Avoiding food wars and establishing good lifetime eating habits.

This is an abridged and edited excerpt from Savvy Eating for the Whole Family, Whole Foods, Whole Family, Whole Life by Margaret Kocsis, MD, FAAP

As your child transitions from being an infant to a toddler it’s time to set family eating rules. Being consistent with when and where food is served is the foundation of healthy eating. In fact, establishing a meal schedule and eating meals at the table is as important to your child’s health as what your child eats.

Set the Time, Place, and the Table

Unpredictable eating habits and allowing kids (or adults) to graze make it difficult to self-regulate food intake. This usually leads to overeating. Letting kids over a year of age eat on demand encourages the consumption of unhealthy convenience foods, especially if they are allowed to eat anywhere other than the table. Even if your child is willing to eat leftover spaghetti and salad for a snack, you might find yourself offering a bag of chips instead if he or she plans to eat the snack on the sofa. Predictable meal and snack times as well as eating at the table make healthy eating easier in the long run.

Plan to eat meals and snacks on a predictable and consistent schedule

Only infants eat on demand
Around a year of age, toddlers are ready to eat on a schedule of 3 meals and 2 snacks a day
Primary school-aged children need 3 meals and 1 or 2 snacks per day

Why eat on a schedule?

Eating on a schedule helps kids (and adults) arrive at the dinner table hungry and ready to eat but not starved, and prevents between-meal hunger and begging for food.

People who eat on a regular schedule eat more nutritious foods at meal times and are less likely to overeat.

People who eat on a schedule have more regular bowel movements and fewer tummy troubles.

Tip:

Sweetened beverages and milk are liquid foods.

Only offer them at meal and snack times!

Offer only water between meal and snack times

Your dentist will be very happy!

Frequent snacking is terrible for your teeth.

Eating at the Family Table

It‘s important for adults and children of all ages to eat at the family table.
Encourage young children to set the table. Ask them to put plates, napkins, and silverware on the table Toddlers will take pride in having a job to do. Older children who were taught to do this at an early age will set the table as a matter of course without grumbling.
Sit at the table and take a moment to give thanks. No matter what your religious beliefs are, expressing gratitude is a healthy behavior.
Turn off the TV, and don’t allow reading or toys at the table during the meal. (That includes your phone!) Only answer emergency phone calls.
Discuss the day’s events and what you’re looking forward to. Avoid controversial topics at the table.
Put food on the table in bowls with serving spoons and allow everyone to serve their own plate. Start this by age three.
Everyone should remain seated during the meal but can be excused when they are through eating.
Everyone (above the age of three) should bring their own plate to the kitchen after the meal. Older children should have more responsibility.
Make family meals a priority. Adjust schedules whenever possible to allow the family to eat together daily, even if it’s breakfast.

As your child gets older, enlist your child’s help in choosing or making food. Let him help make a peanut butter sandwich, or toss a salad. Say “Would you like yogurt or bananas with your snack?” rather than asking an open-ended question like “What do you want for a snack?” (The answer might be “ice cream”!)

Why is where you eat important? Because research shows that kids who eat at the family table at least 4 nights a week;

- Are less likely to eat fried food
- Eat more fruit and vegetables
- Are more likely to drink milk and less likely to drink soft drinks
- Do better in school

Are less likely to be depressed

Are less likely to develop an eating disorder

Are less likely to smoke or abuse drugs

Let Young Children Serve Themselves

Preschool-aged kids and older can serve their own plates, and you should let them do this whenever possible. They will be more adventurous with food and develop a better ability to self-regulate if they’re allowed to decide which foods and how much (or whether) they will eat. There will be mistakes in judging the amount of food to take as well as spills, but this is all an essential part of learning to eat well.

Tip

Serve young children on child-sized plates and cups.

This will help them judge how much to serve themselves and cause less waste and smaller spills. They can always serve themselves seconds if they’re still hungry.

Enjoy Food Without Distraction

Don’t let your child watch TV with commercials that advertise junk food, and never let them eat in front of the TV. This is a bad habit to start. Because your kids are distracted while they watch TV, they eat more than they would if they were sitting at the table. The foods Americans typically eat in front of the TV are less healthy than those eaten at meals. The TV needs to be off for snacks and meals.

