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. Your child can eat all types of food, as long as his or her weekly intake is balanced and varied.

How much food is good for my child?

From birth, 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.

When you are caring for a growing child, it may worry you to see your child take a few bites of food at dinner and then announce, "I'm full." Remember, that’s your child’s internal hunger gauge talking. Think about what your child ate during the entire week. It may have been more food yesterday and less food today. Chances are that the amount of food he or she ate balances out over the week.

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

• 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 trust his or her internal hunger gauge.

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

• Making healthy food choices for your own 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' screen time per 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. Take a walk after dinner. Consider "charging" 15 minutes of active play for every 15 minutes of TV time.
• 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.
• 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 health professional.

What causes poor eating habits?

Poor eating habits can develop in otherwise healthy children for several reasons.

• 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 and 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.
• 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 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?

Poor eating habits can cause your child to not receive the necessary amount of nutrients (such as vitamins, minerals, and protein) that he or she needs to grow and develop normally. This can lead to being underweight or overweight. Poor eating habits include routinely not getting enough to eat, having very limited food choices, or repeatedly eating more than the body needs.

• Poorly nourished children tend to have weaker immune systems, increasing their chances of illness.
• 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.

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: Is Your Child at a Healthy Weight?

Healthy eating means eating a variety of foods from all food groups. It means choosing fewer foods that have lots of fats and sugar. However, 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. For adults, an appropriate portion for many foods is about the size of your palm. Remember that younger children may eat smaller or larger amounts. 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. Serve water or milk to drink at meals instead of sugar-sweetened drinks. You can encourage your child to drink more water and fewer sugar-sweetened drinks by keeping cold water on hand in the refrigerator.
• Use the food guide pyramid to get an idea of the variety of foods to offer to your family. For a personalized food guide, go to the interactive Web site: http://www.MyPyramid.gov.
• 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 give up on offering new foods. Children often need as many as 15 exposures or more to a new food before they try it and like it.

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 topic 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.
• 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 the food guide pyramid 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.

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"). 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: "Just make sure that you've eaten enough to hold you till snack time, which is after we get back from your swim class." This can help your child make a wise decision about what and how much to eat now.

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 child. 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.

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 power struggles over eating.
• Psychiatrists, who can provide counseling and medication.
• 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

The American Academy of Pediatrics, the American Dietetic Association, and the American Heart Association each have guidelines for treating overweight children. These guidelines stress a common goal: Rather than striving for weight loss, most overweight children should only slow or stop their weight gain while they continue to grow in height. The goal is "growing into" their current weight. Low-calorie diets are recommended only for very obese children or teens who are under close medical supervision.³ For most children, weight loss diets are not recommended because they can interfere with growth in height. Weight-loss diets also cause children to become out of touch with their hunger and fullness cues, which often results in eating more than the body actually needs.

If your child's weight has suddenly increased, you and your doctor will need to look for underlying causes and then correct those, rather than put your child on a diet.

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:

• 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 meal times. 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. A good guide to a healthy diet is the food guide pyramid .
• 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 ditching the bathroom scale altogether.
• 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.

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 all children to lead a healthy lifestyle and appreciate their 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 about "being fat" and "needing to diet" in front of your child. 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.

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

• 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.