Healthy Eating for Children

	Topic Overview
	Health Tools
	Changing Your Family's Eating Habits
	Helping Your Child to Eat Well
	Helping the Overweight Child
	Other Places To Get Help
	Related Information
	References
	Credits

What is healthy eating?

Healthy eating means eating a variety of foods so that your child gets the nutrients (such as protein, carbohydrate, fat, vitamins, and minerals) he or she needs for normal growth. If your child regularly eats a wide variety of basic foods, he or she will be well-nourished.

How much food is good for my child?

From birth until about 2 or 3 years old, children have an "internal hunger gauge" that signals how much food they need at a given time. Babies cry to let us know they're hungry. When they're full, they stop eating. Children continue this pattern as they grow—they eat as much or as little as their bodies need. But after the age of 2 or 3, this internal hunger gauge is also affected by other things. It is important to get your child to pay attention to the natural signs of hunger from his or her body.

It may worry you to see your child eat very little at a meal. Children tend to eat the same number of calories every day if they are allowed to eat in response to their internal hunger gauge. The pattern of calorie intake is different from day to day. One day a child may eat a big breakfast, a big lunch, and hardly any dinner. The next day this same child may eat very little at breakfast but may eat a lot at lunch and dinner. Don't expect your child to eat the same amount of food at every meal and snack each day.

How can I help my child eat well and be healthy?

Many parents worry that their child is either eating too much or too little. Perhaps your child only wants to eat one type of food—peanut butter and jelly sandwiches, for instance. One way to help your child eat well and help you worry less is to know what your job is and what your child’s job is when it comes to eating. Some food experts call this the division of responsibility.¹ If your child only wants to eat one type of food, he or she is doing the parent's job of deciding what food choices are. In the division of responsibility, it is the parent's job to decide what foods are offered.

The division of responsibility is outlined below:

• Your job is to offer nutritious food choices at meals and snack times. You decide the what, where, and when of eating.
• Your child's job is to choose how much he or she will eat of the foods you serve. Your child decides how much or even whether to eat.

If this idea is new to you, it may take a little time for both you and your child to adjust. In time, your child will learn that he or she will be allowed to eat as little or as much as he or she wants at each meal and snack. This will encourage your child to continue to trust his or her internal hunger gauge.

You can help support your child's healthy eating habits and physical activity level by:

• Eating together as a family as often as possible. Keep family meals pleasant and positive. Avoid making comments about the amount or type of food your child eats. Pressure to eat actually reduces children's acceptance of new or different foods.
• Making healthy food choices for your family's meals. Children notice the choices you make and follow your example.
• Setting limits on your child's daily television and computer time. The American Academy of Pediatrics recommends a limit of 1 to 2 hours of screen time a day.² Sit down with your child and plan out how he or she will use this time allowance.
• Making physical activity a part of your family's daily life. Some ways to do this include walking your child to and from school, and teaching your child how to skip, hop, dance, play catch, jump rope, and ride a bike.
• Taking a walk after dinner.
• Taking your child to all recommended well-child checkups. You can use this time to discuss your child's growth rate, activity level, and eating habits with a doctor.

What causes poor eating habits?

Poor eating habits can develop in otherwise healthy children for several reasons. Infants are born liking sweet tastes. But if babies are going to learn to eat a wide variety of basic foods, they need to learn to like other tastes, because many nutritious foods don't taste sweet.

• Available food choices. If candy and soft drinks are always available, most children will choose these foods rather than a more nutritious snack. But forbidding these choices can make your child want them even more. You can include some less-nutritious foods as part of your child's meals so that he or she learns to enjoy them along with other foods. Although in the division of responsibility it is your child's job to decide how much of a food he or she will eat at a meal, it is okay to limit dessert to one serving. It is your responsibility as a parent to decide what foods are offered as well as when and where meals and snacks are offered. Try to keep a variety of nutritious and appealing food choices available. Healthy and kid-friendly snack ideas include:
  • String cheese.
  • Whole-wheat crackers and peanut butter.
  • Air-popped or low-fat microwave popcorn.
  • Frozen juice bars made with 100% real fruit.
  • Fruit and dried fruit.
  • Baby carrots with hummus or bean dip.
  • Low-fat yogurt with fresh fruit.
• The need for personal choice. Power struggles between a parent and child can affect eating behavior. If children are pressured to eat a certain food, they are more likely to refuse to eat that food, even if it is something they usually would enjoy. Remember, your responsibility is to provide a variety of nutritious foods. Your child's job is to decide what and how much he or she will eat from the choices you offer.
• Emotion. A child's sadness, anxiety, or family crisis can cause undereating or overeating. If you think your child's emotions are affecting his or her eating, focus on resolving the problem that is causing the emotions instead of focusing on the eating behavior.

