The Development of Healthy Eating

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

Early childhood is the time when our eating habits and food preferences are developed. Healthy childhood eating habits like drinking water rather than soda, eating vegetables daily, and ending a meal when satisfied and not full, are likely to carry over into healthy adult eating practices. Unhealthy practices, like drinking sweet beverages, frequenting fast food restaurants, and overeating are likely to persist into adulthood too. Patterns established in childhood for better or for worse are difficult to change.

Starting off Right: Breastfeed or Practice Paced Bottle Feeding

The most important thing you can do for your newborn is if at all possible, to breastfeed for at least 12 months. Breastfed infants are healthier, and are less likely to become overweight adults. When you feed your child breastmilk or iron-fortified formula from a bottle, let your baby eat at his or her own pace. Use paced bottle feeding technique: hold your baby in your lap and keep the bottle horizontal to the floor, not tilted up when feeding. This lets your baby suck the formula into his mouth, rather than having it poured into his or her mouth. Observe your baby for signs of being satisfied and don’t encourage him or her to finish a bottle if he or she isn’t hungry.

Relax

Show your child the right attitude toward food—that food is to be enjoyed and eaten only until hunger is satisfied. Infants start to eat solid foods at four to six months of age. During this stage, babies get most of their nutrition from breast milk or formula, so parents can relax and have a “take it or leave it” approach to solid foods. Remember, it’s your job to start offering solids, not to make sure that they’re eaten.

Starting Solid Foods

By six months, most infants are ready to start solid foods. Offer a new fruit, vegetable, or infant cereal every five to seven days. They will learn to like most of the foods they are exposed to. Some foods they will like from the first bite, and others they will like only after trying them ten to twenty times. Yes, ten to twenty times. Many parents assume that a child does not like a new food because he refuses it three or four times. While you must accept that some foods will never be liked, it’s wise to offer green beans over and over again even if they end up on the bib. Many children will refuse all or most new foods the first few times they are offered.

Cultivate a Playful Attitude

Having a playful attitude and a smile on your face during feedings is more important than what your child eats from the spoon at this age. Your pediatrician will be following your child closely to make sure that he or she is growing well and getting good nutrition. Your pediatrician will recommend a vitamin or iron supplement if necessary. So relax and enjoy feedings for what they are: messy food exploration. You provide a good example by being happy and adventurous with food while refraining from pushing food once your child is satisfied. When your baby turns his or her head, closes his or her lips, and looks away from the food, chances are he or she is through. That means leaving that little bit of sweet potatoes in the jar rather than trying to make him finish them up.

Unfortunately, many children start to lose their self-regulatory abilities at an early age. Bottle-fed infants are often encouraged to finish an arbitrary amount of formula in their bottles, even if they are satisfied. Some babies are encouraged to eat a measured amount of cereal whether they are hungry or not. These babies learn to eat until stuffed. This may be part of the reason that breastfed babies are less likely than bottle-fed babies to be overweight children and adults. Follow your baby’s cues. Stop feeding when he or she loses interest.

Meal times are an important social for the whole family. Make sure you sit with your child at meals so he or she can see you enjoying a variety of foods. Your child will learn to sit peacefully in his or her chair and enjoy eating if you are sitting too. Kids who fight the high chair usually have family members that don’t sit with them.

At the Right Time, Branch Out with Caution

By the time your child is nine months old, he or she is ready to branch out and try new textures and finger foods. He or she will take pride in picking up food and feeding himself and may want less help from you. This is the right time to start slowly and cautiously introducing your child to mashed table foods. Set the food out in bowls on the table. Pass the bowls to older family members and let them serve themselves. Let toddlers point to foods they would like to try. Offer infants table foods in turn, but let your child decide how much of, or even if he or she is going to try a food Children are more likely to accept a new food if trying it in the first place is their own idea.

Learning to like mashed table food is a key developmental milestone. If your baby learns to eat what you’re eating, you aren’t stuck preparing separate meals for the adults and the kids for the next ten years. Granted, some adult foods are inappropriate for young children, especially if they are very spicy or difficult to chew. That’s when you are stuck modifying the meal or offering additional child-appropriate foods. However, many of the soups, pasta dishes, and rice dishes are ideal for little ones as well as adults. As long as you offer them to your children on a regular basis, healthy foods will become comfort foods and staples in your child’s diet.

A child that refuses solids at nine months is unusual and should be brought to your pediatrician’s attention. It’s more common for them to be putting everything in their mouths. At this time your job broadens from being a tour guide in food adventures to being a gatekeeper and protector.

The main concerns at this age are protecting your child from potential choking hazards, and unhealthy yet attractive convenience foods.

To avoid choking, infants and toddlers need to be offered only small pieces of mashed foods or foods that can easily dissolve in the mouth with minimal chewing.

