Module 6: Toddler nutrition and eating

This module is designed to cover all the background information and knowledge you will need in order to support parents with toddler eating.Using a wide range of disciplines from anthology, and biology to psychology, we will cover how we learn to eat, and how toddler eating differs from how we eat as adults. Following this we will look at approaches that we can use as ToddlerCalm consultants to support parents with their toddler's eating. 

How humans eat

How we learn to eat

How we learn to eat

Eating is not something we are born instinctively knowing how to do - it is something we learn how to do. Every human begins by drinking milk, and over time our diet adjusts from milk to solid food.

As omnivores, humans have no inbuilt knowledge of what foods are safe and good. At the most basic level, we have to learn to identify what is food and what is poison. Along the way, our individual tastes are configured; we find out what foods are likeable, lovable, and disgusting (to us). From these preferences, our individual patterns of eating take shape. 

The foods you regularly eat (so foods that you have an appetite for) are foods that you've learned to eat*. By the time we reach 18 years of age, it's estimated that we've had 33,000 learning experiences with food.*

*Wise, Roy A. (2006), 'Role of Brain Dopamine in Food Reward and Reinforcement', Philosophical Transactions of the Royal Society, 361, 1149-58

*Leigh Gibson, Edward (2001), 'Learning in the Development of Food Craving', in Marion Hetherington (ed.), Food Cravings and Addiction, Leatherhead: Leatherhead Food Publishing

There is also a genetic component to our preferences - some people have a heightened sensitivity to flavours (notably bitterness), while others are blind to them.* we will explore this a little more in "The science of taste section".

There are also genetic variations in our appetites, the speed we eat, and the extent to which we enjoy eating.*

*Catanzano, Diane, Emily C. Chesbro and Andrew J. Velkey (2013), 'Relationship between food preferences and PROP taster status of college students', Appetite, 68, 124-31

*Llewellyn, Clare H., Cornelia H.M. van Jaarsveld, Laura Johnson et al. (2010), 'Nature and nurture in infant appetite: analysis of the gemini twin birth cohort', American Journal of Clinical Nutrition, 91, 1172-9

A parent weaning a baby is guiding them on what foods are safe and what those foods taste like. But this is not our only learning experience - we also learn from what we see others eat, as well as culture, rituals, and religion. 

Human tastes are astonishingly diverse - varying not just from culture to culture and country to country, but from person to person as well. We all have our own preferences, our own likes and dislikes, and these adjust throughout our lives.

Why do we eat?

Why do we eat?

Humans are designed to eat for three reasons:

  • to stay alive (so that our body can perform essential biological functions)
  • to grow / gain weight (everything our body is composed of is a product of what we eat - muscles / bones / blood / fat / hair / nails)
  • to move, work and play

Unfortunately in today's society this has become somewhat distorted by other factors. In modern society there is a tendency for humans to eat for a variety of unnatural and unnecessary reasons, including:

  • They are bored
  • It improves their mood
  • It is socially accepted
  • They are addicted to certain foods and drinks (sugar, caffeine)
  • The media advertises eating constantly because it makes them money
  • Food is much too readily available (and our primitive brains haven't caught up)

What we eat

What we eat

As a general rule, all species will ingest the amount of food they need in order to grow to a 'normal' / average size (although this has become a little 'off' for humans due to the food available to us - which we'll look at shortly). 

Our adult size is primarily determined by genes, and only a small part can be attributed to nutrition. Our appetite is what regulates our intake of food, and this is true for children as well. 

A child's appetite will regulate their intake of food in a way that adequately meets their individual and unique needs (why they need food, as we looked at previously). As babies, we acquire our first eating habits according to our environment. As we grow older, our eating habits change due to our perceptions, expectations, or motivation (social expectations, 'bad' vs 'good' food, eating healthier, holiday, losing weight etc).

By contrast, children have no preconceived ideas about how much, when or what to eat. 

Most human adults naturally eat what they need without being told. Our system that controls food intake is actually quite good - many people manage to weigh about the same, give or take a few lbs, over many years. 

This is also true for the quality of our diets. Do you know what vitamins and minerals you need, how much you need, and what foods contain them? Probably not. Yet most of us manage to ingest a generally balanced diet with a variety of vitamins and minerals without becoming deficient. Everyone has an innate mechanism to look for the food you need and eat the right amount. This also applies to children - if they are allowed to eat what they want, they will eat what they need.

But then why do so many humans struggle so much with food?

However like our reasons for eating (highlighted in the previous section), our innate selection mechanism has gone a little haywire due to our modern diets and the food available to us in our society. 

