How to help your child with food

I spend a lot of my time in pediatrics looking at growth charts. Often, children are referred because their weight falls high or low on the growth chart. But that doesn’t mean the child has a problem!

The below are examples of entirely normal growth charts (borrowed from a presentation by Ellyn Satter (CLICK HERE for the webinar). Some children may fall on the higher end of the growth chart and others fall on the lower end. What’s important is that weight is trending up at a relatively consistent rate. 

When weight plateaus, accelerates or decelerates quickly, it’s time to investigate what might be happening: 

• Dieting. If food is restricted from a child, they may lose weight initially. However, it’s most common that the child will regain the weight (and at a quicker rate). For other children, restriction results in weight loss and increased fear about weight gain and unhappiness with the body. A common phrase in the eating disorder field is, “not every diet leads to an eating disorder but every eating disorder starts with a diet.” 

• Family, social, environmental changes. Starting school, changing schools, new social situations, and family changes such as divorce may impact a child’s eating behavior resulting in increased or decreased weight

• Illness. Food allergies / intolerance, chewing/swallowing issues, gastrointestinal upset, feeding tubes, sensory issues, and genetic variables (eg, Prader Willi or melanocortin 4 receptor) are all factors that may affect a child’s appetite and desire for food. Notes that these factors require professional assistance to treat. 

As a parent, we all want to just “fix” the problem and literally see it resolve. However, body weight is not the issue here. It’s a symptom of imbalanced behaviors / environment / feeding dynamics. The behaviors are what need to be fixed and behavior change is not fast. Moreover, the goal is to create a positive, long lasting relationship with the body and food. 

I am a tremendous fan of Ellyn Satter’s Division of Responsibility in Eating (see image below). It’s a fantastic model to foster trust between a parent and a child. It’s perhaps the most well referenced child feeding model used in pediatric nutrition. However, it’s only effective if carried out consistently and in the right environment. What’s great about the model is that the shift more to the child as they get older. 

Here are some extra tips to take into consideration: 

• Encourage fun and age appropriate movement. Watching the “calories burn” on a treadmill isn’t fun for children (or adults). If something isn’t enjoyable, it will become a fight to continue. Instead, help your child find activities they enjoy. Do not put pressure about “moving the whole time” or “getting your heart rate up” or “improving.” Instead, help them recognize the rewarding social experience, the warmth of the sun, and the excitement of learning something new. Choose activities (distances, durations, speeds) that they can accomplish without feeling overwhelmed. 

• Provide food regularly and predictably. The human body is designed to eat every 3-4 hours. If a body goes longer than that without nourishment, appetite and cravings increase. Create a predictable meal/snack routine so your child is confident that food is coming. 

• Adults are in charge of what foods are offered. Children do not have the capacity to eat for health– they eat for pleasure and taste! If you ask them what they want to eat, you may not like the answer and it results in an argument. If you want to offer your child choice, consider offering them 2 options (eg, do you want an apple or a banana?). It is the parent’s job to make sure healthy foods are available but it is the child’s job to decide whether or not to eat those foods. 

• ​Provide meals and snacks that are filling and satisfying. Include fruits/vegetables (to fill) with lean proteins / healthy fats (to satisfy) and whole grains (for quick energy). Examples are blueberries with yogurt OR whole wheat bread with peanut butter OR cheese stick, apple, and whole grain crackers. Check out these previous blog posts on snacks and satisfaction. 

• Take into consideration their taste preferences (but do not cater to them exclusively). For example, if your child wants chips, you may say, “Those aren’t on the menu right now, but let’s enjoy some together this afternoon.” That allows the child to
  be heard, feel confident they’ll get to enjoy the food, but keeps the parent in control of what foods are available. If treats are never made available, children can’t learn how to interact with those foods and eat them in a mindful way.  This leads to overeating or eating them in secret to avoid getting in trouble. This is a common problem, especially as young adults leave home for the first time and are left to make their own food decisions. For the first time, they have to learn how to navigate a world of treats but were never taught the skills (other than avoidance) as a child! 

• Eat meals together. Children learn by example. If they see you enjoying a variety of healthy foods, they are more likely to consider trying them. Eating meals together can also create a positive social experience that encourages the child to stop when they’re satisfied. 

• Eat without distraction. The brain can only process 1.5 activities at any given time. Cell phones, TV, computers, books, and video games, etc often occupy the majority of attention leaving only ½ of the attention to the pleasure of food and body’s signals of fullness and satisfaction. “Have you ever sat down to eat a bag of chips in front of the computer or TV only to wonder, ‘where did they go?’ a few minutes later? You ate them, but your mind didn’t get a chance to enjoy any of those tasty treats! The whole point in eating chips is to enjoy them, so why not focus your attention on that?” 

• Involve your child in food prep. Children who are involved in gardening, grocery shopping, farmer’s markets, and cooking are more likely to try the foods they had a role in selecting and working with. It makes the food more familiar to the child and gives them a personal connection / ownership.

• Help your child recognize types of hunger. There is biological thirst/hunger (eg, stomach growling, hands shaking, tired feeling, dry mouth) but hunger can also be non-biological (eg, feeling hungry because you see someone else eating, triggering commercial, boredom, emotional fulfillment). It’s difficult for children to recognize the difference between these types of hunger. All they know is, “I want/need food!” Arguing with them that they’re “not hungry” is invalidating for their feelings. They’re more likely to sneak food. Instead, it’s helpful to teach them what signs of biological hunger are, reassure them that food will be provided (and when it will be provided), and ask them if it’s possible to wait. 

