My child won’t eat!

I hear from worried parents often that their kids won’t eat. There are many reasons for this. Usually as long as a child is hydrated, gaining weight appropriately, and getting a variety of nutrients, I’m not worried.

Some reasons kids don’t eat:

They’re really getting enough food, parents just have unrealistic expectations.

This is very common.

Portion sizes are smaller than many parents think. They vary with age and size of a child as well as his activity level. If your child is growing well and has plenty of energy throughout the day, why should he eat more?

Kids tend to eat small meals frequently and even on holidays they don’t overeat like the adults tend to do.

When offering snacks, think of them as mini meals to help balance out the nutrients of the day. Don’t let them snack all day long though or they’ll never really be hungry.

Schedule meals and snacks and allow water in between.

We have an obesity epidemic in this country, so if you’re comparing your child to another child, chances are that your thin child is healthy and normal, but the other one is one of the 30% who is overweight.

Or maybe not.

It doesn’t matter. Just be sure your child is getting a proper variety of nutrients. Parents can choose what foods are offered, but kids should determine how much to eat.

Talk to his doctor about growth at regularly scheduled well visits (more often if you’re concerned) to be sure it’s appropriate.

They’re sick and it’s temporary.

When kids are sick they lose their appetites.

This is normal.

It usually returns with a vengeance when they’re feeling better. They need to drink to stay hydrated and can eat what they feel up to it, but don’t force it. See their doctor if you’re worried.

It’s a new food and they just aren’t sure yet. 

I encourage that kids over 3 years old take one bite of a food.

Kids often hear me say, “taste a bite without a fight.” The bite needs to be enough that they taste it. If they like it, they can keep eating. If they don’t want more, resist trying to convince them to eat more.

Allowing them to take ownership of the decision of what to eat empowers them. Kids like power, right. Give it to them while modeling healthy eating behaviors yourself. They learn from what you do, not what you say — and not from what they’re forced to do.

When preparing a new dish, include familiar foods they like to balance out the meal so they can enjoy at least something on the plate.

They’re picky eaters.

Aren’t they all?

Most kids go through phases where they love a food, then they suddenly dislike it. They might dislike a certain texture or a whole food group. While there are kids with real problems eating, most picky eaters can be encouraged to eat a healthy variety of foods as described above.

Some children really suffer from being overly restrictive. Children with autism, sensory problems, food allergies, and other issues are not included in this “typical” picky eater category.

A great series of blogs on picky eaters (typical and more concerning) is found on Raise Healthy Eaters.

They’re more interested in something else. 

Make meals an event in itself.

Sit together and talk. Turn off the television. Put away your phone.

Have everyone focus on the meal, which includes the food and the conversation. Try to keep the conversation pleasant and not about the food. Take the pressure off eating!

They’ve filled up already.

If kids have access to snacks all day, they won’t be hungry for meals.

Make sure they have set meal and snack times, but no foods between. They’ll come to the table hungry if they haven’t snacked all day.

Some kids drink too much milk, juice, or other calorie-filled drinks. While it might seem that milk or juice are healthy, the reality is that they do not have a variety of nutrients that our kids need. Milk at least has protein, but it’s missing iron and other key nutrients. Juice is mostly sugar and really should be avoided. Don’t let your kids fill up on drinks.

When they’re hungry, they’re more likely to eat what’s offered.

A medicine makes them not hungry.

Some kids take medicines that decrease their appetite.

If your child is on one of these, their physician will need to follow their growth carefully, but it doesn’t automatically mean they shouldn’t take the medicine. Most kids can get the calories they need for healthy growth despite these medicines.

In summary…

In general, parents should choose what foods kids are offered so that there’s a balance of nutrients, but kids determine how much they eat.

If they’re hungry, they’ll eat. If they’re not hungry, they shouldn’t eat. Learning to eat when not hungry is something that causes many of us to struggle with weight. Most kids are able to limit intake to needs. Don’t force them to change that great quality!

