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Childhood Nutrition – A Healthy Start (Part 1 of 2)

March is National Nutrition Month in the United States. I realize that every month has a number of designations such as this, and most people pay little attention to them, myself included. However, as it relates to child health, I can think of few topics of greater importance. In fact, the way we eat as a nation is contributing to the fact that generational life expectancy is actually decreasing for the first time. This is a tragedy that can be avoided.

The Extent of the Problem

It’s no secret that we have a very serious problem in this country with overweight and obesity. Although awareness of the problem has increased, there has not been any significant improvement in national statistics. In fact, they continue to get worse.

It is estimated that 35 to 40 percent of adults in the United States are obese. Overweight accounts for another 30 to 35 percent. These rates represent a threefold increase since the 1970s, and the rates of childhood obesity parallel those of the adult population. About 20%of children in the U.S. are obese. That’s 1 out of every 5! The lifelong health consequences of this problem are well documented.

It’s impossible to fully cover such a broad topic in a single article (or a thousand-page book for that matter!), so I wanted to offer a few important ideas about helping our children develop and maintain healthy eating habits. This article will focus on the broad issue of intuitive eating and how to cultivate this in our children (and ourselves). The next will offer more specific advice.

But First, a Disclaimer

I will not address physical activity in this article, simply due to the fact that it is also an incredibly expansive topic. However, its absence does not suggest a lack of importance. Indeed, physical activity is a vitally important part of a healthy lifestyle and should not be overlooked. But it will have to be the subject of another article.

Intuitive Eating

Most of us are born with the natural instinct to eat when we’re hungry and stop when we’re full. But somewhere along the way many of us develop habits of eating which have nothing to do with the basic reason for food consumption. Add in access to bottles for too long, foods that are for pleasure only, treats given as a reward for good behavior, as well as many other contributing factors, and it’s easy to see how caloric excesses may arise.

The assault on our natural intuition toward eating starts early on. As a toddler or preschooler, most of us were told by proud parents, “You’re such a good girl (or boy) for finishing all of the food on your plate!” We beamed with pride as we learned that eating a lot of food pleased our parents and equated to us being “good.” How many of us have said similar things to our children?

It’s best if we try to leave value judgment out of eating. Instead of using the above phrases, or similar ones, with our children, we might consider saying things like; “It looks like you’re really hungry today. Would you like some more vegetables?” or, “I see that you don’t feel like eating right now. I’ll save your food for later when you’re hungry.” If we try to state our observations rather than make value judgments about our children’s eating, mealtime will be more enjoyable for all.

We should remember that one of our jobs as parents is to provide healthy foods for our children to eat, several times per day. The child will then decide what she eats and how much. This applies to the vast majority of children, with rare exceptions. I know that sounds too easy, but most of the complicating factors in this arena are created by us, the parents. Anxiety, feelings of rejection, power struggles, age-related behavioral issues, and many other factors, contribute to making the feeding relationship seem overly complex. We will do better if we try to leave our own emotions out of it, and encourage the feeding intuition our children come equipped with from the start.

The following topics are related to intuitive eating, including some exceptions to the rule:

“…but she doesn’t eat anything!”

On occasion, this can be a concern. But only when a child is not growing well and not gaining enough weight to stay consistent on the growth curve. Fortunately, this is typically not the case. The vast majority of children who go on hunger strike altogether (or hold out for only their favorite foods) are healthy and growing fine. Let’s face it… it doesn’t take many calories to keep a little 2-year-old going. Even older grade school kids don’t need as much as we might think. As I have told the parents of some overweight and obese children who expressed this concern, sometimes we have to adjust our expectations.

“He has what you might call a narrow diet”

If your child will eat only chicken nuggets and french fries, then it might be appropriate for those foods to disappear from the house (and the car, and grandma’s house, etc.) for a little while. Until he or she discovers that there are other edible substances available, there may be some whining and dramatic displays of deprivation, but survival is very likely (for all involved parties). Keep in mind that it may take up to a dozen tries before a new food is accepted, but if the child is hungry, that number is likely to decrease.

A tried and true technique on this front is the “one bite method” or the idea of “no thank you bites.” It’s essential that we respect the child’s tastes in this process. One bite means one bite. If they don’t like it or say, “No, thank you,” to more, then that’s it. Don’t try to cajole your child into eating “just 5 more bites” of something he obviously doesn’t like. It’s exceedingly rare for a child to be so picky and stubborn that he will actually stop growing, lose weight, or become malnourished. So once again, offer the healthy foods you would like your child to eat, and eventually things will work out.

The Forrest Gump Eater – “You never know what you’re gonna get”

Toddlers and preschoolers are often known for their inconsistency regarding different foods. As parents, this can drive us crazy! I remember saying to my sons when they would refuse to eat something they had devoured the day before, “But you just ate this yesterday! What’s going on?” We tend to worry about those “not hungry” days, and fear that our child will be unable to make it through the week. But as long as some “hungry” days are in the mix, and we take full advantage by allowing them to eat their fill on those days, everything should be okay. Inconsistency is aggravating, but I, for one, am still working to overcome this tendency in my parenting style. So we should probably cut our kids a little slack here, too.

“She’s a good little eater!”

On the other end of the spectrum is the child who never met a food she didn’t like, and lots of them. This brings delight to the parents of an eight-month-old… less so for those of an eight-year-old. It all depends on where the child is on the growth curve. There are some children who seem to be able to eat more than their parents and maintain an appropriate weight, but this is not generally the case. If the child is in the overweight or obese category, something has likely gone wrong with the eating intuition, and appropriate interventions should be made. It’s essential that a child who likes everything is offered healthy foods for both meals and snacks, and that portions are appropriate, both in size and number. “Only fruits and vegetables as snacks” is a good rule for these children (and basically everyone). There will be more specifics about this in the next article.

“Do as I say, not as I do” vs. “Let’s do this together!”

As with almost everything regarding our children’s behaviors, we should also consider our own. Here are a few potentially revealing questions we can ask ourselves about how well we are modeling the intuitive eating behaviors we encourage in our children:

Have I ever eaten a meal and then realized that I wasn’t hungry before I ate?

Have I bought into the “clean your plate” mentality?

Do I often eat until feeling overfull?

How many of my calories come from foods or drinks which offer no nutritional value?

How much time do I spend thinking about food?

Are there foods in my house that are off-limits to the children?

Do I follow the recommendations for fruits and vegetables and limit my sugar intake?

Some of the most powerful influences in our children’s lives are the things they see us do, much more so than what we say. This is rarely truer than in the realm of nutrition. Remember with regard to our food choices, if it’s in the house, it’s fair game, for everyone! If the eating expectations we have for our children are far afield from our own habits, our words will often fall on deaf ears. However, if we set specific goals as a family, and encourage each other along the way, there is a much greater likelihood of success.

[…to be continued later this month]


Food Fights (Second Edition) by Laura Jana, MD, FAAP, and Jennifer Shu, MD, FAAP

Center for Disease Control website (

American Academy of Pediatrics website (

2015-2020 Dietary Guidelines for Americans (

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