If the older children and adults in your family have gotten into the habit of eating in front of the TV instead of at the family table, it is worthwhile to put that habit to an end. When people eat in front of the TV they

Eat more food more quickly
Feel less satisfied
Eat fewer healthy foods and more junk food
Feel more isolated

Plan Ahead for Better Nutrition

Once you’ve established a schedule for eating and gotten the family used to sitting at the family table for meals and snacks, it’s time to turn your attention to what you serve. Most parents want to worry about the content of their diet before worrying about the time and place of eating, but studies show that establishing the time and place for eating makes improving the content of your family’s diet much easier.

Everyone knows that it’s important to eat plenty of vegetables and fruit, whole grains, and healthy proteins as part of a good diet and that processed foods like crackers, chips, cakes, cookies, candy, and french fries, are less nutritious, but not everyone is aware of the importance of balancing the foods offered at each meal and snack.

Getting your family to eat well requires planning meals and snacks in advance. Don’t worry, it’s not complicated. You may already be doing much of the planning without even thinking about it!

Here are the basic principles:

What to Eat

Offer at least one food your child likes at every meal and snack.

Do not prepare separate meals for each family member.

There are no forbidden foods but don’t offer the same foods every day.

Prepare foods YOU like to eat because these are the foods your children will learn to like.

Don’t serve food you don’t like just because it’s “healthy” (unless another family member likes it).

Offer at least 3 different categories of food at each meal.

Offer at least 2 different categories of food at each snack.

There are 3 categories of food when it comes to meal planning

Proteins: meat, seafood, eggs, milk, yogurt, cheese, beans*, lentils*, tofu, nuts, nut butter, soy or pea milk (but NOT almond or oat milk because they’re low in protein)

Starches: rice, corn, oatmeal, flour, bread, granola bars, muffins, potatoes, peas, beans*, lentils*, cereal, pasta, tortillas

Non-Starchy Vegetables and Fruit: tomatoes, tomato sauce, lettuce, spinach, herbs, broccoli, carrots, peppers, grapes, citrus fruit, apples, melons, peaches, cherries, berries, etc. Fresh, frozen, or canned

*Notice that beans and lentils count as both a starch and a protein. They’re a nutritional powerhouse!

Why it’s important to serve 2-3 food categories at each meal and snack: SATISFACTION

Sugars and processed carbohydrates (candy, crackers, white bread, pasta, white rice) are digested quickly and leave you hungry again in an hour.

Complex carbs (whole grains, produce) make you feel satisfied soon after you eat them but only keep you satisfied for a couple of hours.

Protein takes longer to make you feel satisfied but satisfies you longer than carbs and sugars.

Fats are a part of many protein-rich foods as well as some fruit, vegetables, and grains. They take the longest to digest but keep you satisfied for 3 to 4 hours.

Combining food groups keeps you satisfied even longer and helps balance your diet!

Tip

Children 12 months to 8 years of age need 2 servings of high-calcium food daily, and people 9 years old and up need 3 servings. Choose from plant milk, cow’s milk, cheese, yogurt, or fortified tofu. If you choose plant-based milk, be sure to read the label to make sure it’s fortified with calcium and that you shake the container well so the calcium doesn’t sink to the bottom!

Avoid Low Nutrient Density Foods (LND foods)

Low Nutrient Density Foods have relatively little nutritional value for the number of calories they contain. Prime examples of LND foods are cookies and other sweets, crackers, pretzels, chips, puffed rice cakes, sweet cereals, sweetened drinks, fried foods (even “veggie” chips), and bread and pasta made with white flour, corn, or white rice. Those who eat LND foods consume more calories and have more cravings than those who eat nutrient-dense foods like fruits, vegetables, low-fat dairy products, and whole grains. Studies show that eating more low-nutrient-density foods correlates with an increased incidence of obesity as well as nutritional inadequacy.

A Healthy View on Temptation

As children start preschool and grade school they are exposed to a lot of eating habits that are out of your control. Even if you pack all of your child’s meals and snacks, he or she will notice what other kids are eating, and Pandora’s Box is opened. It’s difficult for kids to see why they should eat vegetables when they see their friends eating salty fish-shaped crackers, snack cakes with sprinkles, and brightly colored sugar water in a pouch. Thanks to effective marketing, these types of foods are irresistible to most kids. Many parents are determined not to expose their children to these unhealthy snacks, and that is a good approach for the first year or so of life. But, unless your children don’t go to school and never play with other kids you cannot shelter them from knowing about these foods for long.