If you’re worried about your child’s appetite, talk to your pediatrician. The physician will need to see your child to check the growth pattern and to examine him or her for signs of illness. Labs are usually not needed, but can be done if there are concerns for some medical conditions. Medicines are rarely used to stimulate the appetite.

For more, see my related blogs:

If your child doesn't eat as much as you think he should, check out this list of possible reasons.
If your child doesn’t eat as much as you think he should, check out this list of possible reasons.

Distracted Eating

We all do it sometimes. We grab a snack and plop down on the couch to watch a movie. Before we know it the whole thing is gone. We only meant to eat some of it, but downed it in one sitting. That is distracted eating at it’s finest. It exemplifies the problem of eating without intention. Not eating because of hunger. Not even eating healthy foods usually. Just eating because it’s there.

What happened to sitting around the table and eating as a family without the tv or cell phones?

What is distracted eating?

I see many kids who always have distracted eating. Parents often worry that they’re not eating enough, but they’re typically getting too many unhealthy foods.

Distracted eating is eating when your mind is elsewhere. It’s the opposite of intentional eating, where we enjoy our meal and make smart choices about what and how much we eat.

It occurs when kids are distracted by a television or video game while eating. When any of us eat in front of the screen, we don’t focus on what goes into our mouth.

Or when parents allow kids to carry food around the house all day and take a bite here and there.

It can happen when any of us eat because it’s there and we aren’t listening to our body’s hunger cues.

Dream feeding

The youngest distracted eaters might fit into another category all together, but they certainly aren’t intentionally eating. These are the babies who parents “dream feed” – basically feed them while they’re sleeping.

This can be because parents think they don’t eat as much as they should when they’re awake. Or maybe parents want to get one more feed in before they go to bed so baby will let them sleep.

I know many parents rely on it, but I will never recommend it for many reasons.

  • It can disrupt their normal sleep cycles if you feed during periods of deep sleep.
  • Dream feeds also feed a baby who might not be hungry or need to eat. It’s hard to know when to stop.
  • After the first 4-6 months most babies don’t need to eat at night, but they are trained to eat at that time.
  • Once they get teeth it can increase the risk of cavities if they eat without brushing teeth before returning to sleep.
  • There are also risks of choking, though if they’re being held, it won’t go unrecognized. A parent can use CPR techniques to help them.

Constant snacking

As kids move into the toddler years, they often become picky with foods and eat small volumes. This is normal.

Parents need to offer healthy foods and feed small frequent meals. Think of snacks as mini meals so you will offer healthy foods – and no, goldfish crackers are not healthy foods. Young children tend to eat about six small meals a day. Each meal offer either a fruit or a vegetable and a protein to help ensure your child gets enough of these food groups daily.

Unfortunately, some parents solve the “problem” of kids not eating a lot at meal times by allowing them to carry around food all hours of the day. This might be cereal, crackers, milk, or whatever the favorite food of the week is.

This allows the child to snack all day, which means they’re never hungry, so they don’t eat at meal times. Parents will think it’s better than eating nothing, and even think that since it’s cereal or milk it’s healthy.

But it’s not.

Risks of constant snacking

  • Snack foods are usually highly processed and have little nutrition.
  • Constantly nibbling doesn’t allow the body to learn hunger cues.
  • Nibbling throughout the day doesn’t allow saliva to clean teeth between feedings, which increases the risk of cavities.
  • If kids drink excessive milk they are at risk of severe malnutrition. Parents argue that milk is healthy, but they are thinking of mother’s milk or formula for infants. Cow’s milk has protein, calcium, and other nutrients, but it is not a complete meal substitute. I have seen children need blood transfusions due to severe iron deficiency anemia from excessive milk intake. Blood transfusions. It can be that bad. Yes, your child might like milk. And he might refuse to eat at meal time. But if you keep giving milk he will never get hungry enough to eat the food offered.

Feed while watching tv

Other parents realize that kids will eat more if they feed the child, especially if the child is watching tv. This is wrong on many levels.