When we were hunter-gatherers, our preferences for salty and sweet foods helped us to achieve a balanced diet (sweet foods were fruit and milk, and salty foods were meat). 

Now, the sweet food that's available to us is much sweeter than fruit, and the salty food we have available to us is much saltier than meat, but our internal selection mechanisms haven't changed (while our tastes have become 'dulled' to the more balanced sources of salty and sweet that we would have chosen previously). 

For what 3 primary reasons do humans need to eat?

  • to stay alive
  • to move, work and play
  • to keep warm
  • for social reasons
  • to stay healthy
  • to grow / gain weight
  • for comfort

How might weaning affect how children learn to eat?

Based on how humans learn to eat, consider how weaning method might affect the eating learning that babies do.

  • Individual foods aren't recognisable when pureed
    When babies get older they don't see the solid version as a safe food
  • If babies are spoon-fed
    Their natural impulse to feed themselves can be overridden

How are our innate selection mechanisms affected by modern life?

Our innate selection mechanism has gone a little haywire due to  and the  available to us. 

As hunter-gatherers, our preferences for and foods helped us to achieve a balanced diet. 

Now, we have all kinds of sweet food that are much sweeter than , and salty foods that are much saltier than , but our internal selection mechanisms haven't changed (while our tastes have become 'dulled'). 

Children and eating

A (brief) history of child eating

A (brief) history of child eating

We don't know much about how children ate before the 1900s (it simply isn't recorded). 

In the early 1900s, fruit and vegetables were introduced very late to children, at around 2 - 3 years of age and 'with caution'.

At this time, all babies were breastfed (substitute milks weren't available), and human milk provided the necessary vitamins. As substitute milks became more widespread, vitamin deficiencies started to occur. It became necessary to introduce fruit and vegetables much earlier. 

The problem with this is that they were low in calories compared to milk, and this is still an issue today. 

How children grow

How children grow

Many adults believe growth is due to good nutrition. This is, in fact, not true - growth will only be affected in cases of true malnutrition. Children eat because they are growing - they don't grow because they eat.

The fastest stage of growth for a human is in the womb. 

After this, the next fastest is in the first year. During the first year of life, babies generally triple their weight. A person will never grow as much as they did during their first year of life. 

In the first four months of life, babies use 27% of what they eat to grow. Between 6 and 12 months, this decreases to 5%, and in their second year, to 3%. 

For their size, babies eat far more (comparably) than adults. 

Why children eat

Why children eat

We discussed before that humans eat for 3 reasons: 

  • to stay alive
  • to grow / gain weight
  • to move, work and play

This is exactly the same for children, with a few provisos that we need to keep in mind:

  • to stay alive - how much food a person needs depends on their size. As children are smaller than adults, they need less food to stay alive than adults do
  • to grow - the faster a child grows, the more food they need. Children are not always growing at the same rate, so they will not always need the same amount of food
  • to move - if we truly analysed how much children move, we would see that (in reality) it is not a huge amount. Certainly not vast amounts more than adults move (and often, it's less)

Milk vs solids

Milk vs solids

Small children have small stomachs - they need concentrated foods that are high in calories (and fat and protein), but low in volume. Milk is the best source of this. However, when babies are weaned by spoon-feeding, the calorific milk is removed and replaced with a food that is low in calories (as well as fat and protein). For example: 

  • breastmilk - 70 kcal / 100g
  • apple - 52 kcal / 100g
  • orange 45 kcal / 100g
  • carrot - 27 kcal / 100g

Even homemade baby food, made with a variety of food (including meat), is low in calories. Research showed that the average calories of homemade baby food was approximately 50 kcal per 100g. Some had as little as 30kcal per 100g.*

*Van Den Boom, S. A. M., Kimber, A. C. and Morgan, J. B., Nutritional composition of home-prepared baby meals in Madrid. Comparison with commercial products in Spain and homemade meals in England, Acta Paediatrics, 1997, 86: 57-62

If left to their own devices, most babies will eat a few bites of vegetables. The problem often comes when we try to replace their meal of milk with one that is nowhere near as nutritional. This is where the 'fighting' begins.

How children eat

How children eat

Between 6 months and 1 year of age, children want to feed themselves (and they really enjoy doing it). Yes, they eat less, take longer, and get very messy. But if they're allowed the feed themselves at this stage, they will continue to feed themselves for the rest of their life. 

If parents override this (because spoon feeding is quicker / less messy / means more food is eaten), children may not show the same interest in feeding themselves as they get older.

