Your Child’s Growth
It’s important to understand normal growth so you don’t worry unnecessarily or let yourself start to do your child’s job of eating in order to manage growth. Parents of children who are smaller than average tend to worry and sometimes get overzealous or even pushy with feeding. It’s only natural for parents to fear the worst when their child is small or not gaining. This fear can really override good feeding practices and make the problem worse or altogether create new feeding problems. But the same thing can happen when a child is larger than average.
When we work with with parents to identify areas of feeding that can be improved, it rarely involves a major dietary overhaul. But it often does involve changing the feeding relationship and dynamics between parent and child.
Healthy kids come in all sizes.
An excellent measure of whether your child is getting enough to eat is to examine the consistency of their growth. Typical healthy growth is consistent. If a child has been on the 50th percentile for a while but then takes a drastic dip to the 15th or climbs to the 90th, that’s worth investigating. But a small child who has consistently kept near the 5th percentile is showing consistent growth, not problem growth. Same with the child who is holding steady near the 95th percentile. A consistent pattern of growth is most important, not growth at a certain percentile.
When there are changes in growth.
A child who starts off small but grows heavier may be catching up. And both larger/smaller children could change their growth patterns to look more like his parents–this is okay. But if a child’s growth pattern starts to shift considerably and it isn’t catch up growth or related to parental body type, feeding practices might need to be examined.
If growth has been an issue for your child examine how feeding has gone from birth to now:
— Were you able to follow baby’s cues for feeding or was there pressure to make baby fit into a schedule or go longer/shorter between meals?
— Did you feel comfortable giving baby as much as he/she wanted to eat from breast or bottle?
— Did you work hard to make baby eat more/less of milk or purees than they were inclined to eat?
— Did/do you feel pressure to fatten up or slim down your child?
— Did/do you feel pressure to get your child to eat more/less of all or certain foods?
Can you find any past evidence of pressure or restriction sneaking into your feeding? Do you spot areas where your feeding jobs have been reversed or confused? (Keep in mind that the eating job of babies puts them in control of all aspects of feeding and our job is to follow a baby’s cues).
Whether or not you can spot past errors in feeding, following your Feeding Job Description is most likely to improve feeding and allow your child to grow according to the way nature intended.
Concern about dip on growth chart
Natalia had a 2.4 year old patient whose parents kept a food record of everything he was eating for almost two years prior to seeing her, including calorie count.
The reason – extreme concern about a “dip” on a growth chart from 70th to 45th percentile soon after solids were introduced. Although the growth remained consistent after the growth curve reestablished at this lower percentile, the parents remained very concerned about his eating. The boy never seemed to like purees very much and mother reflected that she has been trying to distract him with games, videos and books to get more baby food into him.
Once he started self-feeding, he started further reducing his repertoire of accepted foods. The parents kept catering by offering him food different from what the rest of the family was eating and pressured him to eat them. Most of the 10-12 foods he enjoyed were of the typical “toddler snack” variety: crackers, cereal, waffles and flavored yogurts, accompanied by twice the amount of milk he needed for his age. The foods had to be of certain brands. The speech therapy evaluation did not identify any delays. The boy had trouble eliminating and needed help with constipation.
After feeding and eating jobs was established, the boy kept eating only his acceptable foods that were served as meal components. But he touched and put on his plate new foods without eating them. In the meanwhile, the constipation issue was kept under control with the help of Miralax, with his doctor’s approval and cutting down dairy to the equivalent of 16 oz of milk or two servings. After 2 months of continuing with each person’s Feeding Job Description he tried and added to his diet two new foods. At a yearly physical (4 months after starting this new way of feeding) the doctor confirmed consistent growth at the same percentile (45th). Reassured parents continued on sticking to their feeding job description. In 3 more months (at the last follow up appointment) he remained on the same curve but added 7 more acceptable foods including 1 vegetable.
This boy’s parents’ worry over his dip on the growth chart led them to apply pressure in feeding and cater for the sake of getting their child to eat something. But of course their feeding behavior only made his eating behavior worse. Once they backed off and implemented the same feeding principles you’re learning here, things gradually but steadily improved with his eating.
“You don’t want to feed me!”