  • Once kids are able to feed themselves, it is a great skill to use. They work on fine motor skills when self feeding.
  • When offered healthy options, kids will eat when hungry and stop when full. When parents do the feeding, they keep pushing foods until the plate is empty. Many parents have an unrealistic expectation of how much food a child should eat and overfeed the child.
  • If a child is watching tv while eating, the focus is on the screen, not the food. Again, the child then doesn’t listen to hunger and satiety cues.

Self feeding is an important skill.

I see several kids each year who will be going to full day school for the first time and parents worry that they won’t be able to eat lunch because they never self feed. Many of these kids are overweight because they’ve been overfed for years yet the parents often think the child doesn’t eat enough.

Beyond the first birthday, most toddlers should be able to self feed. Many infants can do so even earlier. They don’t need a lot of teeth to eat small pieces of foods. Of course hard, round, chewy foods should be avoided for all young children, but most foods can be safely given to young kids at the table.

Don’t wait until your child is school aged to realize they’re behind on this important skill!

Family Meals

Eating together as a family is one of the best things you can do to raise healthy and independent children. As long as you use the time wisely.

If families eat while watching television or playing on smart phones or tablets, no one is connecting during the meal. No one is really enjoying the food or the conversation.

There are many studies that show the more often families eat together the less likely kids will develop obesity, get depressed, do drugs, smoke, and consider suicide.

Kids who eat with their families are more likely to eat healthy foods, do well in school, delay having sex, and have stronger family ties.

Help stop the habit of mindless eating.

Encourage eating at the table as a family as much as possible.

Offer healthy food choices and let everyone decide how much of each thing to eat.

If you worry that your child isn’t eating adequately, talk to your pediatrician.

We all do it sometimes. We grab a snack and plop down on the couch to watch a movie. Before we know it the whole thing is gone. We only meant to eat some of it, but downed it in one sitting. That is distracted eating at it's finest. It exemplifies the problem of eating without intention. Not because of hunger. Not even healthy foods typically. Just eating because it's there.

Resources:

MyPlate offers portion sizes for children, tips on healthy foods, activities for kids to learn about nutrition, and more.

If you’re a Pinterest fan, check out my Nutritional Sites and Getting Kids to Eat Vegetables and Other Healthy Stuff

Nutrition.gov has several resources for healthy eating.

Stanford Introduction to Food and Health looks very interesting. I haven’t taken the free online course yet, but another pediatrician friend highly recommends it.

Weight is Weighing on My Mind

Too much sugar is causing an epidemic of obesity in our kids. Even the ones who aren’t overweight are often less healthy due to food choices. Excess sugar consumption over time is linked to many health issues such as high cholesterol, diabetes, metabolic syndrome, and it can trigger earlier puberty – leading to overall shorter adult height. Not to mention the psychological and social implications of bullying, depression, eating disorders, and more.

Back in the day…

Why is weight so much more of a problem now than it was years ago?

As a child I did not have a perfect diet, yet I was not overweight (and neither were my classmates) because we spent most waking moments outside if we weren’t in school.

My mother packed a dessert in every lunch box. We ate red meat most days. My mother usually put white bread and butter on the table at dinner. I drank 2% milk and ate ice cream every night.

But we walked to school– without a parent by the time I was in 1st grade. (gasp!)

There were only a couple tv channels, and Saturday morning was the only time we could watch tv.

We were able to ride bikes, go to a wooded area, play on a nearby playground, dig in the dirt, you name it – we found something to make it fun!

Update: I just read a fantastic blog from Dr. Alison Escalante that shows beautifully how she and her siblings were able to explore and learn as kids. Take a look at The Summer of No TV: Why Boredom Breeds Creativity Part 1.

Why is weight so much more of a problem now than it was years ago?
unhealthy foods
Childhood obesity is a growing problem. Kids need to eat healthy and move daily.

I think it’s a combination of what they’re eating and what they’re doing.

Today’s kids are shut up in the house after school watching one of many tv channels or playing video games.

Even those who are shuttled to activities get overall less exercise because it is structured differently than free play. They ride in the car to practice or class, then sit and wait for things to start. They might sit or stand while others are getting instruction.

