4 Year Old Daughter Not Eating Enough

Hi Melissa,

Your little girl is more resilient than you think. Here is what I often advise clients when eating issues come up.

Have your daughter help with the meal in some way, even if it is only to bring silverware or napkins to the table. Do this lovingly to cue her that dinner is taking place and that it's time to take a break in the play or whatever else is going on.

While you plan your meal, be sure to include two or three things at the table that you know she likes. Maybe some apple slices or bread or cheese, even mac-n-cheese is fine. I like the approach of putting three choices on a plate--making sure that at least one is a welcome choice in her eyes--and being matter of fact about it. This eliminates the game of "are you interested?" on the parent's end and gives your child clear direction and options. She may eat what's on her plate or she may go play. Do not bring out extra 'favorites' later on in order to get her to eat; but do let her have seconds on her favorites, even if she hasn't eaten the other foods. Some kids may need to take whatever offends them off their plate; if your daughter finds this necessary, offer her a saucer to do this and no commentary on your part.

Parents sabotage themselves by trying to hard-sell foods to children that their palates haven't developed a taste for yet. There's nothing wrong with this: we have a biological preference for sweet and bland foods (these are often the ones that aren't poisonous, in the natural world) and it take some time for some children to develop a cultivated palate. I don't care for the "one-bite" type rules, which can encourage and cement food aversions. Instead, I think that children need to be respected as to their own preferences and allowed to try things when *they* are interested. (Hey, if I thought that monkey eyes tasted gross, I'd be horrified to have someone insisting not only that I eat at least a bite, but that I'm going to like it!---so is the thinking of children. Many foods=monkey eyes to them!)

Lastly, if you are worried that she's only going to eat junk foods, don't have them in the house. It's that simple. We have some snacky foods in our house, but they are well-chosen, so that if my son asks for them I don't have any qualms. Think whole grain crackers served with cheese, almonds, apples, graham crackers with almond butter...you get the picture. This can also eliminate some food battles.

Take your time with whatever new routine you choose. From my observation, it generally takes a week or two to tell if your new way of presenting dinner is working. Sometimes kids just get a little lost as they are flexing their own muscles of autonomy, and they need our confidence and faith that they will figure it out in their own time. Keep a nice choice of food on the table at meals, offer a simple plate and let it go. She's going to have to figure this out on her own. (And no!- no "you're going to be hungry later on" warnings--she's going to learn it better on her own.:)

Cheers and happy dining~H.

Our bodies are not made to eat the way we do. She actually has quite healthy eating habits. A person should eat a large breakfast, a medium lunch, and a small dinner. The key to getting her to eat nutritiously is to focus less on what she won't eat for dinner, and focus
more on what you are serving her for breakfast. If she eats cereal, shoot for General Mills be because they are made with whole grains and an average of 25/ of most vitamins and minerals in each bowl. That means that two helpings gives her half of what an adult needs of many things. Focus less on quality and more on quality.

Also, you are right about growth slowing down at this age, but you don't sound like you really believe it. My son is in the 90th percentile and used to eat anything and everything. He is still in the 90th percentile, but eats only my required one bite of everthing at dinner, half a cheese sandwich for lunch, and 3 breakfasts. Even though he slowed down his eating, and maintained his percentile, he has only gained about 3 pounds in the last year.

This happened with our son a while ago. He would eat great at breakfast and then his eating would decrease gradually throughout the day. When I asked his pediatrician about it, I was told a couple of things. First, physiologically it can be better for him to eat this way because the sleep/eat cycle is interconnected and it could be that his body doesn't need a "normal" amount of food in the evenings before settling down to sleep. Second, it may just be a phase or break in growth spurts. The thing to remember was to watch his weight to see that he didn't lose any weight or go down too much on the growth chart. Soon after, he started eating again and he didn't go down at all on the growth chart or in his weight.