“You don’t want to feed me!” — from Jenny*, a chubby grade-schooler, to her mom when she noticed her thin older sister was allowed to have snacks and she wasn’t. Jenny had a hearty appetite for many years and was consequently restricted from eating as much as she wanted. This was a patient of Adina’s. 2 weeks after Mom was instructed in what her feeding job was, what her daughter’s eating job was, and the importance of allowing Jenny to feel like she can get her fill, she’d calmed down measurably around food and wasn’t taking the usual extra portions. Mom will need continued support to ensure she doesn’t fall back on old ways, but Jenny is off to a good start.
*name has been changed to protect privacy.
“You need to get your baby to eat less”
One of Natalia’s clients was told by the doctor to limit her 9 month old formula intake way under the recommended amount for this age because she was “gaining too much”. At the same time, parents did a wonderful job of introducing a lot of new foods into the baby’s diet and were confident they were feeding her in an attuned way, allowing her to eat as much as she needed. Natalia knew that babies are wonderful self-regulators and they would eat the amount of food that is right for them, if the feeding approach is correct. She recommended that Mom continue with her focus on what, when and where of feeding and avoid limiting any foods. In a couple of weeks the parents reported that the baby started drinking a little less formula all by herself (but not going as low as doctor’s recommendation) and she started crawling which required a lot of energy! From the last conversation with the parents, they reported that the growth stabilized and weight gain slowed down.
Concern about dip on growth chart
Natalia had a 2.4 year old patient whose parents kept a food record of everything he was eating for almost two years prior to seeing her, including calorie count.
The reason – extreme concern about a “dip” on a growth chart from 70th to 45th percentile soon after solids were introduced. Although the growth remained consistent after the growth curve reestablished at this lower percentile, the parents remained very concerned about his eating. The boy never seemed to like purees very much and mother reflected that she has been trying to distract him with games, videos and books to get more baby food into him.
Once he started self-feeding, he started further reducing his repertoire of accepted foods. The parents kept catering by offering him food different from what the rest of the family was eating and pressured him to eat them. Most of the 10-12 foods he enjoyed were of the typical “toddler snack” variety: crackers, cereal, waffles and flavored yogurts, accompanied by twice the amount of milk he needed for his age. The foods had to be of certain brands. The speech therapy evaluation did not identify any delays. The boy had trouble eliminating and needed help with constipation.
After parents began focusing on their Feeding Job Description, the boy kept eating only his acceptable foods that were served as meal components. But he touched and put on his plate new foods without eating them. In the meanwhile, the constipation issue was kept under control with the help of Miralax, with his doctor’s approval and cutting down dairy to the equivalent of 16 oz of milk or two servings. After 2 months of continuing sticking to their new feeding strategy, he tried and added to his diet two new foods. At a yearly physical (4 months after starting this new way of feeding) the doctor confirmed consistent growth at the same percentile (45th). Reassured parents continued with the same feeding philosophy. In 3 more months (at the last follow up appointment) he remained on the same curve but added 7 more acceptable foods including 1 vegetable.
This boy’s parents’ worry over his dip on the growth chart led them to apply pressure in feeding and cater for the sake of getting their child to eat something. But of course their feeding behavior only made his eating behavior worse. Once they backed off and stopped trying to do his eating job, things gradually but steadily improved with his eating.
Ultimately, the best response to a growth concern is to do your best to feed with feeding. Stick to your feeding jobs (be reliable about providing consistent eating opportunities and safe foods) and let your child master his eating tasks. If growth is a pressing concern and you’re not sure you can trust your child to eat enough, please let us know in case we can give you additional support or help you find a local professional who can.
Unsolicited Feeding Advice – What is a Parent to Do?
Before learning that parents have certain responsibilities for feeding and kids need to be in charge of eating and implementing the necessary changes in your household, a lot of casual comments and questions may have seemed benign to you, barely noticeable. But now that you’ve got a new perspective on feeding, these comments and advice from well-meaning family and friends may become more bothersome than before. We want you to be prepared for what’s to come and give you some tips on how to respond.
* Is that all she’s going to eat?
* Looks like this girl has a good appetite!
* What do you mean, she decides how much to eat?