Simply put: They eat a lot of processed and junk food and they don’t get to do active things at their own pace with their own creativity for as long as they want.

Shouldn’t we worry about them getting hurt?

I know parents are worried that their kids will get hurt or abducted if they play outside with friends, especially if they go out of sight from a parent. But I think in some ways we’re killing our kids slowly by allowing unhealthy habits to kick in.

The reality is that most kids won’t get hurt if they’re playing. Yes, some will. But if they play video games all day, they won’t get injured. They are likely to have long term problems though.

I’m seeing adult problems in young kids, such as Type 2 diabetes, high cholesterol, non-alcoholic fatty liver disease, hip/knee problems, and more. The poor kids who are overweight have the potential to suffer long term consequences.

What to do???

On one hand kids need to learn to make healthy choices to maintain a healthy body weight for height, but on the other hand you don’t want to focus so much on weight that they develop eating disorders. I think this is possible if we focus on the word “healthy” – not “weight”.

Starting at school age I ask kids at well visits if they think they are too heavy, too skinny, too short, or too tall. If they have a concern, I follow up with something along the line of, “How would you change that?” I’m often surprised by the answers, but I can use this very important information to guide how I approach their weight, height, and BMI. We talk about where they are on the graph, and healthy ways to either stay in a good place or how to get to a better BMI.

I focus on 3 things we all need to be healthy (not healthy weight, but healthy):

  1. Healthy eating (eat a plant and protein each meal and snack)
  2. Exercise (with proper safety equipment but that’s another topic!)
  3. Sleep (again, another topic entirely!)
Food is a part of our daily needs, but much more than that.

It’s a huge part of our lifestyle.

We have special meals for celebrations but on a day to day basis it tends to be more repetitive.

We all get into ruts of what our kids will eat, so that is what we prepare. The typical kid likes pizza, nuggets, fries, PB&J, burgers, mac and cheese, and a few other select meals.

If we’re lucky our kids like one or two vegetables and some fruits. We might even be able to sneak a whole grain bread in the mix.

If our family is busy we eat on the run– often prepared foods that are low in nutrition, high in fat and added sugars, and things our kids think taste good (ie things we won’t hear whining about).

We want our kids to be happy and we don’t want to hear they are hungry 30 minutes after the meal is over because they didn’t like what was served and chose not to eat, so we tend to cave in and give them what they want.

We as parents need to learn to stop trying to make our kids happy for the moment, but healthy for a lifetime.

There’s often a discrepancy between the child’s BMI (body mass index) and the parent’s perception of healthy.

The perception of calorie needs and actual calorie needs can be very mismatched. I have seen a number of parents who worry that their toddler or child won’t eat, so they encourage unhealthy eating unintentionally in a variety of ways:

  • turn on the tv and feed the child while the child is distracted
  • reward eating with dessert
  • refuse to let the child leave the table until the plate is empty
  • allow excessive milk “since at least it’s healthy”
  • allow snacking throughout the day
  • legitimize that a “healthy” snack of goldfish is better than cookies
Any of these are problematic on several levels.  Kids don’t learn to respond to their own hunger cues if they are forced to eat.  
If offered a choice between a favorite low-nutrition/high fat food and a healthy meal that includes a vegetable, lean protein, whole grain, and low fat milk, which do you think any self-respecting kid would choose?
If they’re only offered the healthy meal or no food at all, most kids will eventually eat because they’re hungry.
No kid will starve to death after 1-2 days of not eating.  
They can, however, over time slowly kill themselves with unhealthy habits.  

So what does your child need to eat?