“Evidence* now shows that child-feeding practices play a causal role in the development of individual difference in the controls of food intake.” In other words – how parents feed their toddlers can have a lasting effect on their toddler’s eating patterns.

*Birch LL, “Development of food acceptance patterns in the first years of life.” Proc Nutr Soc. 1998 Nov;57(4):617-24.

“An enormous amount of learning about food and eating occurs during the transition from the exclusive milk diet of infancy to the omnivore's diet consumed by early childhood. This early learning is constrained by children's genetic predispositions, which include the unlearned preference for sweet tastes, salty tastes, and the rejection of sour and bitter tastes. Evidence suggests that children can respond to the energy density of the diet and that although intake at individual meals is erratic, 24-hour energy intake is relatively well regulated. There are individual differences in the regulation of energy intake as early as the preschool period. These individual differences in self-regulation are associated with differences in child-feeding practices. Initial evidence indicates that imposition of stringent parental controls can potentiate preferences for high-fat, energy-dense foods, limit children's acceptance of a variety of foods, and disrupt children's regulation of energy intake by altering children's responsiveness to internal cues of hunger and satiety. This can occur when well-intended but concerned parents assume that children need help in determining what, when, and how much to eat and when parents impose child-feeding practices that provide children with few opportunities forself-control. Implications of these findings for preventive interventions are discussed.”

Source: Birch LL, Fisher JO. “Development of eating behaviours among children and adolescents.”Pediatrics. 1998 Mar;101(3 Pt 2):539-49.

Younger children also tend to graze - that is, they eat several times over the course of the day, rather than having the '3 main meals' that we eat as adults. This helps to regulate blood sugar levels and avoid extreme highs and lows. Both WHO and UNICEF recommend that children under the age of 3 eat 5 - 6 times per day. 

Depending on how much a child eats on a given day, he / she may have eaten all of the calories they need for that day by dinner time, and so may want very little (or nothing) for dinner. It is difficult to estimate calorie intakes, which is why so many parents worry about how much their child eats (especially if by dinner they don't want any more food). 

How much children eat

How much children eat

Children are born with an innate ability to know how much food their body needs. Instinctively, babies cry when they are hungry. Toddlers like to constantly graze and eat small amounts of food frequently. During growth spurts or particularly busy days, toddlers may be hungry all the time and on other days when they are not so active, they have less interest in food. 

At some point between 1 and 2 years of age, most children 'stop eating'. 

This is because their growth rate slows massively. Although the energy they need to move increases, as does the energy they need to stay alive, the energy they need for growth decreases enormously. 

An 18 month old needs to eat about the same as a 9 month old (when adults think they should be eating twice as much). 

Also, babies who have been eating watery purees (that are low in calories and not dense foods) need a much smaller amount when they move onto more calorific, denser whole foods. 

Parents often attribute this loss of appetite to something external, like illness or teething. They expect that their child will regain their appetite once they're better, but when this doesn't happen, they begin to try and force their child to eat. 

Parents often also overestimate portion sizes for their toddlers, and think they should be eating more than they're capable of. For example, a serving of pasta for a toddler is 2 - 4 tablespoons, and a serving of a banana may only be 1/4 of that banana. It's not reasonable to expect them to eat a whole apple or whole banana unless that's the only thing they're eating. 

In addition, children are often overwhelmed by large volumes of food and will reject the whole plate. Children do not start eating more until around 5 - 7 years of age, but even then it is only a small increase in intake. Many children will remain small eaters until puberty.

What children eat

What children eat

Do you eat everything? Probably not. We've discussed how we learn to eat and how our preferences are shaped. What we eat also comes from our culture - what is seen as edible and what isn't (in China, dog meat is considered a speciality, and in some parts of India, it is a crime to sell beef).

We begin life with an innate liking for sweetness and suspicion of bitterness (a survival mechanism to help us avoid toxic substances in the wild, which has remained since we were hunter-gatherers).

Between 4 - 5 years of age and adolescence, most children will always eat the same things with little variety.

As we saw before, liking any particular food is a consequence of familiarity with that food. Children are bound to like a narrower range of foods than adults, simply because they haven't tried as many foods as we have.

Neophobia (an active fear of tasting new foods) is experienced by all children, and reaches a peak between the age of 2 and 6 years of age. This is normal and is another inbuilt safety mechanism to protect children from toxins. They will choose to eat what they know is safe. It can also be influenced by many things including weaning, method of infant feeding, and negative food related events (such as choking) which may condition a fear of food. Largely though, neophobia can be traced back to parental influences.*

*Benton D. ”Role of parents in the determination of the food preferences of children and the development of obesity.” Int J Obes Relat Metab Disord. 2004 Jul;28(7):858-69.

