This series features questions asked during webinars (that we weren’t able to get to), questions we have been emailed, or questions from social media. The following is intended to offer general information that may be helpful to consider in similar scenarios. Individual details are altered to provide anonymity.
Question: Do you have a resource on quantities of food kids need based on their age? I ask because most families I have seen tend to overfeed but I don’t have a resource to show them.
Start from a place of curiosity
Is the concern the portion sizes the children are eating, the weight status of the children, or the sense that parents are consistently trying to get the children to eat more than they want? (Indications might be conflict, parent overriding child’s cues*…)
Many caregivers try to get children to eat more if they worry the child is too small, or that they don’t eat enough, or that they will become too small…
What is the caregiver’s perception of the child’s growth and size? Any specific nutrition worries? Are they hoping a child may sleep better with more food or last longer until eating again? Are multiple generations involved in mealtimes and approaching feeding with different beliefs?
Is there background that could impact feeding? For example, past food insecurity? Thoughts about wasting food? Another example could be parents who spent time in refugee camps with poor living conditions and sanitation; they may have the impression (perhaps correct in that setting) that plumper babies survive illness better.
Is feeding a way that the caregiver and child experience and access connection? Is food something the parent can give the child in a time of Covid restrictions, or if there is a lack of safe spaces to play or socialize in? Is food a source of pleasure or regulation in chaotic times?
Also consider: What are you bringing to the equation? You might ask yourself, is this something I worry about for all of the children, or only those in bigger bodies? Is my motive to get children to eat less to weigh less, or is this about supporting responsive feeding and relationships? You are likely also getting a lot of pressure to get “results” with BMI, which may have been the reason for the referral in the first place.
We can support healthful behaviors that contribute to wellbeing, but weight is not as under our control as many like to think it is. Just as pressure to eat backfires, restriction, or trying to get kids to eat less often backfires as well. This is tricky, nuanced stuff that took me a few years to wrap my head around and I’m still learning. We will continue to explore this at RFPro in the months ahead.
Many children encouraged to eat more will get turned off and eat less, some seem to not mind and may eat more than they would otherwise. In both cases, children are not eating based on internal cues and over time may have a hard time tuning in.
Consider food insecurity
Responsive feeding therapy requires a whole child lens. That means considering the child, their family, the culture and the economic systems they live in. Many communities experience high rates of food insecurity, made worse by Covid.
Asking routinely about food insecurity is important. This article (content warning for anti-fat bias) has screening recommendations and sample questions. The USDA has a six-question inventory to assess FI. See what works for you and/or your employer. (Jo Cormack will dig into this in her upcoming talk on Pre-Assessment paperwork.)
“Overeating” is a predictable, and resilient response to food insecurity or restriction.
If children don’t have access to enough food reliably and regularly, when they do have access, they may eat a lot. Are you seeing a child eating large amounts in response to food insecurity? To restriction? Meaning have caregivers been trying to get the child to eat less (often recommended by medical professionals), which predictably leads to many children wanting more and seeming insatiable? Stay tuned for a webinar later this year on this apparent “food preoccupation.”
Misperceptions about appetite and growth fuel pressure to eat
Parents have common misperceptions around appetite: they may think the amount children eat should be stable from meal to meal, and predictably increase as they get older.
In fact, appetite often slows around one year of age as growth velocity slows. (Our webinar on growth misperceptions explores this a bit.) And young children’s appetites vary greatly! They may eat two scrambled eggs at breakfast and then one bite of cracker at snack time. Many parents have a hard time with those smaller meals, and try to get children to eat more.
Some ways to support and address “overfeeding”
Portion size considerations
Assuming the above is considered, some education around how children eat may reassure and support responsive feeding (RF) and optimal growth. Here is a link to a handout from the Santa Clara Public health department that is a good start in terms of how much to offer. It’s a handy and simple visual. (My concerns with this diagram are 1) It may imply preplating is preferred. We recommend allowing the child to self-serve when able and if it works for the family. 2) Children will often eat one or two items offered, we are not implying they need to eat everything on the plate.)
You might look at the image with parents and have a discussion along the lines of, “Young children often eat much less than we think they should. They will eat more some meals, and less others, this is perfectly fine. Trying to get them to eat more will often lead to battles, and they may eat less or more than they need. They may only eat one thing that we offer, and that’s okay too. Over a few days, they will usually eat different foods, and you can plan a snack or meal every few hours so they won’t go hungry.”
- Discuss amounts to start offering of what a toddler may eat. Reassure it may be more or less.
- Reassure caregivers and the child with regular eating opportunities every 3-4 hours (more often if younger generally).
- Remind parents that trying to get children to eat more can backfire.
- Help parents attend to the child’s cues. Point them out to parents. Is the child slowing down, distracted, pushing the spoon or hand away, crying, playing, throwing food, trying to get down…
- Support the relationship: if the child is resisting efforts to get them to eat more, discuss the benefit of connection at eating times, and the importance of reducing conflict.
- Perhaps ask caregivers to reflect on their own experience of appetite with conflict. Do they want to eat more or less when upset?
- Connect to resources if food insecurity is a factor.
We hope this helps with a specific resource as well as other things to consider. Good luck!
*Ellynsatterinstitute.org has an excellent video, Feeding With Love and Good Sense II that shows clear examples of children resisting attempts to get them to eat more. It might be a helpful resource for you, and to share clips with parents.