Managing Toddler Mealtimes

Toddlers are at a stage where they begin to develop a sense of independence. They are on the move and are busy exploring the world around them. They sometimes use food to exert their independence by attempting to determine what, when, how much and where they will eat. Feeding a toddler is often challenging and usually messy as they throw, squash and explore food by playing with it. This, however, is an important part of their development and it can be a rewarding time to see their enjoyment and exploration of different foods and textures. It can also be a time for tantrums, food refusal & food fads leading to parental anguish, frustration and concern about your child's nutritional intake. This is all normal and is experienced (in varying degrees) by all parents/carers. Below are some tips and strategies to help you through this time.

What should my toddler be eating?

Refer to Healthy Eating for Toddlers fact sheet.

Remember

Healthy toddlers will not starve themselves. If your child is growing appropriately you can be confident they are getting enough to eat. It may not be the right balance of foods but certainly they are eating enough energy (calories/kilojoules) from food and drink to meet their needs. If you have concerns, have a close look at the foods and drinks you are offering your toddler. Each day try to include the number of serves of each food group as outlined in the Factsheet Healthy Eating for Toddlers. Remember the variety of foods eaten over a week, month or even a year is more important than the variety eaten in a day.

Dealing with a fussy eater?

A positive approach to food and eating can help you to manage mealtimes. Throw away your expectations of what they should eat and try not to outwardly judge them on how much they have or have not eaten. Always remember it is the parent's responsibility to choose what, when and where to eat and the child makes the decision whether to eat or not. How much they eat will depend on how hungry they are and whether they want to eat the foods offered. Learn to trust their appetite and help them to know when they are full or still hungry. Try not to worry if little is eaten and offer food again at the next meal or snack time. They will probably eat more at the next meal (or day) when they feel like it. It is best not to react but stay calm and positive. This will help make mealtimes a positive experience for all. Try to sit with your toddler at meal times, be relaxed and enjoy it as a special time with your child. It is not just time for eating but a time for learning mealtime manners (this takes years!), exploring food and developing socialisation skills.

Some tips for mealtimes:

• Keep calm and positive (often challenging!).
• Meals are a time for families to sit together to eat, talk and socialise - preferably with no distractions such as the TV or phone. Enjoy the mealtime and try to talk to your child about things other than food, such as what they did that day.
• Try to get your toddler to sit down for meals and snacks, at least for a short time. Keeping meals short (no longer than 30 mins) and enjoyable will help.
• Serve food in small portions. They can always ask for more and large portions can be overwhelming.
• Praise your child when they do eat by saying "you are eating well tonight, your tummy must be hungry" rather than comments about them being "good" because they are eating. They are good if they are sitting nicely or behaving well but not because they are hungry and therefore eating. That is instinct!
• Ignoring poor eating is usually more productive than getting angry or upset. If you need to vent frustrations about how little your toddler is eating or their mealtime antics do this away from the mealtime and away from little ears!
• Be patient; changing mealtime behaviours takes time.

Won't eat healthy foods? Try these tips.

It is good if your toddler is hungry before their meal. If they have had food or milk or a sweet drink too close to a meal time they may not be hungry. Some children need 1-2 hours (or more) without food in order to be hungry. Maximise their hunger by trying the following:

• Develop a meal time structure of 3 meals and a small snack (if time permits) between meals.
• You are a powerful role model so look at what, when and where you and the rest of the family eat.
• Offer well balanced meals in small amounts such as:
• • Breakfast: cereal with milk, toast with topping, egg and toast fingers, fruit dipped in yoghurt.
  • Lunch: sandwich with wholemeal bread, margarine and meat/vegetable filling. If your child will only eat a plain sandwich (such as Vegemite) then offer meat strips or shaved meat, cut up vegies such as grated carrot and chopped cucumber or pasta on the side. Toddlers love little bits of food that they can pick up and eat with their fingers.
  • Dinner: try meat or an alternative such as chicken or fish served with a few different colours of vegies such as broccoli, carrot, tomato and some carbohydrate (potato, pasta, rice or noodles).
  • Offer a variety of fruit, with or without yoghurt or custard as a regular dessert after lunch and dinner.
• When offering a new food include it with some well liked and accepted foods that you know your toddler will enjoy. Start with a small amount and let your child know how much you expect them to try eg: "just try one pea".
• Never give up when offering new foods. It can take up to 7-10 times of offering a new food before it is happily accepted.
• Avoiding labelling a child as a "fussy eater" or commenting that they "don't like a food" because they have refused to eat. They may just be more cautious and will take time before they will readily accept a new food. Continue to offer it at times and praise your child when they do try it.
• Offer textures appropriate for your toddler and include some foods they happily eat with their fingers. Toddlers love to be able to feed themselves so encourage them to do this. They will need help at times.
• Avoid giving "other foods" if they refuse to eat their meal. Especially foods high in fat, sugar and salt just so that ‘they eat something'. They will quickly learn to refuse the healthier foods you offer if they know it will lead to something else such as their favourite food or treat. Be confident to say "No" and know that they won't starve if they don't eat the meal you have served.
• Make healthy foods fun! For example, cut sandwiches into their favourite shape, let them help prepare the food such as tearing the lettuce for the salad, or make stories up about foods such as ‘why milk is white?'
• Don't use ‘unhealthy' foods to coax your child to eat the healthy choices. Research has shown that using food as a reward can make this food more desirable.
• Avoid buying and keeping foods in the house that you don't want your child to eat. They will realise that there is no point in crying over something that is not there.
• Overcome your urge to force feed your child. If your child does not want to eat at the table do not chase after them with food. The table is where food should be eaten.
• Have fun and enjoy your child's mealtimes with them.

My child loves his bottle! How do I stop it?

Large intakes of fluid such as milk or juice (or other drinks containing sugar) reduces a child's appetite for foods and is a common cause of iron- deficiency anaemia (low iron). This often occurs in toddlers who drink frequently from bottles. This frequent drinking can cause dental caries, poor dental hygiene, iron- deficiency anaemia, poor appetite & weight gain or overweight in toddlers.

Ideally your child should not have a bottle beyond 12 months of age. Some children stop bottles themselves while others love their bottles and become quite dependent on them. If your child adores their bottle then you will need to step in and stop the habit. There are two ways to stop bottle drinking. Choose the way you think is best for your child:

1. Get rid of the bottle in one go, by throwing away all bottles and telling your child that they are "too big/old/grown up" for the bottle. Be creative and positive with the change. Offer them a fun cup alternative and comfort them till they get used to it. Distract them by offering love and your time such as cuddles and a story and they will soon adapt.
2. Wean them off the bottle slowly by diluting the drink in the bottle, reducing the volume in the bottle and gradually reducing the amount of times they have the bottle each day. Introduce drinks at meal and snack times in a fun cup that your child may choose.

A toddler needs only 200-500mls milk per day (depending on what other dairy products they are eating) and some water over the day. Juice is not necessary and intake of fruit is preferred. Teaching your child to enjoy water is important and a healthy lifestyle habit to teach at this age. If they drink large quantities of milk or juice their little tummies will fill up and they will have less of an appetite for foods.

Tips

• Stop bottles and offer all drinks in a cup (non-spill/ spout /sipper or straw cup).
• Encourage your child to enjoy water.
• Offer up to 3 small glasses of milk per day (500mls max). Full cream milk is recommended to 2 years of age and reduced fat milk from 2 years.
• Avoid offering juice. Encourage your child to eat a piece of fruit instead.
• Other sweetened drinks such as cordial or soft drinks are not recommended.
• Offer drinks after meals and snacks if your child's intake of foods is small.

Eats only chips? Tips to encourage other foods.

• Toddlers go through stages of food refusal. Neophobia (fear of new foods) is common at this age. Remember it can take more than 10 exposures to a food before it is accepted, so if they don't like it, just try offering the food again another day.
• Toddlers often like a food one week and dislike it the next. It is usually just a fad and easier to go along with than fight it. They often have so many fads that in the end, they have quite a varied diet anyway. Just continue offering a variety of foods.
• Alter the foods they do like because children are more likely to eat foods that they are familiar with eg. same sandwich everyday. Add some grated cheese or meat slices to the side of the sandwich; add small gratings of vegetables into their rissoles/meatballs/lasagne/bolognaise sauce.
• Avoid making your toddler a special meal (or substitute foods they like) when they reject a meal or food. Serve the family meal and if they won't eat this (or parts of it) take the meal away (after several attempts to encourage). Say things like ‘it's a shame you weren't hungry, that was such nice food' as you take their plate away, rather than getting mad at them. Put it in the fridge in case they say they are hungry later (and they probably will be!). Your child won't starve and will soon learn to eat their dinner if they feel hungry as they won't get offered something else instead.
• Be a good role model. Children tend to watch and imitate others. If you set a good example when you eat, they are likely to follow. If you pull a face and show a dislike to certain foods, they are more likely to copy that reaction.
• Let your child believe they have some control by granting them simple demands eg. the shape of their sandwich, no crusts on their bread, what shaped pasta they would like with the bolognaise or casserole. Involving them in meal preparation may make them more interested in the meal to be served.

