healthy growth and development.

Furthermore, some parents and caregivers believe that a child’s height and weight must be at the fiftieth percentile for optimal health. This may cause parents and caregivers to restrict certain foods or pressure children to eat certain amount of foods that can negatively impact the child’s relationship with food. Healthcare providers can review healthy growth and development with parents and caregivers, focusing on the proper use of growth charts in relation to a child’s growth.

Toddlers and preschoolers also start to exert their independence and sense of autonomy, which includes choosing how much and which foods they want to eat, as well as wanting to self-feed. Their appetites vary considerably throughout the day, although their total daily energy intake remains fairly consistent.1 Again, parents and caregivers often view this as a form of picky eating, when in fact it is a normal part of growth and development. Healthcare providers should encourage parents and caregivers to respond to their child’s feeding and hunger cues and listen to their child’s body to help promote lifelong healthy eating habits.1

There are many reasons that a child may not eat: they aren’t hungry, they would rather play, they are trying to get a parent or caregiver’s attention, etc. These are all normal behaviours and do not mean that a child is at risk nutritionally. Children are very adept at regulating their energy intakes to match their energy requirements when allowed to follow their hunger and fullness cues. 

 

How can healthcare providers help improve their patient’s eating habits

Anytime a parent/caregiver is concerned about their child’s nutritional status, a healthcare provider should complete an assessment to ensure there is not an organic cause for the change in eating patterns.1 This is especially important if the change in eating patterns has been very sudden and drastic. It may be important to include a physical assessment to look for any signs of malnutrition.1

In many cases, the changes in eating patterns or concerns about picky eating are not due to an organic cause.1 If this is true, healthcare providers can reassure parents/caregivers that the changes in appetite/intake are normal. Healthcare providers have an important role in supporting parents/caregivers to establish a healthy eating environment.

Establishing a Healthy Eating Environment

  1. Discuss the Division of Responsibility in Feeding. Parents/caregivers are responsible for deciding which, where and when foods are served, while children are responsible for deciding which of those foods to eat and how much to eat.2  Parents/caregivers should provide healthy, age-appropriate meals and snacks.
  2. Parents/caregivers should establish a regular routine that includes three meals and up to three snacks per day at about the same time. These meals and snacks should be consumed at the table as a family, as much as possible, with minimal distractions, like phones and television.
  3. Children often don’t like new foods. It often takes 15 to 20 exposures to a food before a child will accept it, so parents/caregivers should be encouraged to continue to offer the new food even if it is refused.2
  4. Children should not be allowed to ‘graze’ on food and drinks between meals and snacks as this will likely affect their appetite at the next meal or snack. Only water should be offered between meals and snacks.
  5. Children should be allowed to self-feed at meals and snacks. Parents/caregivers should avoid threatening, scolding, punishing, pleading, bribing or coercing food intake as this often has the opposite effect than intended. It also teaches children that they are not able to trust their feelings of hunger and fullness, which can create unhealthy relationships with food.2
  6. Parents/caregivers should be encouraged to establish family meals. Parents/caregivers and other family members can act as healthy role models to help promote healthy eating habits. Family meals should be pleasant and free of any distractions.
  7. Parents/caregivers may need to limit a child’s time at the table to ~20 to 30 minutes. If a child does not eat at a specific meal or snack time, no other food should be offered until the next planned meal or snack.2
  8. Children should be included in all aspects of meals and snacks, such as planning, preparing and cleaning up after meals. Children involved in meal preparation are more likely to have better eating habits.1
  9. Healthcare providers should also discuss the importance of regular physical activity in promoting appetite and healthy growth and development.
  10. Parents/caregivers should be encouraged to avoid labeling foods as ‘good’ or ‘bad’ and should refer to them as ‘everyday’ and ‘sometimes’ foods instead.
  11. Most importantly, healthcare providers can support parents/caregivers in learning to trust their child’s appetite and their ability to consume the amount and type of foods they need to grow and develop properly. 
 
Date of creation: November 28, 2017
Last modified on: January 19, 2020

References

1Canadian Paediatric Society. (2017, January 30). The ‘picky eater': The toddler or preschooler who does not eat. Retrieved from
https://www.cps.ca/en/documents/position/toddler-preschooler-who-does-not-eat
2Satter, E. (2017). Division of responsibility in feeding. Retrieved from
https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/