If your child is healthy and eating a nutritious and varied diet, yet eats very little, he or she may simply need less food energy (calories) than other children. Similarly, some children need more daily calories than others the same age or size, and they eat more than you might expect. Every child has different calorie needs.

In rare cases, a child may eat more or less than usual because of a medical condition that affects his or her appetite. If your child has a medical condition that affects how he or she eats, talk with your child's doctor about how you can help your child get the right amount of nutrition.

What are the risks of eating poorly?

A child with poor eating habits is going to be poorly nourished. That is, he or she won't be getting the amounts of nutrients needed for healthy growth and development. This can lead to being underweight or overweight. Poorly nourished children tend to have weaker immune systems, which increases their chances of illness. Poor eating habits can increase a child's risk for heart disease, high blood pressure, or diabetes later in life.

Poor eating habits include:

• Eating a very limited variety of foods.
• Refusing to eat entire groups of foods such as vegetables.
• Eating too many foods of poor nutritional quality such as soft drinks, chips, and doughnuts.
• Overeating due to being served large portions or due to a parent saying "clean your plate" or "finish it all up.

Frequently Asked Questions

Health tools help you make wise health decisions or take action to improve your health.

	Interactive tools are designed to help people determine health risks, ideal weight, target heart rate, and more.
	Interactive Tool: What Is Your Child's BMI?

Healthy eating means eating a variety of foods from all food groups. It means choosing fewer foods that have lots of fats and sugar. But it does not mean that your child cannot eat desserts or other treats now and then.

With a little planning, you can create a structure that gives your child (and you) the freedom to make healthy eating choices. Think of this as planning not just for the kids but for everyone in your family.

First steps

• Set up a regular snack and meal schedule. Kids need to eat at least every 3 to 4 hours. Most children do well with three meals and two or three snacks a day.
• Eat meals together as a family as often as possible.
• Start with small, easy-to-achieve changes, such as offering more fruits and vegetables at meals and snacks.
• Look at your portion sizes. Remember that younger children may eat smaller amounts than adults. Although paying attention to portion sizes is important (especially of less-nutritious foods), it is up to your child to decide how much food he or she needs to eat at a meal to feel full.
• Slowly cut down on soda pop and other high-sugar drinks. At mealtime, serve whole milk to children under the age of 2 (the essential fatty acids in whole milk are needed for brain growth and development). Serve nonfat or low-fat milk to children over the age of 2 (at this age, children will be getting enough fat in their diet to supply these nutrients). At other times of the day, serve water to quench thirst. You can encourage your child to drink more water and fewer sugar-sweetened drinks by keeping cold water on hand in the refrigerator.
• Use MyPyramid as a general guide for planning meals and to get an idea of the variety of foods to offer to your family.
• Consider meeting with a registered dietitian for help with meal and snack planning (nutritional counseling). For basic information about nutrition, see the topic Healthy Eating.
• When trying new foods at a meal, be sure to also include a food that your child likes. Don't be discouraged if it takes several tries before your child actually eats a new food. On average, it takes 8 to 12 tries for a child to accept a new food.
• Even though your child may not eat the food, it is important to keep serving it so that your child can see other family members enjoying it. Also, you child should not think that meals are going to get planned only around his or her food preferences. Remember, you are in charge of deciding which foods are served at meal and snacks.

If you are feeling out of control over your own eating habits or weight, your child may be learning some poor eating habits from you. See a registered dietitian, your doctor, or a mental health professional experienced with eating problems, if necessary. For more information, see the topics Healthy Eating and Healthy Weight.

Encourage healthy choices

Help your child learn to make healthy food and lifestyle choices by following these steps:

• Be a good role model. Practice the eating and exercise habits you'd like your children to have. Your example is your child's most powerful learning tool.
• Increase active time. Make physical activity a part of your family's daily life. Set limits on your child's daily TV and computer time to no more than 2 hours a day.
• Eat breakfast. Having breakfast with your child can help start a lifelong healthy habit.
• Involve your child in meal planning and grocery shopping. When your child is old enough, teach him or her about food preparation, cooking and food safety and, later, how to use food label information. While giving your child a role in decision making, remember that you have the final say in food planning.
• Involve your child in cooking. Children enjoy helping out, and they learn easily with hands-on experience. They can also use other skills, such as math, when counting or measuring ingredients.

