19.8: Guest Lecturer - How Much Should My Child Eat?

Guest Lecturer: Ellyn Satter, MS, RD, LCSW, BCD

How Much Should My Child Eat?

“How much should my child eat?” is a deceptively simple question. The issue of how much, the same as issues related to feeding overall, must be considered in the context of the overall parent-child relationship. Feeding is more than picking out food and getting it into a child. Feeding is about the love and connection between parent and child, about trusting or controlling, providing or neglecting, accepting or rejecting.

Years ago, when I first began consulting in pediatrics, I designed a short guide for introducing solid foods to infants, a guide to be distributed to parents by the nursing staff. The handout made recommendations, by age, for solid-food additions to the baby’s diet and told the reasons for the additions. I thought it was a nifty little piece that would answer most of the parents’ questions.

However, within a day after the guide was introduced, a pediatric nurse called. “The mothers want to know how much they should feed their babies.” How much? She had me there. I didn’t know how much. I had raised three babies and hadn’t paid much attention to how much. I just assumed my babies knew how much, and went by what they told me. But the question still intimidated me: How was I to tell those mothers and nurses how much when I didn’t know it myself? What kind of nutritionist and mother was I?

I thought and thought and read everything I could get my hands on, but I still didn’t know. There was nothing consistent on which to base a recommendation. I looked at calorie requirements for infants (which varied), asked for recommendations by pediatricians, nutritionists, and nurses (which varied), and talked with parents about how much their babies ate (which also varied).

About the only thing I came up with that made any sense was a guide to the minimum amounts of solid food that babies need to eat in order to satisfy their nutrient requirements. That wasn’t very much—either information or food. Beyond defining the minimums, with respect to saying how much a child should eat, I was stuck. I couldn’t possibly answer.

I further realized that for me, or even for the parent, to say how much was inappropriate and, in fact, took away a prerogative that belonged to the child. It was not for me to say how much, sitting in my office miles away from where the really important decisions were being made. It was not even for parents to say how much, because they couldn’t possibly experience the infant’s hunger and desire for food. Parents can only learn to detect and trust the infants’ signs of hunger and fullness and use those signs to guide the feeding process. In short, only the child could say how much, and that information was not going to fit on my neat little feeding guide.

Dividing Responsibility

Children are extremely tuned in to their internal signals of hunger, appetite and satiety. Provided parents give them appropriate support for their eating, children know how much they need to eat. They pick and choose from what parents have provided. Even though on any one day their food intake appears imbalanced, over time they eat a variety and that variety adds up to a nutritionally adequate diet.

Proper child-feeding depends on a division of responsibility: Parents are responsible for the what, when and where of feeding. Children are responsible for the how much and whether of eating.

Jobs parents need to do with feeding include:

• Choose and prepare the food
• Provide regular meals and snacks at predictable times
• Make eating times pleasant
• Show children what they have to learn about food and mealtime behavior
• Not let children graze for food or beverages between times
• Let children grow up to get bodies that are right for them

Fundamental to parents’ jobs is trusting children to decide how much and whether to eat. If parents do their jobs with feeding, children do their jobs with eating:

• Children will eat
• They will eat the amount they need
• They will eat an increasing variety of food
• They will grow predictably
• They will learn to behave well at the table

Parental Behavior and Children’s Eating

Generally,children eat best when their parents are neither over-managing nor over-permissive. In order to eat the amount they need to and to learn to enjoy a variety of food, children need both opportunities to learn and autonomy. They need to have regular mealtimes where they are exposed to a variety of food, and they need to be allowed to determine what and how much to eat at those mealtimes. Studies show that children eat worse when they coerced to eat, whether that coercion is positive as in cheerleading or rewards, or negative, as in threats and punishment. Appropriate parenting appears to be a factor in obesity as well. Children whose parents give both leadership and autonomy are less likely to be overweight than children of parents who are domineering, permissive or neglectful.

Attempting to manipulate children’s food intake simply doesn’t work. Children who are forced to eat more or different food that they eat voluntarily become turned off to food and undereat when they get the chance. Children whose food intake is restricted become food-preoccupied and prone to overeat when they get the chance.

Feeding is Parenting

But poor eating habits, undesirable as they are, may not be the worst consequence of interference with food regulation. A child can outgrow a diet that is less than optimally chosen, as long as it is offered supportingly and lovingly. However, outgrowing deeply ingrained attitudes about self and the world is devilishly difficult. If the parent-child relationship around food is distorted, it is likely to distort the whole relationship. Parents’ attempts to manipulate or control their child’s eating can spoil the parent-child relationship and have a far-reaching impact on a child.

Parents’ attitudes about their children are reflected in the way they feed. If parents have an attitude of curiosity, relaxation, and trust, they watch for children’s cues and respond to them. They depend on information coming from children to guide feeding and let them develop bodies that are right for them. On the other hand, if parents’ attitudes grow out of a sense of responsibility and a need to control, they are likely to closely supervise the child’s eating, monitor growth, and attempt to manipulate the child’s food intake in order to produce an “acceptable” growth pattern. That pattern is likely to reflect the parents ideas of appropriateness rather than the child’s constitutional endowment.

Refusing food to a hungry child or forcing food on a satiated child is miserable for the child and miserable for all but the least tuned-in feeders. But just as bad as the struggles around eating are the lessons children learn from the struggles about themselves and about the world. Children whose size and shape are deemed unacceptable learn that they, themselves, are unacceptable. Children who have to beg and fight in order to get enough to eat learn that the world is untrustworthy. Conversely, if their needs are met in a supportive and consistent fashion, they learn that the world is trustworthy and they can allow themselves to depend on others.

Feeding interactions also teach children whether or not they have the ability to influence others. If they have to fuss and fight and struggle mightily to get their needs met, or if what they get has little or nothing to do with what they want, they are likely to think of themselves as not having much clout in the world. On the other hand, if other people respond to them in a prompt and appropriate fashion, they learn that what they want and need does matter and that other people will respond to them.

Teaching Feeding Teaches Parenting

The way health professionals teach parents to feed children has an impact on parents’ attitudes about their children. Teaching parents how much to feed children teaches them to be controlling. Being wary about growth and vigilant about preventing fatness teaches parents to be controlling. Worst of all, putting a child on a diet, encourages parents to be controlling in a way that is absolutely guaranteed to disrupt the entire family. That is very serious business.

Children have a growth potential that they tend to maintain and defend, and attempting to modify that potential requires the most persistent of efforts. Further, it appears that attempting to modify food intake can backfire and promote the very problems the intervention is intending to avoid, whether it is overgrowth or undergrowth.

Regulation of food intake and appropriate growth depends on a delicately balanced interaction of nutritional, behavioral, physical, and psychological factors. Because the process is so complex, we must be extremely careful about intruding upon it. Changing or overruling the body’s ability to regulate food intake and growth potential can only be done against odds, and at a cost that is highly likely to be unacceptable.

^{Ellyn Satter has Master’s degrees in Nutrition and in Clinical Social Work. She is the founder of the Ellyn Satter Institute, which provides resources for professionals and the public on eating and feeding. She is a lecturer and author. Her books include Your Child’s Weight: Helping Without Harming, and Secrets of Feeding a Healthy Family}