Now, our daughter, on the other hand, doesn't really eat a lot at all and hasn't since she was about 3. At one point our pediatrician recommended that we give her ensure once a day for a while because she was significantly underweight. She is now in the 5th% for weight, which means she's actually on the scale now. Before, she wasn't even on the page. We did everything we could to make sure she gained, but not too fast (that'll get you going in a wrong direction too). For her height and build she is doing alright now. We still ask her to drink ensure every now and then (and she likes it, so she asks us to pick it up from the store every now and then) so we can keep her calorie intake at a decent level.

I think it just depends on your daughter and what works for her. The important thing to continue to keep in mind (and by asking, you obviously do) is what's healthy for her. Some people don't put a lot of stock into what their pediatrician tells them, but they do their best for your child based on their knowledge. They don't know everything, but they can help you follow your child's progression and make sure she stays healthy. You've gotten a lot of really sage advice from moms on here and, if I were you, I would value their advice and consider it accordingly.

Another thing that I have really tried to keep in mind is "How do my children view their bodies?". I don't want my kids to feel bad about their bodies, but to keep nutrition as an important part of their daily routine... something to think about that is important. I have always tried to let them know that what they eat makes it easier or harder for their bodies to work properly. It's okay to have some of this stuff (cookies, cake, candy, chips... all the yummy stuff that's not so great for you) as long as you keep your body fueled with the things it needs FIRST. They also know that each person's specific needs are different, but that, generally, there are certain things we all need to eat every day to stay strong and healthy and to grow into healthy people. Don't get me wrong, we still struggle, but they know the importance of food in their lives. Another thing that we try to do is make food prep an interactive thing. I don't just fix for them. My 2 year old picks out which kinds of apple and cheese he wants to eat and I let him cut cheeses with his little toddler knife while I cut up his apple with my sharp knife. We always drink water first with every meal or snack... whatever. My daughter (now 13) has been mixing her own oatmeal and putting her own flavors into it since she was very young. Some of her favorite things to add are peanut butter, cinnamon, and raisins. We still have whole milk for the kids... whatever works.

Not saying what you *should* do, just what we did/our experience with our son:

My mum has/had an unhealthy relationship with food, and DH was raised by addicts... where there was never enough food... and what little food there was didn't go to the kids. Coming from that background (plus a psych & nursing degree -with requisite nutrition classes)... we decided to feed kiddo "on demand".

- Milk whenever he wanted (milk is superfood)... until he was old enough to pour it himself we kept a sippy cup on "his" shelf in the fridge.
- Gave him a shelf on the fridge and a drawer in the kitchen that was/is always filled with healthy foods he can eat whenever he wants.
- Have a house rule : You have to try it, but if you don't like it, you're always welcome to a sandwich. "Try it" includes smelling... btw... if you don't like how something smells one usually isn't forced to put it in their mouth! Eeeeew.
- All leftovers get put in a ziplock container and left on his shelf in the fridge. He'll frequently eat those for other "meals" and snacks throughout the day.
- Did the culinary-adventure-tour-before-2 thing (a chemical reaction happens in the brain between the approximate ages of 2ish-5ish... any chemical signature that has not been tagged by the brain as "food" before the age of 2 gets a gag/spit it out response when introduced after that until about the age of 5. It's an evolutionary thing that MOST kids have... keeps them from poisoning themselves from the typical weaning/exploring age of 2ish. Not as hard as it sounds, because cilantro -for example- only has to be tagged as "food" by the brain, not cilantro in italian, AND chinese, AND blah blah blah. Ditto cumin/ wheat/ strawberries/ each kind of flesh -proteins all have unique signatures-/ etc.).
- Taught table manners instead of food rules (aka how to sit at the table and eat, not how much to eat or when). We're fairly lax about many table manners (we play games for the different types of manners in different places: picnics, casual dining at home, casual dining at friend's, casual dining with company, casual dining out, semi-formal at different places, formal, & high... plus cross-cultural rules for the different strata of dining, and tips/tricks of eating anywhere anytime with anyone).