Setting the stage for pleasant mealtimes

Make a point to eat as many meals together at home as possible. A regular mealtime gives you and your family a chance to talk and relax together. It also helps you and your child to have a positive relationship with food.

• Think of the family meal table as a conflict-free zone where you each come for positive time together. Save problem solving and difficult discussions for a separate time and place.
• Save distractions, such as reading, toys, television watching, or answering the phone, for another time and place.
• Teach and model good table manners and respectful behavior.

No more power struggles—learning to trust your child's choices during meals and snacks

Most children self-correct their undereating, overeating, and weight problems when the power struggle is taken out of their mealtimes.^{3, 4} But the hardest part for most parents is stopping themselves from directing their children's choices ("Eat at least one bite of vegetable." "That's a lot of bread you're eating." "Clean your plate." "No seconds."). When you say things like this, you are taking over the child's job in the division of responsibility. Do your best to avoid commenting.

If your child skips over certain foods, eats lightly, or eats more than you'd like:

• Check yourself. Remember that your child has an internal hunger gauge that controls how much to eat. If you override those signals, your child won't be able to tune into that internal hunger gauge as easily.
• Let your child decide when he or she is full. You can remind your child of the next scheduled meal or snack time, by telling them, for example, "You can eat as much or as little as you want now. We will have our next snack at 4 o'clock."

Expect some rebellion as you change the way you feed your family. At first, your child may eat only one type of food, eat everything in sight, or stubbornly refuse to eat anything. Fortunately, no harm is done if your child chooses to eat too much or skips a meal once in a while. Although it can be tempting to give in to your child's demands, if you give consistent messages to your child about eating and mealtimes, your child will eventually become more comfortable with the division of responsibility.

Gradually, your child's eating habits will balance out. You'll notice that, as long as you provide nutritious choices, your child will eat a healthy variety and amount of food each week. Try to relax through this change in roles, and you'll see your child relax too.

Adjusting your approach based on your child's age

Feeding your infant. From birth, infants follow their internal hunger and fullness cues. They eat when they're hungry, and they stop eating when they're full. Experts recommend that newborns be fed on demand. For more information on feeding your baby, see Feeding Your Infant.

Feeding your toddler/preschooler. As you introduce new foods to your young child's diet, you are encouraging a love of variety, texture, and taste. This is key, because the more adventurous your child feels about foods, the more balanced and nutritious his or her weekly intake will be. Remember that you may need to present a new or different food as many as 15 times or more before your child will be comfortable trying it. This is normal. The key is to offer the new food in a relaxed manner without pressuring your child.

Feeding your Teen.

When your child becomes a teen, he or she has a lot more food choices outside the home. The division of responsibility still applies. You are still responsible for providing balanced meals in the home. Family mealtimes become especially important.

When should I get help for my child’s eating habits?

If you are worried about your child’s eating habits, you can call your family doctor for help. He or she can advise you on actions you can take or direct you to someone with specific expertise, such as:

• Registered dietitians, who teach people about nutrition or develop diets to promote health. They can also specialize in counseling to help treat food-related problems, including eating disorders.
• Primary care pediatricians, who may have special training and experience in caring for children with eating issues.
• Therapists or counselors, who can help your family cope with eating disorders and with power struggles over eating.
• Psychiatrists, who can provide counseling and medicine.
• Pediatric gastroenterologists, who can rule out or treat conditions of the digestive system, which could cause an eating problem.
• Pediatric endocrinologists, who can rule out or treat hormone conditions that can lead to weight problems.

Call your doctor if:

• Your child has a major change in appetite or weight. This could include eating too much or too little, or gaining or losing weight.
• Eating issues have turned your family’s mealtimes into a battleground.
• You suspect your child may have an eating disorder, such as anorexia or bulimia.

Medical considerations

"Overweight" and "at risk of overweight" are terms sometimes used when referring to children who weigh more than expected. Doctors use the U.S. Centers for Disease Control and Prevention growth charts or the body mass index (BMI) to measure a child's weight in relation to his or her height. To find out your child's BMI, use this Interactive Tool: Is Your Child at a Healthy Weight?.