Children under 4 years of age should not be given these choking hazards:

Whole or pieces of nuts, seeds, or peanuts
Whole small round fruits or vegetables (whole grapes, berries, carrots, etc.)
Popcorn
Hot dogs or large chunks of meat
Hard candy or chewing gum

Avoid honey until after a year of age to prevent botulism, a potentially deadly condition caused by bacterial spores that can be found in honey.

Meals and snacks should be eaten while seated to avoid choking.

Wandering around while eating snacks is dangerous and encourages your child to graze rather than sit with the family for meals and snacks. Children learn social skills and good eating habits from watching adults at the table. If you put a child in a high chair or booster chair every time he eats (including snacks) you won’t have as hard a time keeping him in the high chair for meals. You will also spend less time cleaning up mashed cheerios and juice spots in other rooms of your house.

Everyone, Even Infants Should Eat at the Family Table

Infants learn eating habits and social skills from you. That’s why it’s important to sit at the table together for meals and snacks. Infants will be curious about what you’re eating and want to try new things. Be courteous to your baby and other family members. Pay attention to your family, not your phone, tablet, or the TV during meals!

If you are an adult that never learned to eat at the family table without distractions, it will be difficult at first to remind yourself to sit together and put away your phone for all meals and snacks, but it is well worth the effort. Eating without distraction is a vital part of healthy eating. If you’re focused on your food you are much less likely to overeat.

Finger Foods and Snacks

Because they can pick up, chew, and swallow graham crackers, cookies, and goldfish crackers, and it gives them great pleasure to do so, parents often succumb to both peer pressure and their child’s insistence on eating these fun foods. Most cookies and crackers contain refined sugar, refined white flour, and sometimes preservatives, additives, and dyes. These processed unhealthy foods have no place in an infant’s diet. The longer you can avoid introducing him to these foods, the better.

It’s tempting to offer little ones processed snack foods because they’re too young for many healthy snacks like raw vegetables, hard fruits, and nuts. Fortunately, kids love snacks like toasted oat cereal (Cheerios), bits of toasted whole grain bread, cooked whole grain pasta, soft fruit, and even chopped cooked veggies. Don’t worry about offering a huge variety of finger foods for snacks. Kids get a great deal of variety by learning to eat chopped-up table foods at mealtimes. Snacks can be more basic.

Remember that unless toddlers are taught that snacks usually come in little plastic packages, they are content to eat healthy foods for snacks as well as meals.

Next time you see a toddler wandering around grazing on snack food, consider that the average baggie full of goldfish crackers often has about 150 calories. The total energy needs of an average one-year-old are often only around 600 to 700 calories a day. That package of junk food may be a quarter of that child’s daily calorie requirement. No wonder he’s not hungry for supper.

Finicky Toddlers

Sometime between a year and two years, ravenous little babies become finicky toddlers. They’re growing more slowly and eat much less food than they did in previous months. Parents are often frustrated because their toddler just seems to play with food, not really eat it. They often consume only a few mouthfuls at a meal, but somehow manage to paint the whole kitchen with peas and carrots. They will put new food in their mouth only to take it back out again. This is their way of learning about new foods. Knowing that this behavior is normal can help you feel less stressed about your child’s eating habits.

This is the age when it is difficult and yet very important to stand firm. Continue to offer healthy foods to your child alongside other favorite foods, even if very little is being eaten. Don’t give in and offer junk food just so he’ll eat. If the healthy food is there when he gets hungry, then that is what he will eat. Your child will develop taste preferences based on what he is exposed to the most often. If he eats fruits, vegetables, and whole grains most often, then that is what he will like. If he is given chicken nuggets or pizza every time he balks at a meal, then that is what he will prefer.

Most kids, and especially cautious kids (AKA picky eaters), want foods with predictable textures. That is part of the reason so many kids get into a rut eating chicken nuggets, French fries, mac and cheese, and peanut butter sandwiches. They know exactly what to expect: no unpredictable lumps, stringy things, or intense flavors. These foods are easy to like. Cautious kids don’t like most foods at first bite, especially if the food falls into the “unpredictable” category. Parents often become frustrated with food refusal and give up offering healthy foods. However, if cautious kids are repeatedly exposed to healthy foods like carrot soup, bean burritos, and oatmeal they will become favorite comfort foods rather than unhealthy typical American fare.

The toddler years into the preschool years are the time to make sure that you do not enter into food battles. Accept that your child will be picky or hardly eat at times, and don’t worry about it, as long as your child’s pediatrician says that your child is growing normally. Resist the temptation to give your child junk food because he whines for it. Setting the ground rules now will save you a lot of trouble later.