Observations:

1) Left to his own impulses, kiddo typically eats small meals 5 times a day. Roughly around 7, 10, 1, 4, & 7. We time dinner to coincide with his hunger, since we have the freedom to. He'll eat earlier or later, but is always starved right around 7.

1.5) During a growth spurt he will also wake at around 1am to eat a rather large meal. (No hardship on ME... as my "bedtime" is typically 230 am... now that Kiddo's older if I'm asleep Ds7 will nip downstairs get something from his shelf and then pop back in bed himself. Most of the time though, I'm up)

2) The AMOUNT kiddo eats varies wildly. About a month before a growth spurt kiddo starts PACKING away food. He doubles, easily, what my husband eats. Chubs up like mad. This is also when he's waking in the middle of the night hungry. Then overnight he goes back to his more typical eating volume (about 1/4-1/2 what Dh eats). As he's shooting up the fat melts off of him, and we're counting his ribs and vertebrae again. Throughout all of it, his ripped little muscles stay about the same. Tons and tons of physical activity have given him a little baby 8 pack, and the "braided" shoulders/back. <laughing> And don't worry, they're not "cut" just very very obvious.

Would this work for most kids? No idea. Not for all, certainly, as some kids have reflux issues and have an ingrained "eating will make me hurt" thing, and some kids have hormonal or trauma issues. But it's what has worked for us.

My oldest weighed 24 lbs in Kindergarten and about 30 lbs in 3rd grade. She was always picky about what she ate, and therefore had constipation problems because she didn't eat enough fruit, fiber, and veggies compared to how much rice and cheese she ate. For each meal she only reliably ate about 1/4 c of food, but she did drink milk (or later milkshakes and smoothies). And she loved fruit - kiwis, strawberries, cooked apples, etc.

I also tried to hide veggies in food - but in retrospect this was a bad idea -- your child (and later, your teen) never wants to have obvious veggies on their plate and they KNOW "you never made me eat them before". And she may be able to taste them anyway as kids taste buds are more sensitive - and then develop an aversion to foods she would otherwise like.

Our pediatrician tried to get us to offer her 10 different foods a day, and to increase the calorie count of what she did eat by buttering cooked veggies and adding cream to her cereal, mixing half-n-half and wheat germ in pancake batter, or giving high-fat ice cream as a treat.

We also had a rule - no between meal treats if you didn't eat the expected amount of food at the previous meal. So when she'd get up from the table, we'd remind her if she hadn't eaten enough "real" food (we preloaded her plate) that there would be no snacks until the next mealtime. This was hard for me to do at first because she needed every calorie she could get - but it was more effective when her little sister would get either an afternoon snack or evening dessert and she didn't.

Another thing to try is sending your daughter to eat dinner at a friend 4 yr olds home and see if she'll eat what her friend eats (peer pressure to try new things because her friend likes them). Tell that mom not to fix anything different from normal, and see what the mom reports.

My daughter is now a college student and eats a fairly wide variety of foods. She still weighs on the light side (5'4", and under 120lbs), but she is healthy and has lots of energy.

I think your approach today was a great one! Try it for a week and see what happens. My oldest is also a very light eater on a normal day, but she's sick right now and ate hardly anything all day. Step back and let her lead the way and she'll probably realize how much control she does have within your boundaries. Good luck!

If it helps, here's what my 2.5 year old had to eat in all of today:
2 bites of squash soup
2 bites of chibatta bread
1/3 of an apple (about)
1T peanut butter (about)
1/2 cup spaghetti noddles (about)
breastmilk
water

A.,

If my math is correct your little girl is 4? There is no way my 4 year old would get away with not eating meals but that's my house. I could understand this behavior in a 10 year old and maybe let her get away with it, but 4?

My daughter is a lot pickier about her food than her older brother, but they either eat what's in front of them or they wait until the next meal. If they get hungry in between that's just too bad.