Out of interest exclusive breastfeeding / not introducing solids until 6 months reduces the incidence of neophobia:

"Children who were introduced to complimentary foods before 6 months of age had 2.5 times higher odds of developing food neophobia and limited variety of foods. Children who were breastfed exclusively for longer than 6 months had lower odds of developing a preference for specific food-preparation methods by 78%, food rejection by 81%, and food Neophobia by 75%. Breastfeeding and introduction of complementary foods after 6 months of age reduced the odds of picky eating during early childhood. This study documents an association between infant-feeding practices and the development of picky eating behaviours in early childhood."*

*Shim JE, Kim J, Mathai RA “Associations of infant feeding practices and picky eating behaviours of preschool children.” 2011 Sep;111(9):1363-8.

Neophobia can be broken down by a child eating a food at least 15 times - however, first the child has to decide to try the food, and there are several steps that need to happen before they reach the stage of eating the food (allowing the food on the plate, touching it, sniffing it, putting it to there mouth, tasting a bit - and possibly spitting it out, tasting a bit and swallowing it).

 

How many times a day should a child under 3 eat, and why?

Younger children graze - they eat . This helps to regulate and avoid extreme highs and lows. Both WHO and UNICEF recommend that children under the age of 3 eat times per day. 

Why do children 'stop eating'?

  • Growth rate
    Slows massively
  • Moving away from watery purees
    Need a smaller amount of solid food
  • Amount of food needed
    Does not increase by much
  • Parents overestimate portion sizes
    Children don't eat it all

When do children noticeably increase their food intake?

  • 1 year of age
  • 18 months
  • 5 - 7 years old
  • Puberty

The science of taste

Understanding taste

Understanding taste

Recent studies are changing the way science looks at the sense of taste in a number of significant ways. For over a generation, school children have been taught that the tongue could distinguish four tastes: salty, sweet, bitter and sour. Recently, a new taste has been added - the flavour-enhancing taste associated with MSG - and others may follow. We used to think that variations in taste conformed to a specific geographical pattern across the tongue too, with sweet and salty tastes registering on the tip of the tongue, and sour taking over along the sides. Now, we know that many areas of the mouth can record multiple tastes, although some taste receptors are better at distinguishing certain tastes (like sweet) than others.

These revelations in the way we experience one of our most important senses opens the door to other questions about the ways taste is experienced by different people and by all people at different times in their lives.

Adults and taste

Adults and taste

The average adult has about 10,000 taste buds. Taste buds, or taste receptors, are grouped inside papillae, the small bumps you see on your tongue. The taste buds themselves are composed of lots of small receptor cells, between 50 and 150, which actually process tastes.

Some people have dense concentrations of certain types of papillae, making them sensitive to strong flavours. People who like bland foods may actually taste more of the flavor in what they eat than the rest of us. What we would consider just enough sweetness or saltiness might seem overwhelming to them. These super-sensitive people are called super tasters and exist on one end of the taste spectrum. On the other end are older people who've lost some of their sense of taste, or people with medical conditions whose sense of taste is limited or absent. As we age, we can lose up to half of our taste buds, which is one of the reasons food can taste less flavourful to us as we get older.

Children and taste

Children and Taste

Taste is one way in which infants and young children experience the world, and as their bodies develop, so do their taste buds. 

Our senses of taste and smell changes over time. The average adult has approximately 10,000 tastebuds, but children have many more than this, including some dotted along the inside of their cheeks, which adults do not have.

Adult taste remains at roughly the same level, although damage to our taste buds, both through the normal course of life but more particularly through more society driven behaviour such as smoking or drinking very hot drinks repeatedly, has a dulling effect on them.

Research* has indicated that variations in a taste receptor gene influences taste sensitivity of children and may go some way to accounting for individual differences in taste preferences and food selection. In addition age seems to have an effect on the perception of bitterness. Like super tasters, children with a certain taste receptor genotype were more sensitive to bitter tastes than adults of the same type, with 64% of children but only 43% of adults able to detect bitterness in the weakest experimental solution.The lead researcher of the study commented: "The sense of taste is an important determinant of what children eat. We know that young children eat what they like. We also know that many children do not like bitter taste, thereby interfering with vegetable consumption and potentially limiting in take of important nutrients.... This type of information will one day help to improve the diets of our children by allowing us to devise better strategies to enhance fruit and vegetable acceptance in children who are sensitive to bitter taste... It may be that childhood represents a time of heightened bitter taste sensitivity in some children, which lessens with age. Such a scenario would account for the increase of vegetable consumption that often occurs as children mature into adulthood. This is definitely an area that merits more research."