If you have concerns that your child is overweight or at risk of becoming so, first ask your doctor to review your child's growth charts and medical history with you.

• If your child's BMI has been high on the growth chart from birth, this may be his or her healthy size and growth rate. He or she may simply be bigger than other children of the same gender and age.
• If your child's BMI pattern has suddenly jumped from a lower range to a higher range on the growth chart, your child may be at risk of becoming overweight. Your doctor will carefully track growth over time, watching for a change in the rate of weight gain.
• If your family has a history of obesity, your child has a higher risk of becoming overweight.

Sometimes a child's BMI and weight can increase without a child being at risk of having too much body fat. For instance, before and during puberty it is normal for children to have a significant gain in weight before they begin to grow in height. Also, children who are very muscular (such as children who are very active in sports), may have a high BMI but have normal or even lower-than-normal amounts of body fat.

If your child's BMI and growth pattern suggest a weight problem, your doctor will give your child an exam that looks for health problems that can cause weight gain. This may include questions about eating and physical activity habits. Regular checkups for health problems will also be important over time.

Weight management goals for the overweight child

Use the division of responsibility. Your job is to offer nutritious food choices at meals and snack times. You decide what, where, and when your family eats. Your child's job is to choose how much he or she will eat of the foods you serve. Your child even gets to decide whether to eat.

Do not restrict food. Food restriction causes children to ignore their internal hunger gauges. Children who have their food restricted often end up heavier, because they become anxious about food and eating. Anxiety about not getting enough to eat will often lead a child to overeat whenever he or she gets a chance. This causes the child to become less in touch with how hungry or full he or she is, and the child becomes more likely to eat more than his or her body needs. This can also happen when children or teens follow weight-loss diets. It doesn't work to put a child on a diet—you get the opposite effect.

Pay attention to behaviors that may be adding to weight gain and then work to correct them. Then trust that your child will develop the weight that is right for him or her.

If you are concerned about your child's weight, talk to your child's doctor. He or she can tell you if your child is gaining weight too quickly and can give you steps to take to help your child have a healthy weight.

How you can help your child

As a parent, your job is to give your child the tools for a healthy lifestyle and remain as relaxed as possible about the result.

To help your overweight child eat well, use the same healthy eating approach with everyone in your family:

• Follow the division of responsibility.
• Eat together as a family as much as possible. The entire family, regardless of each family member's weight, should be offered the same food choices at meals.
• Choose water instead of sugary drinks, such as sport drinks, soft drinks, and fruit-flavored drinks. For some kids, cutting back on sugary drinks makes a big difference in balancing the calories your child takes in and burns off.
• Remember that all foods, even less nutritious foods in small amounts, can fit into a healthy diet. Do not make any food item completely off limits. This may increase the desire for the forbidden food and can lead children to overeat when they get the chance.³
• Avoid power struggles over food. Your job is to provide healthy choices at specific snack and mealtimes. It's your child's job to choose to eat or not eat.
• Stick to a regular meal and snack routine instead of snacking throughout the day. Schedule snacks for when your child is most hungry, such as after school or exercise.
• Offer nutritious food choices.
• Keep foods moderate in calories to help your child avoid getting too many calories. But don't make meals so low-calorie that your child can't feel full.
• Avoid using food as a reward, whether for an achievement, or for eating all of one's green beans. (The "nutritious food, then dessert" tactic makes the healthier food seem like a less desirable food.)
• Serve dessert as part of the meal to avoid the "dessert struggle." Offer healthier desserts, such as yogurt and fruit, more often than rich desserts. When you serve a rich dessert, it's okay to set out a single portion for each person.

To help your overweight child develop a balance between the calories he or she takes in and burns off:

• Shift the focus away from pounds and toward a healthy lifestyle by avoiding weighing your child daily. Consider not even using the bathroom scale.
• Move more. Make physical activity a part of your family's daily life.
• Keep total TV and computer "screen time" to 2 or fewer hours a day.² Encourage outdoor play as often as possible. Children should have at least 1 hour of active play a day.

As for any child with health concerns, make sure your child has all of the well-child checkups and treatment that your doctor recommends.