Kindly,
Melissa

Take a look at this website.

http://www.kidsgethealthy.org

They have a pamphlet also about serving sizes for children which I think we forget is much smaller than ours. They have a lot of information about teaching our children to have a healthy relationship with food. They talk a lot about preventing childhood obesity but the information they provide will most definitely help us to teach our children to make healthy food choices and listen to their body's hunger cues. They talk some about vegetarian diets for children but that information can easily be used for a non-vegetarian diet.

I have a 2 year old who is 75% height and 30-40% on weight.I think it is normal for some kids, my husband is 6'4" and I think she is just meant to be tall and slender. My son is only 8 months and doctor is telling me he could have more weight on him also. However, if you look at it, his growth mimics his sisters 75% height 30% weight. I think some of it is just genetic. However, my advice would be to not ever make her separate meals at mealtimes. All I think that does is tells her if she doesn't like the healthy food you will make her junk! That will end up being a habit that will last into her teens and starts the floor for unhealthy food choices. I do daycare and watch a 3 year old who is a foster child now. Obviously the previous parents fed her cereal and pop tarts and never a decent meal. She would not eat meat, no vegetables, refused half the fruits I gave her, etc. I gave her healthy meals anyways(as per USDA meal program I am on for child care children). The people she is staying with would make her separate meals at dinner, etc. and I refused to.There were days she would be here all day and refuse to eat anything and just drink her milk (which she did not get seconds on!). It was a very rough start but eventually she tried everything. Then the rule was she had to eat at last half or no movie at naptime, then eventually she had to finish it all. Now, it has been less than 2 months and she will sit down and eat ANYTHING I put in front of her(by her own choice) from raw/cooked vegs to all meats and grains. Which has really improved her happiness and behavior also. So, basically, long story but if you stay firm the battle will go away. There does have to be a little forcing them to try new things. My own 2 children are low on weight but I do not offer my daughter anything except the healthy food the rest of the family is having and she eats extremely healthy choices and likes them. I think if they already eat very little you really have to make sure the foods they are eating are packed with nutrients and nutrition. That is more peace of mind, that i know she is getting plenty of vitamins and nutrition than what the doctor scale says. I think if she were eating all healthy food choices it would put you at ease also because then you know she is healthy!

There a plenty of good ways to incorporate the needed nutrients into a meal that your daughter might like...and not know it's healthy for her. ;) I give my son V8 Fusion (not the light one because that only has 1/2 juice). It has daily serving of fruit and veggies in an 8 oz glass and it doesn't taste like anything but nummy fruit! I also make a lot of good casseroles, like homemade mac & cheese. I throw in some veggies and a few bacon bits and WHAM! Instant goodie. Most children will go through their phases...eat a lot for awhile, then the next they eat like a bird. Unless she's allergic to anything, make sure you stick to having her eat what everyone else is having.

I would ask your pediatrician first before doing anything to make sure he agrees with any supplements you're going to offer. For instance, our pediatrician only recommends 1/2 Flintstone's vitamin for both our 3.5 YO and 21 month-old for now.

I have a different approach from most of the recommendations you've received. Our 3.5 year old has learned to be more interested in other things than dinner, so getting him to eat is a struggle.

He is NOT allowed to be excused from the table until he eats the quantity of the foods we ask him to eat (never unreasonable amounts). It may be 3 bites of broccoli and 3 bites of his taco.

I ALWAYS have a fruit or vegetable on the table, and it's not an option to eat them. I'm lucky that my kids LOVE things like broccoli. I don't hide it under cheese, just steam it with some butter, and it's usually the first thing gone.

Jerry Seinfeld's wife had a best selling cook book about how to "hide" healthy foods in your kids "will eat" items. I disagree with hit because it doesn't give them the appreciation of healthier foods. Not every kid is going to like broccoli, but if you don't offer it, they'll never learn to like it.

We have the opposite problem with our 21 month-old. She could care less about breakfast. Usually, if she eats a string cheese, it's a major accomplishment whereas her brother wants to eat something first thing each morning.

