Food Refusal

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What if a child does not eat? The first word of caution is to avoid punishment for refusing foods. Then review center schedules (timing of snacks/meals and playtime) so that children come to the table ready to eat. Day care presents an opportunity to provide structure, an unbiased environment, and positive role models for introducing the toddler to new and unfamiliar foods. Meals can be offered at predictable intervals, and foods can be repeatedly offered 5 to 10 times before deciding to remove them from the menu for a while.

When a child does not eat at mealtime, especially the very young child, many care providers become anxious and supplement with snacks between meals. There is nothing wrong with snacks when they are simple nutrient-dense choices from the Food Guide Pyramid. But many times the snacks do not match up nutritionally to the meal because the foods may be high fat or high sugar and they may displace more nutritious foods served at mealtime. Change your view of snacks and treat them as mini meals or a time to try new fruits and vegetables, or a time to add fiber to the diet. Avoid reliance on quick convenience snacks such as cookies, crackers, fruit (jelly) snacks, popsicles, chips, or candy.

Another technique often used when a child refuses to eat is ignoring the behavior by walking away from the "whiny" child, especially if the child is using food to get attention. A frustrated and fatigued child should be allowed to rest before eating; you then avoid a tug-of-war over food.

When the care provider is faced with a child who will not eat, there may be little the center can do but discuss the child's behavior with the family or, if available, a social service professional. The parent–child relationship at home may affect the food intake and preferences. The following list of concerns may help the care provider understand why the child won't eat. Is the child

• developmentally ready for the foods and equipment presented?
• hungry?
• exerting some independence?
• too busy, "on the go," exploring the environment?
• tired and in need of sleep more than food?
• expected to eat foods not eaten by other family members or care providers?
• using utensils, chair, and table of right size?
• served portions that are an appropriate size?
• eating enough?
• becoming ill or recovering from an illness?
• emotionally distressed from interactions at home?

Feeding Disorders

When does a picky eater become a child with a feeding disorder? When a child's refusal to eat severely impacts his or her growth and development—the child is unable to eat sufficient calories and nutrients to maintain health and sustain appropriate growth for age. These children may appear to be falling off their growth charts or they may linger below the 5th percentile for height and/or weight for age. Feeding disorders will require physician intervention and behavioral management. For more information on feeding disorders go to the Kennedy Kreiger Institute Web site at http://www.kennedykreiger.org/ or call 1-800-554-2080.