Helping your child with social and emotional concerns

It doesn't take long for children to figure out that our culture and their peers idealize thinness. As a result, surprising numbers of school-aged children and teens are unhappy with their bodies. This includes many who are not even at risk of being overweight.⁵ Children who are overweight are especially at risk of being teased and feeling alone. This can result in low self-esteem and depression.

For information about helping a child who is being teased, see the topic Bullying.

Regardless of a child's size, pediatric experts want every child to lead a healthy lifestyle and appreciate his or her body as it is.⁵ You can help your child develop greater health, confidence, and self-esteem by:

• Not talking in terms of your child's weight. How you talk about your child's body has a big impact on your child's self-image. Instead, talk in terms of your child's health, activity level, and other healthy lifestyle choices.
• Being a good role model by having a healthy attitude about food and activity. Even if you struggle with how you feel about your own body, avoid talk in front of your child about "being fat" and "needing to diet." Instead, talk about and make the same healthy lifestyle choices you'd like for your child.
• Encouraging activities, such as sports and drama. Physical activity helps build physical and emotional confidence. Try different types of sports and activities until your child finds one he or she likes. Drama can help a child project strength and confidence, even if he or she doesn't feel it at first.
• Encouraging social involvement in community, church, and school activities, which build social skills and confidence.
• Helping your child eat well by providing healthy food choices. Consider seeing a registered dietitian for guidance and new food ideas.
• Not allowing any child (yours included) to tease another child about weight. Talk to your child's teachers and/or counselors, if necessary.

Online Resources

Organizations

• Anorexia Nervosa
• Binge Eating Disorder
• Bulimia Nervosa
• Bullying
• Fitness
• Growth and Development, Ages 11 to 14 Years
• Growth and Development, Ages 12 to 24 Months
• Growth and Development, Ages 15 to 18 Years
• Growth and Development, Ages 2 to 5 Years
• Growth and Development, Ages 6 to 10 Years
• Healthy Eating
• Type 2 Diabetes in Children

Citations

1. Satter E (1987). How to Get Your Kid to Eat But Not Too Much, pp. 13–28. Palo Alto, CA: Bull Publishing.

2. Committee on Nutrition, American Academy of Pediatrics (2003). Policy statement: Prevention of pediatric overweight and obesity. Pediatrics, 112(2): 424–430.

3. Ikeda JP, Mitchell RA (2001). Dietary approaches to the treatment of the overweight pediatric patient. Pediatric Clinics of North America, 48(4): 955–968.

4. Hood MY, et al. (2000). Parental eating attitudes and the development of obesity in children. The Framingham Children's Study. International Journal of Obesity, 24(10): 1319–1325.

5. Littleton HL, Ollendick T (2003). Negative body image and disordered eating behavior in children and adolescents: What places youth at risk and how can these problems be prevented? Clinical Child and Family Psychology Review, 6(1): 51–66.

Other Works Consulted

• American Academy of Pediatrics (2007). Dietary recommendations for children and adolescents: A guide for practitioners. Available online: http://www.pediatrics.org/cgi/content/full/117/2/544.

• American Academy of Pediatrics (2007). Screening and interventions for overweight in children and adolescents: Recommendation statement. Available online: http://www.pediatrics.org/cgi/content/full/116/1/205.

• Heird WC, Cooper A (2006). Infancy and childhood. In Modern Nutrition in Health and Disease, 10th ed., pp. 797–817. Baltimore: Lippincott Williams and Wilkins.

• Krebs NF, Primak LE (2007). Normal childhood nutrition and its disorders. In WW Hay et al., eds., Current Pediatric Diagnosis and Treatment, 18th ed., pp. 283–314. New York: McGraw-Hill.

• Lucas BL (2004). Nutrition in childhood. In LK Mahan, S Escott-Stump, eds., Krause's Food, Nutrition, and Diet Therapy, 11th ed., pp. 259–283. Philadelphia: Saunders.

• Castro-Rodriguez JA, et al. (2001). Increased incidence of asthma-like symptoms in girls who become overweight or obese during the school years. American Journal of Respiratory and Critical Care Medicine, 163(6): 1344–1349.

• Coughlin JW, et al. (2003). Body image dissatisfaction in children: Prevalence and parental influence. Healthy Weight Journal, 17(4): 56–59.

• Gidding SS, et al. (2005). Dietary recommendations for children and adolescents: A guide for practitioners. Consensus statement from the American Heart Association. Circulation, 112: 2061–2075.