The most reasonable approach to keeping these unhealthy foods from tempting your children is to avoid keeping them in the house, but not restricting your child from having them when they attend a party or go to a friend’s house. If you restrict your child from eating the “forbidden foods” even at parties your child will usually react by desiring the forbidden item even more. Studies show that when a restricted child is away from his or her parent, at school, or at a party where he or she has access to the “forbidden food”, he or she will often gorge him/herself on that food until he or she is stuffed. An occasional indulgence is the spice of life.

If certain junk foods are already a regular part of your family’s diet, suddenly restricting them can make your child want them more. Instead, plan what to serve at meals and snacks in advance. Don’t serve the same foods every day or keep an unlimited supply of junk foods in the house. When the favorite junk food is offered as a part of a meal or snack, offer other choices with it. Your child may choose to eat only that food at a particular meal or snack, but make it clear that the food that is on the table is the only food being offered at that particular meal or snack, and that the amount of food on the table must be shared by the whole family.

If you plan to serve chips, put a reasonable portion in a bowl on the table rather than an economy-sized bag. If you plan to serve cookies, put a few cookies per family member on a plate rather than the whole box.

Avoid the Fast Food Habit

People who frequent fast food establishments eat fewer vegetables, fruits, and whole grains. They eat more processed foods and more calories. Eating fast foods dramatically increases your chances of becoming obese. Kids who eat a monotonous diet of French fries, cheeseburgers, chicken nuggets, and ice cream do not learn to like fruits and vegetables and grow to prefer processed bread to whole grains. If you must go to fast food restaurants, make sure your child has the option of salads, fruit, and milk at least as often as burgers and fries.

If you always wondered how your grandmother managed to raise eight healthy children without the help of drive-throughs or happy meals, it’s because she fed them the ideal kid food, soup. Messy, yes, but homemade soup is loaded with vegetables cooked to softness, little bits of tender meat, and flavorful broth. Kids love it.

Watch the Drinks

Teach your child that water is the beverage that quenches thirst. While skim milk and occasionally 100% fruit juice (up to 4 ounces per day)are part of a healthy diet, train your child to reach for water when he or she is thirsty. Milk and juices are foods that one drinks when hungry. Don’t buy sodas, fruit drinks, or sweet tea. They have no place in a child’s diet. Even fast-food kids’ meals offer milk or water as an option. Set a good example. If your child sees you drinking a sweet beverage he or she will inevitably want some. Save sweet drinks for rare occasions.

Summary: If you want to avoid conflict at the table and help your child develop healthy habits, follow these guidelines.

Eat together at the table and allow your child to serve his or her own plate.
Don’t force a child to eat. Respect his or her ability to self-regulate food intake whether he or she is plump, thin, or just right.
When your child refuses food, don’t give in and offer junk food so he or she will eat.
If a child refuses all foods except a few unhealthy foods, simply do not buy those foods as often.
Adjust portion size to the child. Don’t serve kids on adult-sized plates.
Don’t be overly restrictive with food choices, especially at parties, celebrations, and times spent with friends. While junk foods and sweet drinks should not be available on a daily basis, kids don’t need to eat perfectly all the time.

Troubleshooting:

When Desserts and Processed Snacks Leave No Room For Veggies

Parents often tell me “My child is usually too full for vegetables, but always hungry for dessert.” Choosing to eat healthy foods can be problematic for children. Respect your child’s ability to know when he or she is satisfied and don’t push your child to clean his or her plate.

However, if your child is pushing away from the table before he or she is satisfied in hopes of filling up on ice cream and cookies later, offering dessert at the same time as the rest of the meal can solve the problem. Because life is uncertain: “Will there be dessert? Will I get to eat it? How much is there?” your child may feel restricted when it comes to sweets and treats. If a limited amount of dessert is placed on the table at the same time as the other foods your child will no longer feel restricted. Your child knows at the beginning of the meal whether or not to expect dessert and can eat enough of the food provided to become satisfied. It doesn’t matter if he or she eats dessert first!