The other intriguing point raised in this research is that some mothers and their children may live in variations in a taste receptor gene influences taste sensitivity of different sensory worlds when it comes to taste due to differences of taste sensitivity related to genes, age, or both. Another of the researchers stated:"This knowledge may bring relief to parents who learn that their children reject foods that they themselves like because of inborn differences in taste ability, rather than rebelliousness or defiance of authority,"

Julie A. Mennella, M. Yanina Pepino, and Danielle R. Reed. Genetic and environmental deternimants of bitter perception and sweet preferences. Pediatrics, 2005. 115(2), e216-e222.

Although this kind of study and much common wisdom suggests that children are more sensitive to certain tastes than adults, taste can be subjective and so the mechanism that causes taste sensitivity in youngsters can be difficult to analyse. Taste is a composite sense that's partly determined by the taste buds, but also affected by a food's aroma, its appearance and even previous experiences with that or similar foods [University of Washington].

A study conducted by the University of Western Sydney, New South Wales, Australia, comparing young male subjects between the ages of eight and 10 to adult males found that the adolescents had a higher anterior papillae density than the adults, making them more sensitive to sucrose or sweet flavours [Segovia]

Another study conducted at the University of Copenhagen involving 8,900 Danish schoolchildren discovered that there's a noticeable change in taste perception as a child develops into a teenager. Teenagers show an increased ability to distinguish flavors, together with a decreased preference for sweet flavors [University of Copenhagen].

Because smell, appearance and our expectations have a lot to do with the way we perceive taste, children who are tasting things, perhaps for the first time, are probably relying on their sensitive taste buds as well as their sense of smell and other visual cues to decide if a food tastes good or not. Our taste buds introduce us to a particular flavour, but the experience of eating is a packaged deal. If we think we'll like a food, there's a much better chance that we actually will.

Here is another interesting perspective:

How many taste receptors do most adults have?

  • 100,000
  • 10,000
  • 5,000
  • 1,000,000

Taste quiz

Please choose whether each of the statements are true or false

  • Taste changes over time
  • Taste can be broken down into four clear categories
  • Different parts of the tongue taste distinctly different things
  • Due to genetics, some adults have more acute sensitivity to taste - known as super tasters
  • It is likely that toddlers taste is more similar to these super tasters (and even more so with those who have the genetics too)
  • Everyone actually tastes things the same way but learn to prefer different foods
  • There are lots of factors that affect taste

Toddler eating 'problems'

Where the eating 'problem' stems from

Where the eating 'problem' stems from

Children have no preconceived ideas about how much or when or what to eat. It is often parental expectations that are the problem. The concept of 'bad eaters' comes from the difference between what's actually eaten by the child and what the parent expected to be eaten. Parents also often compare their child's diet / eating habits to other children's. Because parents think there is a 'problem', they think that something must have caused it. Parents believe that it's their fault, due to:

  • method of weaning / how weaning was approached
  • preparation / presentation of food
  • not 'teaching' their child adequately
  • lack of variety in diet
  • too much variety in diet

Eating 'problems' also get muddled up with other (normal) issues the parents are experiencing, such as behaviour and sleep. These normal issues are attributed to what the child is or isn't eating. Sleep is a significant issue for many parents anyway (as they have no idea what constitutes normal sleep for children), and it is an easy leap to make that a child isn't sleeping because they're not eating. 

In truth, research has shown that children do not sleep more when they have more solids.*

*Macknin, M. L., Medendorp, S. V. and Maier, M. C., Infant sleep and bedtime cereal, Am. J. Dis. Child., 1989, 143: 1066-1068

As discussed previously, we also know that children are sensitive to bitterness and will reject bitter foods as potentially toxic. This can be interpreted as an innate resistance / dislike of vegetables (many vegetables are bitter as a method of protection from predators), and so parents try to get round this by hiding vegetables (in a tomato and veg sauce, or a chocolate and beetroot cake) so that their children swallow them unawares. However, what the child learns that they are eating is a pasta sauce or a chocolate cake - and this only entrenches their liking for pasta sauce and cake, rather than the hidden vegetables. 

