Clinical Reference Systems: Pediatric Advisor 10.0
Appetite Slump in Toddlers
CHARACTERISTICS OF A CHILD WITH A NORMAL DECLINE IN APPETITE
- It seems to you that your child doesn't eat enough, is
never hungry, or won't eat unless you spoon-feed her
- Your child is between 1 and 5 years old.
- Your child's energy level remains normal.
- Your child is growing normally.
Between 1 and 5 years of age many children normally gain
only 4 or 5 pounds each year even though they probably
gained 15 pounds during their first year. Children in this
age range can normally go 3 or 4 months without any weight
gain. Because they are not growing as fast, they need less
calories and they seem to have a poorer appetite (this is
called "physiological anorexia"). How much a child chooses
to eat is governed by the appetite center in her brain.
Kids eat as much as they need for growth and energy.
Many parents try to force their child to eat more than she
needs because they fear that her poor appetite might cause
poor health or a nutritional deficiency. This is not true,
however, and forced feedings actually decrease a child's
Once you allow your child to be in charge of how much she
eats, the unpleasantness at mealtime and your concerns about
her health should disappear in a matter of 2 to 4 weeks.
Your child's appetite will improve when she becomes older
and needs to eat more.
HELPING A POOR EATER REDISCOVER HER APPETITE
- Put your child in charge of how much she eats.
Trust your child's appetite center. The most common
reason for some children never appearing hungry is that
they have so many snacks and meals that they never
become truly hungry. Offer your child no more than two
small snacks of nutritious food each day, and provide
them only if your child requests them. If your child is
thirsty between meals, offer water to quench her thirst.
Limit the amount of juice your child drinks to less than
6 ounces each day. Let your child miss one or two meals
if she chooses and then watch her appetite return.
Skipping a meal is harmless.
- Never feed your child if she is capable of feeding
Parents of a child with a poor appetite will tend to
pick up her spoon, fill it with food, smile, and try to
trick the child into taking it. Once your child is old
enough to use a spoon by herself (usually 12 to 15
months), never again pick it up for her. If your child
is hungry, she will feed herself. Forced feeding is the
main cause of eating power struggles.
- Offer finger foods.
Finger foods can be started at 6 to 8 months of age.
Such foods allow your child to feed herself at least
some of the time, even if she is not yet able to use a
- Limit milk to less than 16 ounces each day.
Milk contains as many calories as most solid foods.
Drinking too much milk can fill kids up and dull their
- Serve small portions of food--less than you think your
child will eat.
A child's appetite is decreased if she is served more
food than she could possibly eat. If you serve your
child a small amount on a large plate, she is 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).
- Consider giving your child daily vitamins.
Although vitamins are probably unnecessary, they are not
harmful in normal dosages and may help you relax about
your child's eating patterns.
- Make mealtimes pleasant.
Draw your children into mealtime conversation. Avoid
making mealtimes a time for criticism or struggle over
- Avoid conversation about eating.
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 a lot. Children should eat to please themselves.
- Don't extend mealtime.
Don't make your child sit at the dinner table after the
rest of the family is through eating. This will only
cause your child to develop unpleasant feelings about
- Common mistakes.
Parents who are worried that their child isn't eating
enough may start some irrational patterns of feeding.
Some awaken the child at night to feed her. Some offer
the child snacks at 15- to 20-minute intervals
throughout the day. Some try to make the child feel
guilty by talking about other children in the world who
are starving. Others threaten, "If you don't eat what I
cook, it means you don't love me." Some parents force
their child to sit in the high chair for long periods of
time after the meal has ended. The most common mistake
is picking up a child's spoon or fork and trying various
ways to get food into her mouth.
PREVENTION OF FEEDING STRUGGLES
The main way to prevent feeding struggles is to teach your
child how to feed herself at as early an age as possible.
By the time your child is 6 to 8 months old, start giving
her finger foods. By 12 months of age, your child will
begin to use a spoon and she should be able to feed herself
completely by 15 months of age.
When you feed your child (before she is old enough to feed
herself), you can wait for your infant to show you when she
is ready to eat (by leaning forward, for example). 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
inadvertently opened it. Do not insist that your child
empty the bottle, finish a jar of baby food, or clean the
CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:
- Your child is losing weight.
- Your child has not gained any weight in 6 months.
- Your child also has symptoms of illness (for example,
diarrhea or fever).
- Your child gags on or vomits some foods.
- Someone is punishing your child for not eating.
- Following these guidelines has not improved mealtimes in
your house within 1 month.
- You have other questions or concerns.