Definition

• You are concerned that your child is not eating enough food each day.
• It may seem like your child is never hungry.
• Usually involves a child age 1 to 5. Main reason: It’s normal for a toddler’s appetite to slow down.

Health Information

Cause in General

• How much a child chooses to eat is controlled by the brain’s appetite center. Kids will eat as much as they need to for growth and energy.
• Their appetites are normal if they have good energy levels and are growing normally.
• Many parents try to force their child to eat more than they need to. They fear that poor appetite may lead to bigger health problems. This is not true. Forced feedings actually decrease a child’s appetite.
• Some parents try to make a short child eat more in hopes he will grow taller. This is impossible because genes determine height. Extra calories will just make him fatter.

Cause in Toddlers

• During their first year, babies grow rapidly. They gain 15 or more pounds.
• Between 1 and 5 years of age many children normally gain only 4 or 5 pounds each year. They can normally go 3 or 4 months without any weight gain.
• Because they are not growing as fast, they need less calories. Many toddlers have a poor appetite. All of this is normal.
• The medical term for this is physiological anorexia of toddlers.

What to Expect

• Allow your child to be in charge of how much they eat. Once this happens, mealtime battles should end.
• After a month, your concerns about your child’s health also should disappear.
• Your child’s appetite will improve when she becomes older and needs to eat more. It will also increase during normal growth spurts.

Feeding Mistakes

• Parents often are worried that their child isn’t eating enough. This may start some irrational patterns of feeding. Avoid all of the following:
• Forced feeding is the most common mistake. The parent picks up the child’s spoon or fork. Then, they try various ways to get food into the child’s mouth. This always causes decreased appetite. It can also cause vomiting. It also hurts the parent child relationship.
• Giving the child high calorie drinks, such as Ensure. That will decrease the intake of regular foods.
• Offering snacks at 1 hour intervals throughout the day. Giving snacks that are larger than a regular meal.
• Forcing the child to sit at the table after the meal has ended.
• Awakening the child at night to feed her. Then she won’t be hungry at breakfast.

Prevention of Feeding Battles

• Prevent feeding struggles by teaching your child to feed themselves as early as possible.
• By 6 to 8 months old, start giving her finger foods. Such foods allow your child to feed herself at least some of the time. Finger foods can be used when she is not yet able to use a spoon.
• By 12 months of age, your child will begin to use a spoon.
• She should be able to feed herself completely by 15 months of age.
• When feeding infants, wait for them to show you they are ready to eat. For example, they may lean forward. Let her pace the feeding herself (for example, by turning her head). Do not put food into a child’s mouth just because she has opened it.
• Your child doesn’t need to empty the bottle or finish the baby food jar. Plates do not need to be fully cleaned off either.

Care Advice

1. Put Your Child in Charge of How Much He Eats at Mealtime:
   • Trust your child’s appetite center. Children eat as much as they need. Your child’s brain will ensure he eats enough calories for normal energy and growth.
   • Serve well-balanced meals. If your child is hungry, he will eat. If he’s not, he will be by the next meal.
   • Even skipping an occasional meal is harmless.
   • Just reminding him to eat or to eat more will work against you.
2. Allow One Small Snack Between Meals:
   • Some children who never seem hungry may be eating too many snacks. Excessive snacking is the most common reason children don’t eat at mealtime. They never become truly hungry.
   • Be sure your child arrives at mealtime with an empty stomach.
   • Offer your child no more than two small snacks of nutritious food each day. Provide them only if your child requests them.
   • Keep the snack size small. Limit to 1/3 of what you would expect him to eat at mealtime.
   • If your child is thirsty between meals, offer water.
   • Limit the amount of juice your child drinks to less than 6 ounces each day.
   • Let your child miss snacks if she chooses and then watch the appetite return.
3. Never Feed Your Child if He is Capable of Feeding Himself:
   • Parents of children with poor appetites may feel they have to force feed. You pick up your child’s spoon or fork. You try to get food into their mouth while smiling and playing tricks. Forced feeding is the main cause of feeding power struggles.
   • By 12 to 15 months, children are old enough to use a spoon by themselves. Once this happens, never again pick it up for them.
   • If your child is hungry, they will feed themselves.
4. Limit Milk to 16 Ounces Each Day:
   • Milk contains as many calories as most solid foods. Drinking too much milk or juice can fill kids up and dull their appetites.
   • If your child is thirsty, offer water.
5. Serve Small Portions of Food (Less than You Think Your Child Will Eat):
   • Don’t serve your child more food than she could possibly eat. This will decrease your child’s appetite.
   • Instead, serve your child a small amount on a large plate. She will be more likely to finish it and gain a sense of accomplishment.
   • If your child seems to want more, wait for her to ask for it.
   • Avoid serving your child any foods that she strongly dislikes (such as some vegetables).
6. Make Mealtimes Pleasant:
   • Draw your children into friendly conversation. Talk about fun subjects.
   • Don’t discuss how little your child eats in her presence. Trust your child’s appetite center to look after her food needs.
   • Also, don’t praise your child for eating more. Children should eat to satisfy their appetite, not to please the parent. If your mealtimes are a battleground, change your expectations.
7. Don’t Extend Mealtime:
   • Don’t make your child sit at the dinner table after everyone else is done. This will only cause your child to develop unpleasant feelings about mealtime.
8. Consider Giving Your Child Daily Vitamins:
   • Although vitamins are probably not needed, they are harmless in normal dosages.
   • Giving them may help you relax about your child’s eating patterns.

Call Your Doctor If

• Your child is losing weight
• Your child has not gained any weight in 6 months
• Your child also has symptoms of illness (such as diarrhea or fever)
• Your child gags on or vomits some foods
• Someone is punishing your child for not eating
• Mealtimes have not improved after trying these suggestions for 1 month
• You have other questions or concerns

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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