Mealtime battles

Mealtime battles

Parents often feel that their child's eating 'problem' is a hostile act. They believe that their children are testing limits, showing 'strong will', being stubborn, manipulating, and 'winning'. 

Children are powerless at the table. They (typically) can't control what is put in front of them or where they sit or how they are spoken to. Their one power is to accept or reject the food they're offered.

Mealtimes often become a place of emotional conflict, with punishments and rewards, criticism and praise dished out depending on whether food is eaten or not. 

To a child, this becomes a very simplistic 'love me or not'. When I eat my food, I am loved. When I don't, I'm not. They learn that their choice to eat or not eat can unleash deep emotions in grown-ups, and sometimes it becomes a choice between eating the food and pleasing the adult, or unleashing the adult's rage.

What parents often don’t realise is that their best intentions often destroy their child’s instinctive eating skills. 

As parents we often believe it is our duty to ensure our child “eats up all their food”. We bribe them with stickers and dessert and we chastise them for “not eating up”. 

Research has actually shown that bribes have the opposite effect to that intended on toddler eating habits. A new food was offered to two groups of children. One group was bribed, one was not. A few days later, the children who had received no bribe were eating more of the new food.*

*Birch, L. L. and Fisher, J.A., Appetite and eating behaviour in children, Pediatr. Clin. N. Amer., 1995, 42: 931-953

What are we teaching them with these practices? We are teaching them to ignore their own innate hunger cues, to override them and ignore them which can have lasting consequences into their future eating habits. 

We teach our children at an early age that food is something they can use to get rewards, food is something to be given to cope with emotions, food is something we give them to keep them quiet or busy – so it is something than they can use to fill boredom or an emotional need later in life. 

As parents we play games pretending our hands holding loaded spoons are aeroplanes and praise them encouraging them to eat more. We say “Good boy! You ate it all up!” What are we really teaching the toddler? That eating makes mummy and daddy happy - is that a good belief for later in life?

Using food as a treat or a reward (or withholding it as a punishment) can lead to an idealisation of those foods (and they are always foods that we don't want our children to overeat). A 1999 study showed that children who were around a certain food but not allowed to eat it, wanted that food more.*

*Fisher, J. O. and Birch, L. L., Restricting access to palatable foods affects children's behavioural response, food selection, and intake, Am. J. Clin. Nutr., 1999, 69: 1264-1272.

Conversely, when criticism and punishments are involved, food can become a very stressful, even fearful experience.

Children (including babies) have 3 lines of defence when we try to force them to eat:

  1. Close mouth and turn head away (a strong physical communication that they do not want to eat)
  2. Open mouth but will not swallow
  3. Crying / being sick

Some parents believe that being being sick is an act of manipulation - do we really think that a child is being sick in order to get something else to eat (and can you be sick voluntarily at a moment's notice when you want to make a point?)

Order the non-verbal communications that children give us that they don't want to eat

  • Close mouth and turn head away
  • Open mouth but don't swallow
  • Cry / be sick

What inbuilt safety mechanisms can affect toddler eating?

  • Suspicion of bitterness
  • Gag reflex
  • Tongue thrust reflex
  • Neophobia
  • Suspicion of sweetness

How many times does a child need to eat a food for neophobia to be broken down?

  • 7
  • 15
  • 20

ToddlerCalm's eating tool

How to approach toddler eating

How to approach toddler eating

Children's eating 'problems' will disappear when either:

  • the child eats more (which as we've seen, can take a long time), or
  • parental expectations change

Change needs to come from parents. We cannot force a child to eat more - not without significant resistance, distress, and long term negative effects on their health and wellbeing. 

To help parents approach toddler eating, we use the acronym FORKS. 

  • F amiliarity 
  • O wn servings and portions
  • R esponsibility and choice
  • K eep mealtimes neutral
  • S afe foods

Familiarity

Familiarity

  • Make sure food is recognisable 
  • Don't hide it in other foods - this will aid familiarity with the food it is hidden in, not the hidden food itself
  • Offer foods repeatedly
  • Neophobia of a particular food is broken down after eating it at least 15 times - but there are a number of steps before this can happen, and it is up to the child to move through those steps
  • Get toddlers involved with preparation and cooking of food - this can really help progress the steps mentioned previously, as they'll be handling / exposed to the food in various states. It can also help with foods that look different once cooked or that are mixed together when cooked as a meal, as they'll see the whole process which aids familiarity with that food at all stages of cooking