Let the Portion Fit the Child

If your hungry child often balks when served a plate with two vegetables, meat, fruit, and pasta, even if he likes the food, he is probably overwhelmed. Make sure that you are not offering unreasonable portions. (Most fruits and vegetable servings are about one tablespoon per year of age up to age 8) Small children can easily be overwhelmed when faced with too many choices, or by a large amount of food on their plate. Try serving the meal family style, with all the dishes of food on the table. Ask a young child which foods he wants, spoon a small serving onto his plate, and ask if that is enough. You can offer additional foods once the first round is eaten.

Don’t Resort to Force.

Children often refuse food or just pick at it. How do you get your child to eat? The answer is you can’t. Children are often not hungry when we offer food, and other times they’re too distracted to eat even when they are hungry. Never force your child to eat if he is not hungry. Imagine how stressful it would be to be forced to eat when you are full. Being stuffed is a miserable feeling.

It’s good to imagine how your child feels when offered food he’s never tried. A good example would be the fabled Bertie Bott’s Every Flavor Beans from Harry Potter. They come in every flavor. Will it be toffee flavor or ear wax? Strawberry or Spinach? Will you be able to spit it out if you don’t like it? If you are a naturally daring person you might not mind risking a bad taste in your mouth. However, if you are a cautious eater having to try a new food or food that caused a previous bad experience can be very stressful. How would you feel if someone forced you to eat what you thought were bogey-flavored jellybeans?

Parental pressure to eat does account for a modest (about 15 percent) change in a child’s eating behavior, but that change doesn’t have a significant impact on a child’s diet and has the potential for negative side effects. Forcing a child to eat a new, unwanted, or disliked food usually backfires. The forced food becomes a hated food to be avoided at all costs. In extreme situations, when food is forced on a child on a regular basis, the child becomes defensive when any food is offered.

Children who are forced to eat develop fears of new foods and anxiety associated with eating that can possibly lead to eating disorders. The child refuses to eat except for a very limited number of “safe” foods, and mealtimes become unpleasant battles.

What’s the most important thing you can do to help your child develop good lifelong eating habits?

Studies show that the single most important thing you can do to promote healthy eating habits in your child is to model healthy eating habits yourself. When children see their parents eating vegetables, trying new foods, and eating only until satisfied, they are likely, in time, to do the same. When children see their parents drinking sweetened beverages, eating until they are full, and snacking on chips while watching TV, that is what they will do too. Scolding your child for his eating choices while making poor choices yourself is counterproductive. “Do what I say, not as I do” doesn’t go over well with kids.

If you and your family members developed healthy eating habits as children consider yourself lucky. If you didn’t, it’s not too late to change. First, recall your own childhood habits. Did you like a variety of vegetables, or were you a picky eater? Were you bold and adventurous with new food, or did you stick to comfort foods like macaroni and cheese? Did your parents indulge your sweet tooth, or were they restrictive with sodas and sweets? Did you eat at the family table or in front of the TV?

If there is a healthy eating habit that you haven’t yet mastered yourself, work through it as you would for a child. Give yourself time. Thirty years of eating fast food are not going to give way to homemade vegetarian dinners overnight. Like infants, you must develop new tastes over time. Also, don’t force family members to eat things they don’t want. Instead, consistently provide them with healthy food choices appropriate for their developmental level. They too will take time to adjust their palate.

Older Kids and Adults Can Be Picky Eaters Too

If there is an adult or older child in your family who never learned to like a variety of tastes and textures, it’s probably because he or she was a cautious eater. Chances are he or she required more than just a few exposures to foods to learn to like them, and, understandably, caregivers became frustrated and gave up offering new foods before he or she grew to accept them.

New healthy foods should be consistently provided for picky adults as well as children. For older kids and adults who won’t eat vegetables, it is a good idea to figure out what they don’t like about them. Is it the texture, the look, or the taste?

If the texture is the problem, try making smooth-textured cream of broccoli soup, or try shredding salads into uniform little bits.

If it’s the look, try sprinkling the offending food with cheese or dipping it in dressing or ketchup.

If it’s the taste, just like with infants, the first step toward acceptance is tolerating the new food on the plate. He will eventually progress to trying a small bite, then, after many more exposures, a serving, and perhaps even learning to like the new food. Remember, it’s OK to offer the food and even to ask if that older child or adult would like to try it, but do not cajole, bribe, or force him to eat. (Not even one bite!)

Summary: Providing safe and healthy foods for your young children with an easygoing attitude are the key issues for infants and toddlers.

Be a good example. Kids model their eating behavior after their parents. You may need to work through developmental issues with your own eating habits.
Keep safety in mind. Make sure the foods you serve are appropriate for your child’s age and development and make sure that everyone sits to eat.
Have a relaxed attitude toward food. It is not your job to make a family member eat nutritious food. Your job is to provide healthy foods on a regular basis. Your child’s job is to choose what and how much to eat from the foods you’ve provided.
Offer unprocessed foods at snacks as well as meals.