Think of the calories used in your child’s life and how many they really need.  Calorie needs are based on age, weight, activity level, growing patterns, and more.
It’s too hard to count calories for most of us though.
If kids fill up on healthy options, they won’t be hungry for the junk.
Offer a plant and a protein for each meal and snack. Plants are fruits and vegetables. Proteins are in meats, nuts, eggs and dairy.
Don’t think that your child needs to eat outside of regular meal and snack times.
One of my personal pet peeves is the practice of giving treats during and after athletic games. It’s not uncommon for kids to get a treat at half time and after every game. Most teams have a schedule of which parent will bring treats for after the game.
Do parents realize how damaging this can be?  
  • A 50 pound child playing 15 minutes of basketball burns 39 calories.  Think about how many minutes your child actually plays in a game. Most do not play a full hour, which would burn 158 calories in that 50 pound child.
  • A 50 pound child burns 23 calories playing 15 minutes of t-ball, softball, or baseball.  They burn 90 calories in an hour.
  • A non-competitive 50 pound soccer player burns 34 calories in 15 min/135 per hour. A competitive player burns 51 calories in 15 min/ 203 in an hour.
  • Find your own child’s calories burned (must be at least 50 pounds) at CalorieLab.
Now consider those famous treats at games.
Many teams have a half time snack AND an after game treat.  Calories found on brand company websites or NutritionData:
  • Typical flavored drinks or juice range 50-90 calories per 6 ounce serving.
  • Potato chips (1 ounce) 158 calories (A common bag size is 2 oz… which is 316 calories and has 1/3 of the child’s DAILY recommended fat intake!)
  • Fruit roll up (28g) 104 calories
  • 1 medium chocolate chip cookie: 48 calories
  • Orange slices (1 cup): 85 calories
  • Grapes (1 cup): 62 calories
  • Apple slices (1 cup): 65 calories

So…Let’s say the kids get orange slices (a lot of calories but also good vitamin C, low in fat, and high in fiber) at half time, then a fruit drink and cookie after the game. That totals about 200 calories.

The typical 50 pound soccer player burned 135 calories in a one hour game. They took in more calories than they used.

They did get some nutrition out of the orange, but they also ate the cookie and fruit drink.

The cookie has fewer calories than other options but no nutritional value and a lot of added sugars.

The kids end up taking in many more calories than they consumed during play.

Water

What’s wrong with WATER? That’s what we should give kids to drink at games.

They should eat real food after the game if only they’re hungry.  Snacks are likely to decrease appetite for the next meal, so if they’re hungry give a mini-meal, not a sugar-filled, empty calorie treat every game.

There are many resources on the web to learn about healthy foods for both kids and parents. Rethink the way you look at how your family eats.

Simple suggestions:

      • Offer a fruit and vegetable with a protein at every meal and snack. Fill the plate with various colors! (As I tell the kids: eat a plant and a protein every time you eat ~ meals and snacks!)
      • Picky kids? Hide the vegetable in sauces, offer dips of yogurt or cheese, let kids eat in fun new ways – like with a toothpick. Don’t forget to lead by example and eat your veggies!
      • Buy whole grains.
      • Choose lean proteins.
      • Don’t skip meals.
      • Make time for sleep.
      • Get at least 60 minutes of exercise a day!
      • Eat together as a family as often as possible.
      • Turn off the tv during meals. Don’t use distracted eating!
      • Encourage the “taste a bite without a fight” rule for kids over 3 years. But don’t force more than one bite.
      • Don’t buy foods and drinks with a lot of empty calories. Save them for special treats. If they aren’t in the home, they can’t be eaten!
      • Drink water instead of juice, flavored drinks, or sodas.
      • Limit portions on the plate to fist sized. Keep the serving platters off the table.
      • Eat small healthy snacks between meals. Think of fruit, vegetable slices, cheese, and nuts for snacks. I tell kids all the time: eat a plant and a protein every time you eat – both meals and snacks. Think of snacks as mini-meals!

 

 

New Juice Guidelines!

Juice that comes from fruit is not the same thing as eating fruit. It’s missing the fiber and even the feeling of fullness that comes from eating foods rather than drinking. Too many kids drink excessive juice, which fills them with empty calories and can contribute to obesity and tooth decay. The American Academy of Pediatrics has updated their juice guidelines to help families limit juice intake to more appropriate amounts.

How much juice should kids have?