While letting your child eat dessert first sounds counterintuitive, it’s actually the most effective method for encouraging healthy eating for kids with a sweet tooth. If this method is routinely and consistently applied, your child’s single-minded food obsessions can give way to improved eating. Be sure to execute it correctly:

Plan meals and snacks in advance and offer a variety of foods. Include at least one food that each family member likes.
Offer meals and snacks on a predictable schedule every day.
Don’t offer your child’s favorite junk food every day, but when you do offer it, offer it at the same time as the other food.
Don’t offer food other than the ones you planned to serve even if your child rejects it. Once your child realizes that the food on the table is the only choice, he or she will choose to eat those foods. You may need to demonstrate this many times before your child accepts that no other food is available.
Junk foods, healthy foods, expensive foods, and rare treats need not be offered in unlimited quantities, however, there should always be plenty of food to eat at each snack and meal.
Don’t shame your child for his or her choices. Loving sweets and processed foods is normal.

If you choose to serve dessert on a regular basis make desserts healthy some of the time. Kids like strawberry smoothies, fresh fruit, popsicles made from 100% fruit juice, chocolate milk, and bananas with chocolate syrup as much as other more decadent desserts.

Keep in mind that every food you put on the table need not be a favorite with your child even if it is dessert. Desserts don’t have to be sweets. Serving “grown-up” desserts like dried fruit and nuts, or fruit and cheese helps teach your child that treats are not always sweets or unhealthy foods. Conversely, they will also learn that dessert is not always the best part of the meal.

When Every Meal is a Food Battle

Food battles with children are exasperating. It’s imperative that you remain calm when dealing with food refusal or obsession and not engage in battle. Knowing that limit testing, food refusal, and strange or picky eating habits are all normal childhood behaviors can help defuse the frustration and anger you may feel when you and your children clash wills over food issues. It pays to have a plan: Accept food refusal and calmly excuse your child from the table. If you set consistent limits about when and where food is available, eventually, your child will catch on.

I often hear “I have tried accepting food refusal but my child just won’t eat anything but chicken nuggets!” Parents with this issue may not have let their children know that they’re serious about sticking to planned meals and snacks. If you appease your child by offering a favorite food when he or she refuses other foods, or offer food between meals and snacks even occasionally, you have undermined your efforts to help him or her learn to like new foods. You need to demonstrate that when your child says he or she is not hungry, you will let him or her leave the table, but no more food will be offered until the next meal or snack time. It’s OK to ask your child to sit with the family at the table for a few minutes and tell you about his or her day. He or she may decide he or she is hungry after all. If not, let him or her leave the table. Don’t offer milk, cereal, juice, or any other food when he or she finally gets hungry. Wait for the next meal or snack time. Don’t offer food or drink other than water at any time other than set meal and snack times. The average preschool child must see you demonstrate this 15 to 20 times before he will accept it as the rule. Once the rule is established you just have to be consistent.

I’m Afraid my Child will be Malnourished if I Don’t Prepare a Separate Meal when Food is Refused

If you continue to offer your child a variety of nourishing food, and include one liked food at each meal, he or she will not starve. Many children have impressive willpower and may refuse to eat several meals and snacks in a row. Being hungry for a few hours or even overnight is not cruel as long as you have offered her food. It is rare that a child will need to go to bed hungry more than once before understanding that mealtimes are when you eat the food provided.

The only reason a child will refuse all foods but chicken nuggets, or another favorite food, is because an adult is continuing to give that food to the child when he or she whines for it.

Your pediatrician will be following your child’s growth at well visits to make sure he or she is getting enough to eat. If you feel your child is not eating enough or has lost weight, call our office for an appointment. There may be a medical reason for repeated food refusal with weight loss.

Offer Healthy Foods on Your Child’s Terms

In all fairness to your child, you should offer at least one familiar and liked food at each meal. Never feed your child something you would not eat yourself.

It’s also a good rule of thumb to offer no more than one new food per meal unless your child is very adventurous. When the family is eating spicy, odd-textured, or strong-tasting foods simply offer the food. If he or she tries it, wonderful! If not, maybe next time.

Don’t automatically put new foods on his or her plate and insist that he or she eat them. Let him or her approach a new food at his or her own pace. Use your judgment. Kids can reasonably be expected to like split pea soup even if it is green, but spicy hot curry or cold octopus salad might be expecting too much.