* She sure should try these peas, don’t you think?
* When my kids were young, we had no picky eaters!
* I always ask my kids to take a bite of everything and they are great eaters.
* Let him go hungry and then he will eat whatever you give him!
These are just a few examples of comments and questions you may end up hearing when you start using this new way of feeding and understand your feeding role as a parent and where that role ends and the child’s eating role begins. Your family and friends who grew up being pushed or restricted at mealtimes and who raised their kids the same way will probably not understand the concept without you providing some background information. They may also be lucky to never have experienced picky eating behavior themselves or with their children who may just happen to be adventurous or compliant eaters.
The criticism you may receive from family and friends may be frustrating and hurtful and make you doubt your parenting. And although the unsolicited advice may be coming from their true concern over your child’s eating, it does not make it qualified or trustworthy.
If you are parenting a child who has little interest in food or eats only a small variety, it may seem like everyone else around you knows what exactly you need to do to fix the problem. But the truth is that your parental instinct is the best guide in this situation. And if the advice seems to be too rigid and lacking in compassion for your child, then it probably is not the best choice for you.
Is it worth explaining your new feeding philosophy to everyone? It depends on how involved these people are in your child’s life. If it is an acquaintance who you do not see very often, you may just say something like:
“Thanks, I appreciate your input, we are doing just fine.” or “The truth is, we have been using this approach for a while and it seems to be working great for my son/daughter”.
If it is your husband, parents, nanny, in laws or anyone else who is directly involved in caring for your child, it may be worth investing some time explaining more about your new feeding philosophy and maybe sharing some printouts from this class.
Some of the talking points you may want to cover:
* The food environment is very different now and the feeding strategies used a few decades ago will simply not work.
* This is the only evidence based approach to feeding that is known today. You can refer to the “Research” section to see some of the research articles on the topic.
* The focus on your Feeding Job Description while letting your child fulfill his feeding job will help your child have a long term healthy relationship with food, rather than just get him to eat certain foods.
* Most children to not do a good job eating when under pressure.
* Some children are more affected by pressure than others and a request to take even one bite may spoil their meal.
* Trusting a child to choose the amount of food he wants to eat helps strengthen the ability to self-regulate.
From our experience, it’s hard to change another person’s perspective. Your parents or in-laws may never come around and understand why you feed the way you do. Some excellent quick responses we’ve read from other parents who follow the same feeding strategy are below:
Phrases to Say to Your Child (loud enough for the food pushing adult to hear):
* “You don’t have to eat anything you don’t want.”
* “Are you full?” (how can someone argue with ‘full’?)
* “Auntie thinks you will enjoy this food, but it is your choice whether or not to try it”
* “You have strong ideas of what you like and dislike, and that’s okay!”
* “Someday you might love fish, but it’s okay that you don’t want to try it right now.”
* “You really listen to your body when it tells you it’s full. That’s great!”
Phrases to Say to a Food Pushing Adult
“I know you love her a lot and worry when she doesn’t eat much. In spite of the way she eats, she is healthy and growing well. She loves being with you and taking part in family meals at your house. I want that to continue. But trying to get her to eat spoils that.”
“Dad, she’s okay.” or “Let me handle this”
“Mom, follow my lead.”
“Thanks, Uncle Jim, he sees how much we enjoy this. Sooner or later, he’ll enjoy it too.”
“Yes, she is selective. I know when she is a teenager I will really appreciate her skill in being selective with who she chooses to date.”
For a quick reference and overview:
Print out this “From the Cook” manifesto to hang prominently in your kitchen. (https://www.ellynsatterinstitute.org/cms-assets/documents/99663-21282.fromthecookheart.pdf) Explain to whoever is taking care of your child that these are the rules your child is supposed to follow at mealtimes.
Coming Up Next: Meal Planning strategies and easy family meal ideas.
Discussion: What do you think about the growth concern case studies we discussed in this lesson? The parents needed to take a leap of faith in order to start trusting their child to regulate their eating. They also needed to do a lot of work around structure and providing variety of tasty food for meals. Do any of the stories remind you of yourself or someone you know?
How do you deal with pressure and unsolicited advice from family and friends?