  • Juice is not recommended at all under 1 year of age in the new guidelines.
  • Toddlers from 1-3 years can have up to 4 ounces of 100% juice a day.
  • Children ages 4-6 years can have 4-6 ounces (half to three-quarters of a cup).
  • Children ages 7-18 years can have up to 8 ounces (1 cup) of 100% fruit juice as part of the recommended 2 to 2 ½ cups of fruit servings per day.

General tips and tricks:

100% juice

Offer only 100% juice if you’re giving juice at all. Fruit flavored drinks are not the same thing as juice.

Water

Water is always healthy!

If your kids want it flavored, cut up fruit and put it in the water.

There are many recipes online to get ideas, but kids don’t need anything fancy – just put cut up pieces of their favorite fruit with water in a glass container. Put the container in the refrigerator for 2-4 hours and then pour the infused water into their cup without the fruit (which could pose a choking risk). The infused water will stay fresh in the refrigerator for up to 2 days.

Water bottles

Some kids like to start the day with a frozen water bottle. Simply put a 1/2 to 3/4 full water bottle in the freezer overnight – don’t fill it too much because ice expands! Add a bit of water in the morning to help it start melting so it’s drinkable when they want a sip. Adjust the amount of water to freeze as needed depending on how insulated your water bottle is.

water it down

If your kids demand more than the recommended amount of juice for their age per day, water it down. By mixing water (or sparkling water for a bit of zip) with juice, you decrease the amount of sugar in every serving. You can give 1/2 the recommended daily maximum amount of juice with water twice and still stay within the daily limit.

Never let kids drink juice out of a bottle

Kids tend to drink more volume when it’s in a bottle. Infants who take bottles are too young for juice anyway. As they get into the toddler years, transition onto cups.

Bedtime!

Never put kids to bed with juice. They should brush teeth before bed and be allowed only water until morning.

Pasteurization

Offer only pasteurized juice. Unpasteurized juice can cause severe illness.

Real fruit

Give kids real fruits and/or vegetables with every meal and snack.

Make smoothies!

Putting fruits and vegetables in a blender to make a smoothie is a great way to give the full fruit or vegetable instead of juice.

Consider adding plain yogurt**, chia, flax, oats, nuts, and other healthy additions to increase the nutritional components of the smoothie! **Flavored yogurts often have added sugars. Look for just milk and cultures in your yogurt.

Juice box: not recommended!

Most juice boxes have more than a day’s supply of juice. Don’t use juice boxes. Offer juice in cups so you can limit to the age appropriate amount.

What about organic?

Organic juice is not healthier than other juice. Many parents presume it has less sugar or more nutrients, but it doesn’t.

Vegetable juice

Vegetable juices may have less sugar and fewer calories than in the fruit juice, but are often mixed with fruit juices so you must read ingredients. They also lack the fiber of the actual vegetable, so eating the vegetable (or pureeing veggies into a smoothie) is healthier.

Read labels

Beware of labels that look like juice but aren’t 100% juice.

The label might say “juice cocktail,” “juice-flavored beverage” or “juice drink.”

Most of these have only small amounts of real juice. Their main ingredients are usually water, small amounts of juice, and some type of sweetener, such as high-fructose corn syrup.

Nutritionally, these drinks are similar to most soft drinks: rich in sugar and calories, but low in nutrients. Avoid them.

Sports drinks?

Sports drinks are not healthy substitutes for water.

They are sugar-sweetened beverages that contain sodium and other electrolytes. Unless one is doing high intensity exercise for over an hour (such as running a marathon, not playing in a baseball tournament), water and a regular healthy diet provide all the calories and electrolytes we need.

water (again)

Water’s the best drink for our bodies.

Buy fun reusable water bottles and challenge your kids to empty them throughout the day.

The old rule of “8 cups a day” is outdated, but we should get enough water (from the water content in foods + drinks) to keep our urine pale.

We need more water when it’s hot, when we exercise, when we’re sick and when the air’s really dry.

Once we feel thirsty we’re already mildly dehydrated, so drink water to prevent dehydration.

juice guidelines
The AAP’s 2017 Juice Guidelines