• Create the same food expectations for everyone (including you). It’s difficult for children to feel different than their peers. Additionally, food is often perceived as / confused with affection. So when some children are allowed to have cake and others are not, it leaves those without cake wondering, “what’s wrong with me?” Explanations such as, “well he/she’s more active” or “he/she is skinny” or “he/she doesn’t have a problem with their weight” tends to isolate and shame.  Similarly, telling your child they can’t have soda but you can, causes a lot of confusion and sends the message that soda is an elite food and something to strive for. Children tend to idolize adults. Remember when you were a child and wanted to do everything that adults do? 

• Create a plan with the other adults. ​Food beliefs can vary greatly between parents, generations, and institutions. It’s important to keep conversations as civil and fact based as possible. Remember, that everyone has the child’s best interest at heart – we want our children to be happy and healthy.  If a family member wants to show love, remind them of non-food ways to show affection. If a family member was raised in a famine environment, food waste may terrify them. Help them understand they can prepare less food. When all else fails, it can be helpful to enlist a doctor or dietitian or therapist to be the mediator of instructions.

• Avoid weight talk. ​Body shape and size is an incredibly sensitive topic. A child’s body is ever changing as they grow into their genetics. As I mentioned earlier, it’s not about the weight! A child’s weight is going to increase as they get older – that weight goes towards height development, musculature, bone development, organ development, you name it! Children need to eat sufficient calories for this growth to occur. When food is restricted through dieting, it’s common to see height plateau on the growth chart. We can’t account  for the cessation of cognitive and internal developments…Instead of focusing on weight as the measure of success, focus on the joy of movement, the fun in exploration in the kitchen (and outdoors), the color of the plate, and the balance of the physical and non-physical reasons that we eat.

• Avoid calorie counting and/or telling your child to stop eating. Telling someone that they’re full or not hungry is about an invalidating as telling someone, “you’re not in pain.” If allowed to eat in the right environment and with the right relationship to food, a child will eat until they are satisfied. A child is more likely to eat beyond satisfaction if food is restricted (eg, they never have a certain food) or if they are trying to emotionally soothe themselves. It is terrifying for parents (even dietitians) to watch their child eat and trust they will stop when they are satisfied.                                                                                                                                                                                                                                                                                                                                                                                                   It’s common in my practice for people to request the “right” portion sizes of various foods.  I am not comfortable telling you “how much” to eat. Because if I prescribe 1 cup of rice and you don’t feel satisfied with that amount, you’re going to feel like a failure, overeat because you’re not satisfied, and feel like change is “impossible” when in reality, what you really needed was 1 1/4 cups…but I have no way of knowing that. I’m not in your body!                                                                                                                                                                                                                Evelyn Tribole (a dietitian and author of Intuitive Eating) recalls her experience with her son eating a piece of cake. He was given a piece of cake and asked for a 2nd piece. She w
  as terrified – because two pieces of cake?! Isn’t that excessive?! However, her entire practice is based around tuning into physical / emotional satisfaction so she gave him the piece and watched. He took two bites ad pushed the rest away. If we allow our children to eat in the right emotional and physical environment, they will stop when they are satisfied. If we restrict, they’re more likely to overeat when it’s around – feast or famine!  

• Avoid judgment about foods / labeling foods “good” and “bad.” Food is not a moral decision. Children do not have the ability to separate “good” and “bad” food from the judgments that they have about themselves and their bodies. Also, telling them that cookies are “bad” doesn’t change the fact that they taste amazing. However if children believe they’re bad, they’re not only more likely to feel ashamed when they eat t hem, they’re also more likely to hide that fact from you in order to avoid punishment. Here’s a great story / example of how applying morality concepts to food can cause more long term damage. 

• Do not pressure your child to eat. Two points here:
  • 1.) It is natural for a child to be skeptical of a new food and not want to eat it. It can take 15-20 exposures before a child will consider trying a new food! Just because they say “no” once, doesn’t mean they’ll never eat it. It is a success if the child allows the food on the plate, touches it, or even chews and then spits it out. It’s all part of the learning process. The expectation is that the food is available – Period. Beyond that, it is up to the child whether or not to eat it. The more pressure you create (eg, “please try it” or “just one bite for me” or “no dessert until you eat your carrots”) the more children will push back and/or use food to manipulate you.
  • 2.) With the exception of disease states, children know when they are full. It is terrifying for a parent to watch their child walk away from a meal with the perception that they didn’t eat “enough.” Well, enough according to who? Similar to the point above, it’s impossible to tell someone when they are full (or when they are empty). When you push a child to eat beyond their full point, it disrupts their ability to connect with their body. Here’s a great story / example of how encouraging children to eat past their full point can backfire. 

 There is a lot to consider when it comes to improving and healing your child’s relationship with food – the above list is not all inclusive and doesn’t account for every circumstance. But the moral is: Food should be healthy and nourishing but also fun and social. The above tips are designed to help find that balance. Nutrition counseling can help you identify reasonable starting points that work well with your goals. 

For more information about helping your child’s relationship with food, check out:

• 1.) Ellyn Satter  the “go to” dietitian when it comes to teaching children how to eat healthy and how to manage over, under eating, and picky eating
• 2.) Intuitive Eating by Elyse Resch and Evelyn Tribole (click here for a YouTube video reviewing the principles) is a wonderful book and program that helps you reconnect with your body and to eat more mindfully (without dieting)