My recommendation, if she's not eating a good dinner, is to keep healthy snacks around and offer those between your sit-down meals. We have a lot of clementines, grapes, blueberries, string cheese, granola bars, etc. That's the only option they get if they don't eat a good dinner.

I'm glad you're aware of, and trying to avoid, the possibility of making food a power issue. That can lead to severe eating disorders later.

Your daughter's daily appetite pattern is pretty normal. Since she has the most appetite in the morning, I'd be inclined to set aside choice leftovers from the night before and offer these in the morning. She'll get a more balanced diet that way. The custom of eating certain "breakfast foods" today is cultural; the result of decades of advertising foods that have been tailored to an increasingly rushed modern lifestyle. In a previous age (and today in some other societies), people prepared and ate large, varied breakfasts.

My grandboy, about your daughter's age, has always been taller and skinnier than average, and VERY healthy. His percentiles are now beginning to be more proportionally average. I think it will be great for his future health that he's managed to avoid putting on extra weight so far, although his mom was always understandably concerned, and wished he would eat more.

Well you certainly can't force feed her or cram it down her throat forcefully. Then she would never eat anything ever again. I used the Dr. Sears method, I think you called it. Sometimes it worked, sometimes it doesn't. Sometimes I use reverse psychology and sometimes it works and sometimes it doesn't. Chicken nuggest and mac n cheese seems to be about the standard for that age. All I do is make sure she had her vitamins.... she will get all the nutrients that her brain requires to grow so she will be alright. Mine filled up on fluids and I cut that down a little bit. That helped a little, still not much. I just keep offering and keep letting her see us eat "GOOD" stuff (that I want her to eat) and eventually she will see us eating it and be hungry at the same time and then she will get brave and try a bite. Very seldom does she try something that she doesn't like. YOu would think she would realize that! But when she gets brave and tries a bite that usually stays with her as long as I offer it often so that she doesn't forget she likes it. So it seems like gradually she is adding more and more foods to her list.
I hope that helps. This is what I have done.

My son is almost 6, and I brought this up that our last ped appt. and she told me not to push food that he will eat when he is hungry. So I offer only healthy snacks (only if more than an hour or more before dinner) and dish up his dinner and he has to eat at least 6 bites (his age)usually will do without a fight, and then usually before bed he will have a yogurt.Also limit his liquids befoe dinner, because he will fill up on drinks instead of food.

You could also get those meal replacement shakes( found near forumula), so she gets nutrients she needs when she doesnt eat.

The Eat Right for Your Test diet lists foods that are beneficial for each person based on their blood type. My son eats a lot more when we use this list to provide him his food choices.

I would not put pressure on her about it. Look to see if this is a control issue. Is she being told what to do often? Kids will push back in quiet ways to find control in their life. Is the lunch situation at the preschool chaotic. She may want to take a few minutes to eat quietly before she goes back and plays w/the others. Sometimes if there is too much going on food is not interesting, once she misses that meal then she may stop feeling her natural hunger signals and food in general is less interesting.

My son loves it when I include him in the shopping and when he gets to be part of making the meal. Some kid cookbooks or kid videos on cooking makes it all much more fun. Help engage her with making food fun.

You can ask your doctor to run a complete blood panel including a vitamin and mineral screen. Some doctors or labs can be stingy with blood panels, but you can be clear and direct that you want a blood panel to see if your daughter has any deficencies going on.
Also, when you go to lab, make sure you request to know her blood type. One more thing - ask the lab tech to please use the smallest needle on her. The small needles don't hurt (as much). Lab's often use the larger ones because they flow faster, but they leave marks and hurt more. It is worth a few minutes to have the smaller needle used. Oh, adults you can ask for this too-it makes it easier for some folks.

Smoothies w/extra vitamins can be a big help. Supplements are ok if they are good quality. I am not convinced that we really get enough nutrition from our existing food sources.

Being objective and finding the inner space to understand what is going on without worrying is a good practice to start now. You will be able to use it throughout your life with her.