Own servings and portions

Own servings and portions

  • Remember that toddlers are intuitive eaters - we need to trust and respect their choices and their appetites. If they're not hungry, respect that. If they ask for more - respect that too
  • Serve meals 'buffet style' and allow toddlers to get their own portions from what's available
  • Let toddlers feed themselves
  • If you serve on plates, keep servings small - too much food can overwhelm toddlers (and lead to rejection of the whole plate). You can always give more if they are still hungry
  • Be aware of toddler portion sizes - they are much smaller than we think they are!
  • Don't expect toddlers to eat at set mealtimes - remember they need to eat more often than us, and may not be hungry at mealtimes (or may be really hungry for lunch at 11am). Be flexible

Responsibility and choice

Responsibility and choice

  • It is the parent's responsibility to offer a variety of healthy foods. It is the child's responsibility to choose what to eat and how much (this doesn't mean cooking a variety of dinners - they don't need to eat what's been prepared but it is not up to the parent to provide a different dinner for them)
  • Children are more likely to choose healthy options if that's what they're regularly exposed to. If there is something you don't want them to eat, don't have it in the house
  • Respect your child's likes and dislikes / preferences (but this doesn't mean avoiding their dislikes - keep exposing them to that food, but don't try and encourage them to eat it)
  • Give your toddler (limited) choices whenever possible eg Would you like cereal or toast for breakfast? Weetabix or porridge? Marmite or marmalade on your toast? 
  • Choices don't have to be about food - allow your toddler to choose their dishes / cups / where they sit at the table

Keep mealtimes neutral

Keep mealtimes neutral

  • Understand that our actions and words can have a lasting effect on our toddlers
  • Remove conflict. Remember that mealtimes aren't a battle and no-one is 'winning'. No airplanes, no distraction, no bribes, no punishments, no rewards, and no emotional ties. The easiest way to do this is to effectively eat your own meal, stay as relaxed as possible, and draw no attention to what your toddler is / isn't eating
  • Don't rush mealtimes - toddlers can take a while to eat, and rushing can be stressful for them. Similarly, don't force them to stay at the table longer than they need to / want to (remember that they lack impulse control and aren't capable of staying still at a table for a long time like adults can)
  • Don't cloud mealtimes with other issues. It's confusing and overwhelming for toddlers, because there are too many things to think about / take on board. For example - manners. Don't worry about 'teaching' them. They will be learning through your modelling of them and don't need explicit teaching 
  • Teach them that the primary role of food is nourishment – not emotional gain for themselves or others (and remember that we can inadvertently do this through our words and actions, so be aware of our own behaviour during mealtimes)

Safe foods

Safe foods

  • Remember that all children reduce their range of 'safe' foods between 1 and 2 years of age. This is normal and they will expand that range in the future - although it can last until adulthood
  • Eat as a family and eat the same things - this can really help with guiding our toddlers towards what foods are safe to eat, as well as encourage them to try new foods
  • Make sure there are always safe foods available as part of the meal, so that your toddler isn't faced with a range of foods that they can't eat (which will lead to frustration and hunger). If the 'main' food isn't a safe food, these can be extra sides, or something as simple as yoghurt and fruit (not as dessert but as an integral part of the main meal)

Match up FORKS with relevant strategies

  • Familiarity
    Food is recognisable Don't hide it in other foods Offer foods repeatedly Eat it at least 15 times Get toddlers involved with preparation and cooking
  • Own servings and portions
    Trust and respect their choices and their appetites Serve meals 'buffet style' Let toddlers feed themselves If you serve on plates, keep servings small Be aware of toddler portion sizes Don't expect toddlers to eat at set mealtimes
  • Responsibility and choices
    Parent's responsibility to offer the food. Child's responsibility to choose what to eat and how much More likely to choose healthy options if regularly exposed to them Respect likes and dislikes / preferences Give (limited) choices whenever possible
  • Keep mealtimes neutral
    Effects of actions and words Remove conflict / distraction / bribes / punishments / rewards / emotional ties Don't rush mealtimes Don't cloud mealtimes with other issues Primary role of food is nourishment
  • Safe foods
    Children reduce their range of 'safe' foods between 1 and 2 years of age Eat as a family and eat the same things Make sure there are always safe foods available as part of the meal

A CRUCIAL strategy for eating

Using CRUCIAL for eating

Using CRUCIAL for eating

Control

Control is huge when it comes to eating. Toddlers typically have no control over all aspects of eating: what food is served, how big the portion is, when they eat, where they eat, what it's served on / in etc. 

Giving a toddler as much control and choice as possible is really important (and is really easy to implement). 