Accept that young children are not usually casserole eaters. Most kids like each food to be separate rather than combined in a dish with sauce. They often don’t even want their foods touching on the plate. When you prepare a dish with pasta, chicken, vegetables, and sauce, you may need to serve the individual components separately, and let your child choose which components to eat and dip them in the sauce if he or she is feeling daring that day.

Some kids are picky for years and then suddenly gain the confidence to branch out and try new things when they see their friends trying them. Let your child experiment with new foods at his or her own pace. It’s more important for your child to feel confident, and never ashamed about eating than for your child to make good nutritional choices. Children don’t start being developmentally ready to make good food choices based on nutrition until around the age of middle school.

Don’t Be Sneaky

Including vegetables in your child’s diet by stealth can have mixed results. Hard-core picky eaters may accept carrot muffins and pasta dishes with shredded broccoli stalks hidden in them, but your child might resent your sneaking them in if he or she detects them. Be honest. Your best bet is to be persistent in offering healthy foods. For those who don’t get 5 servings of fruits and vegetables a day a daily children’s multivitamin is also a good idea.

Make Food Fun and Interesting

Let kids make happy faces or designs with raw veggies, then eat them with dip. Dip apple slices or veggies in peanut butter. A teaspoonful of mini chocolate chips, or sprinkles, or a dash of powdered sugar can go a long way toward making yogurt, oatmeal, or fresh fruit more enticing without adding a significant amount of calories. Try fun pasta shapes: bow ties, twists, and alphabets. Offer healthy drinks like skim milk and water in unusually shaped cups or bottles or with fun straws. Food that looks visually appealing is more likely to be eaten.

Visual appeal can work both ways. Thanks to extensive market research, nothing is more visually appealing to kids than junk food. Junk foods are foods with low nutrient density (LND). In other words, they have very little nutritional value for the number of calories they contain. An active child who eats healthy foods is very unlikely to become overweight, but a child who eats junk food (LND foods) regularly is very much at risk of being overweight.

Nobody but your Child Knows How Much She Needs to Eat

It’s important not to force a child to eat a certain amount of food. The amount a child needs to eat varies widely with his or her energy output for that day, his or her age, and how much he or she is growing. No adult can accurately gauge how much a child needs to eat at a certain meal. Letting a child develop a sense of how much food he or she needs is pivotal in keeping a child from becoming overweight. Forcing a child to “clean his or her plate” whether he or she is full or not, undermines his or her natural ability to regulate food intake. Members of the Clean Plate Club learn to eat until stuffed out of habit.

Don’t Over Restrict

Children with too many food restrictions are also more likely to have difficulty regulating their food intake as adults. Restricted children are more likely to develop obesity or an eating disorder such as bulimia. It’s best to be honest with children, and explain why you don’t often buy unhealthy foods. School-aged children are old enough to understand a basic explanation of why you would like them to eat well. Say “I don’t buy snack cakes (or chips, sweet drinks, crackers, or whatever food is being begged for) because they have chemicals (like sugar, trans-fats, dyes, and preservatives) in them that harm our bodies and they can make us feel bad if we eat too many of them.” End the conversation there. Do not apologize, bargain, or rationalize.

Don’t Dwell on Food Issues

Don’t talk about food choices any more than is absolutely necessary. Dwelling on food is more likely to make a child rebellious or overly concerned with food choices. Continue to offer healthy food choices, and praise your child for making healthy choices on his or her own. (Don’t, however, make a big deal about good food choices. Children who love to please can become performers, often eating past the point of satiety in order to get praise and please their parents.) Talk about how healthy foods make us feel good and strong, and give us the energy to do fun things. Do not comment on foods making you big or fat.

It’s normal to like salty, sweet, and fatty foods that are not the most nutritious foods to eat. Never shame your child or look at them disapprovingly for their food choices. Giving your child “the look” when he or she eats unhealthy food can cause your child to be ashamed of his or her eating and lead to sneaking and binging on food. Do not discuss a child’s weight in front of them. Because young children are not developmentally ready to understand the complexities of being over or underweight, all they hear is your disapproval.