My child won't sit still to eat!

• Toddlers are not good at keeping still for long! They have a lot to explore and do in their day. Do not expect them to sit down calmly for very long.
• A hungry child will be a "food focused" child and will be motivated to eat. Aim for your child to develop hunger ready for the next meal time.
• Keep mealtimes predictable, short and enjoyable. No longer than 30minutes for a meal.
• You are an important role model and they watch and copy your behaviour so avoid eating on the run.
• Limit distractions at meal times such as TV and have quiet time before a meal to allow your toddler to calm down before eating.
• It is important to share meals together as this models enjoyment of food and good behaviour. Sit and eat with your child as much as possible. Breakfast and lunch are good meals to share as toddlers are commonly tired and restless in the evening, so may have dinner earlier.
• Eating with other children around eg: at playgroups, pre-school.
• Make meal times a happy social occasion. Relax and try not to worry about the spilt drink or fingers in the food. They will grow out of this. Give them positive feedback on the habits you want continued, rather than focusing on the negative ones. If your child is throwing food, calmly take the food away.
• Changing behaviours takes time and will not happen overnight. Talk to your child in a calm manner about what behaviours are expected.
• Tell your child the meal is over when they leave the table. Take their food away and tell them that it is the end of the meal and there is no more food till the next meal or snack. Offer their meal leftovers or a healthy snack when they are next hungry.

How much food should my toddler eat?

• It is common for parents to be unrealistic about the amount of foods their child should be eating. It is important to realise that the rate of growth in toddlers slows down and therefore their appetite is reduced. For example, a baby on average gains 8kg in the first year of life, but only 2kg in the second! Research has shown that children are capable of regulating their intake over a 24-hour period, so they are better at knowing the amount of food they need than parents do. If they eat more in one meal, they are likely to eat less at the next and vice versa. It is therefore important that you let your child decide whether they are hungry and how much to eat. Your role is to decide what foods they should eat, that is, to provide nutritious choices.
• Develop a meal time structure offering 3 meals and a small snack between meals if time permits.
• The best way to tell if your child is eating enough is to look at their growth. If they are:
• • Growing well, active, bright eyed and have access to a variety of food, they are likely to be getting enough food.
  • Skinny, healthy and growing fast while eating what appears to be all the time, you may need to accept they have higher energy needs and provide more food.
  • Chubby although they don't appear to be eating enough, look at the types of foods they are eating (& drinking) and their activity levels. If concerned, see your doctor.
  • Underweight and don't appear to be growing, see your doctor.
• You should avoid controlling your child's intake. Research has shown that parents who show authority over the quantity of food eaten affects their child's ability to control their own intake, and can result in overweight or underweight.

Summary

Relax and accept fussy eating as a stage that many toddlers experience. Reassure yourself and remember:

• It is a parent's responsibility to provide a range of healthy foods at meal and snack time.
• It is a child's responsibility to decide how much they will eat. Healthy children eat when they are hungry, and not usually before. No healthy child has ever starved to death from stubbornly refusing food.
• If a child refuses the food that is offered do NOT provide an alternative, wait until the next meal or snack.

Websites

• The Children's Hospital at Westmead
• State Government of Victoria
• Women's and Children's Hospital (South Australia)
• Raising Children Network
• Better Health Channel
• Click on healthy eating and food fact sheets. Several factsheets available under healthy eating tips.
• Ellyn Satter Associates (US site)
• Dietitians Association of Australia
• Baylor College of Medicine: Children's Nutrition Research Centre (US site)

Books

• Food for under fives – How to develop good eating patterns for your child. Rosemary Stanton, 1999.
• Kids Food Health 2 – from toddler to preschool. Dr Patricia McVeagh & Eve Reed, 2001.
• A Healthy Start for Kids – Building good eating patterns for life. Sue Thompson, 1995
• Child of Mine- Feeding with Love and Good Sense. Ellyn Satter, 2000
• Positive Food for Kids. Dr Jenny O’Dea, 2005.