Picky Eaters

What can be done about the child who does not eat?

Actually, children with insufficient calorie intake for growth are rare.  The trick in nutrition for children is controlling the quality not the quantity of what they eat.  If your child really does not eat much, look at how much he drinks.  Children can drink an enormous quantity of calories in milk and juice on a daily basis.  Big drinkers tend to be picky in terms of quantity and variety of foods they eat.

How much milk should a child have?

Milk is not a dietary essential.  It is a convenient source of protein, calcium and Vitamin D; however it has no iron.  Three to four dairy servings a day of milk, cheese and yogurt will cover the calcium needs of growing children.   A child filling up on dairy products (more than 24 oz/day) may not have a good appetite for the other food groups and may be at risk for iron deficiency anemia.  Children who will not take milk should get their calcium from other sources including the calcium-fortified juices, greens, broccoli, dried beans and supplements.

How much juice should a child have?

Juice is not a dietary essential.  It has relatively little nutritional value and plenty of calories.  Its sweet taste is notorious for destroying appetite for anything other than sweets.  I think of juice as a snack and prefer it be limited to 8 oz per day.  Your pediatrician may recommend greater quantities of juice if your child has constipation.

What about children who won't drink water?

Most children will drink water if they are truly thirsty and nothing else is available.  It may take some getting used to if they have been on diluted juice previously.  Diluted juice is senseless to me.  It is grooming children to expect constant taste bud stimulation.  I prefer children have water if they are thirsty and eat fruit if they need a snack. 

When can a child have soda?

When absolutely nothing else is available to drink, i.e. on extremely rare occasions.  Children have no business getting caffeine in soda, iced tea or coffee (yes, I have seen children with coffee in their bottles!).

How much should a child eat?

Caloric requirements for growth depend on a child's age, general health and activity level. Luckily as parents, you don't need to worry about that number.  Children seem to "know" how much they need.

For reassurance, look at your child's diet on a weekly, rather than a daily basis.  They tend to get all the food groups in, if they are offered and if they are snacking responsibly.   Some children do this on three meals a day; others snack and graze all day.  I recommend offering a protein, fruit and/or vegetable and a starch with each meal.  A child may only take one or two of the three this meal, but they will probably make other choices the next time or the next day.

What is "snacking responsibly"?

Always offer a "healthy" food such as fruit, vegetables, seeds or nuts (if your child is old enough) whenever possible.  Avoid prepackaged foods when possible, as they are often high in fat and low in fiber.  Never offer juice within 1 hour of mealtime.  Plan ahead.  Cookies and cake are fine for an occasional snack, but try to offer a healthier snack first, so the child is not eating quite so much "junk."

What can you offer the frustrated parent of the truly picky eater?

Some kids are truly finicky.  Don't make meals a power struggle.  Offer a "default meal" you know your child will eat, such as a peanut butter sandwich and banana.  Offering an incentive for trying the main meal is fine, but avoid coercion.  Children who actually taste novel foods are more likely to later incorporate them into their diets than children who do not even see novel foods.

Avoid offering junk food "just so they will have something!"  A hungry child will eventually eat.  A stubborn, hungry child just takes longer.   And remember,  what a children likes and dislikes changes regularly, so keep trying foods they may have rejected in the past.

Who needs vitamins?

In general, the American Academy of Pediatrics does not recommend vitamins for healthy children.  A multivitamin will not harm a child.  As long as a parent is offering a balanced diet, the child will get the nutrients he needs.  If the child is truly limited in their diet, despite the parent's best efforts, a multivitamin is probably not a bad idea.  Do not "mega" dose vitamins in children.