It’s not known how much overemphasis on food choices, labeling foods as “good” and “bad”, or talking about a child’s size influences the development of eating disorders. While the exact causes of anorexia nervosa and other eating disorders are not known, stress, lack of family support and communication, anxiety, depression, and genetics play important roles. Building positive family relationships and social skills by eating at the family table, while allowing kids to regulate their food intake by serving themselves gives them some protection against eating disorders.

Concerns for Underweight Children

It’s best to respect your child’s ability to self-regulate the amount of food he or she eats. This is especially true for children who are either overweight or failing to thrive. Underweight children respond to food forcing by eating less, not more. As a parent, it’s difficult but imperative that you don’t stress over every bite that your child does or doesn’t put in his or her mouth.

I’ve often been to children’s parties where the concerned parent of a thin child tries to bargain with her 2-year-old “Eat just two more bites of pizza and you can have some cake” as if those two bites of pizza were somehow going to make her child a bigger, stronger, healthier person. The child is often wandering around rather than seated safely as the furrowed-browed parent is trying to poke pizza in her disinterested or outright resistant child’s mouth. The child is more interested in normal social activities like playing than eating. The parent is often totally unaware of how absurd her actions appear to others. It’s a party. It’s time to relax about eating and celebrate.

Children who routinely refuse their cajoling parents will often eat normally when fed by another caregiver, especially if that person both sits and eats with the child and has a relaxed attitude toward food. So parents need to learn to ease off. Their child may not eat much more at first, but once she learns to trust that you will not force him or her to eat, he or she will develop better eating habits and gain weight according to his or her genetic ability.

Dealing with Overweight Children

By the same token, it’s difficult to back off when your pediatrician has told you your child is overweight. Withholding food from overweight children makes them fear that they’ll not get enough to eat. Overweight children tend to eat faster and take larger bites in the presence of a restrictive parent, presumably so they can fill up before food is taken away. They will also sneak food or binge on food when it becomes available without supervision. As the parent of an overweight child, it is not your responsibility to restrict how much food your child eats. You read correctly. However, it is your responsibility to

decide when and where food will be eaten (Preferably at the table, away from the TV, at designated meal and snack times),
provide a variety of healthy foods for your child, and
decrease the availability of low-nutrient-density foods for the whole family, not just the child of concern

Your child is also at increased risk of obesity if she spends two or more hours a day in front of the TV, computer, or video games. An overweight child is less likely to stay overweight if provided with a healthy diet, restricted to no more than one hour of TV a day, and encouraged to exercise daily. (Parents must set the example for daily exercise if they want their children to participate!) Children and teens need a minimum of one hour of vigorous physical activity a day.

The percentage of overweight children in our country has dramatically increased over the last 30 years. Twenty percent of overweight young children become overweight adults. In other words, not all overweight young children become overweight adults and conversely, most overweight adults were not overweight children. It’s usually only when poor eating and activity practices continue throughout childhood that being overweight persists.

However, if a child is still overweight by their teen years, 80 percent of overweight adolescents become overweight adults. That’s why it’s imperative to develop good habits as early as possible.

Studies show that the most important thing a parent can do to prevent their child from becoming overweight is to model good eating habits themselves.

Having a parent who is overweight is a much stronger predictor of whether a child will grow up to be overweight than a young child’s own weight.

While genes certainly contribute to a child’s weight, family eating patterns have a huge influence. Children given large or adult-sized portions are more likely to consume more calories than when they are served child-sized portions or allowed to serve themselves. Serving young children on child-sized plates helps limit portion size. Keep in mind that fast food kids’ meals often contain adult-sized portions of chicken nuggets, cheeseburgers, and fries with unlimited refills on sweet drinks. Children who eat at fast food establishments eat significantly more calories than when they eat at home. If you or your child is overweight, avoiding fast food restaurants is imperative.

What you can do to help prevent your child from becoming an overweight adult:

Eat meals and snacks on a set schedule.
Avoid sweetened drinks.
Avoid rewarding good behavior with food
Avoid eating in front of the TV or with distractions
Eat all meals and snacks at a table.
Avoid pressuring your child to clean his plate.
Avoid giving small children large portions. Use child-sized plates, cups, and utensils.
Serve fruits and vegetables on a daily basis.
Serving low-nutrient-density foods less often
Eat most meals at home and avoid fast food.

If you can do these things your child is much less likely to become or remain overweight.