Let them choose: 

  • what food they eat (from an acceptable range of choices)
  • how much they eat
  • when they eat
  • where they sit
  • what plate it's on
  • what order they eat the various parts of the meal
  • when they are finished and leave the table

Rhythm

Having a ritual before mealtimes can be helpful here - for example choosing a plate / cutlery, and helping to set the table. Toddlers who struggle with eating can also benefit from helping to make the food that they eat. There is a fantatsic story book for children called "Alfie Beastie" that is about eating that demonstrates this concept and is funny for children too.

Understanding

There are a few ways that understanding can help here: 

  • Understanding what is normal in terms of toddler eating behaviour
  • Understanding why your child isn't eating - they might not be hungry, the foods might not be safe foods etc
  • Understanding that most of us have our own complex relationships with food - and understanding how not to pass those things on to our toddlers

Communication

Communication is also key when it comes to eating.

Being aware of what effects our actions and language can have on our toddlers, and being aware of what we say and do at mealtimes. 

Don't bind eating up with emotions and 'good' / 'bad'. 

The 'say what you see' sports commentary approach can be really helpful here: 'I see you ate some carrot.'

Individual

This is about being aware of your child's individuality - both as a whole but also 'in that moment'.

What are your child's safe foods? What is their eating pattern? Are they sensitive to certain tastes?

Why might they not be hungry (or hungrier than normal) at this particular meal? Are there other things going on which mean they can't manage that mealtime as well (eg tired or upset)?

Don't be tempted to compare your toddler's eating with other children you know.

Advocacy

Avoid making mealtimes about anything other than food. Don't worry about trying to get your toddler to sit at the table for a long time, or manners, etc. 

If mealtimes are stressful, try and find a way to avoid that stress. For example, if they're rushed, try to slow down. If getting your toddler to sit at the table is a battle, try having picnic style dinners on the floor. If eating out is stressful, maybe avoid doing that until your toddler is a bit older with better impulse control (or try doing it at times that might work better - breakfast or lunchtime, for example). 

If your child goes to a childminder or nursery / preschool (or is cared for by someone else), make sure that they are aware of your approach to their eating and that they don't try to encourage food to be eaten or withhold parts of lunch as a 'reward'. 

Love

It's incredibly important to show our toddlers that our love for them is not affected by their eating - we don't want them to link eating with emotions. Staying relaxed and keeping mealtimes neutral is key here. 

How does CRUCIAL apply to eating?

  • Give toddlers as much control and choice as possible without leaving them to feel unsupported
  • As parents we must control what toddlers eat otherwise they will just eat sweets
  • Allow toddlers to be involved with all aspects of meal preparation (utensils, table set-up, meal prep)
  • It is not a toddlers job to help in the kitchen, this could put them off food
  • Understand what is normal in terms of toddler eating behaviour
  • Compare what toddlers are eating to what their peers / younger siblings are eating
  • Consider all the possible reasons why a toddler is struggling to eat
  • Understand your own complex relationship with food - and understand how not to pass those things on to your toddler
  • Your own relationship with food clearly has no bearing on what you want for your toddler. By telling your toddler the right way to eat, they will do better anyway.
  • Be aware of what effects our actions and language can have on our toddlers, and be aware of what we say and do at mealtimes
  • Praise your toddler lots when they eat up all of their food or try new foods
  • Don't bind eating up with emotions and 'good' / 'bad'
  • Ensure that you do not accidentally reward you toddler when they do not eat - giving them pudding could mean they never eat proper food again. It is best to make them sit with their food until it's gone, even if it's cold.
  • Use a 'say what you see' sports commentary approach: 'I see you ate some carrot.' but without using any form of judgement ("that's great").
  • Make sure that your toddler knows that you love them lots when they eat their meal, showering them with praise and rewards
  • Make sure you label foods as 'good' and 'bad' so that your toddler knows what to eat and what to avoid
  • Consider your child as an individual and think about what's going on for them at that moment in time
  • Avoid making mealtimes about anything other than food. Don't worry about trying to get your toddler to sit at the table for a long time, or manners, etc.
  • If your child goes to a childminder or nursery / preschool (or is cared for by someone else), make sure that they are aware of your approach to their eating and that they don't try to encourage food to be eaten or withhold parts of lunch as a 'reward'.
  • It is essential that you teach your child about sitting at the table and using their manners
  • Even if mealtimes are stressful, keep doing what you're doing.
  • If it is too challenging to involve childcare providers in your approach to food with your toddler, don't worry about it
  • Stay relaxed and keep mealtimes neutral