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Column originally published Oct 25, 2011

Need To Encourage Healthy Eating

Question: Our twenty-month-old daughter has not gained weight for six months, although she is still growing in height. She has changed from a slightly chubby little girl to being a petite one. Otherwise she is healthy, and her development is completely normal. Our doctor was concerned about her weight and referred her to a gastroenterologist. He did a bunch of tests, including biopsy of her intestines. The results were all normal. She eats one good meal a day, and we give her meat, fruits, and vegetables. The other two meals she just nibbles a little. I am still nursing her, although she does drink some homogenized milk. My husband is concerned about her weight and gives her ice cream and treats when she refuses to eat her meal. We know that this may be harmful for her, but we are just afraid that if she doesn't eat, she is not going to grow. We would appreciate some advice from you.


It is always stressful to parents, as well as physicians, when young children are not growing as expected. They should be gaining weight and growing in height. Physicians have growth charts that can monitor the growth in weight, height, as well as head circumference. If a child slows down in his growth in one or more of these areas, the physician needs to watch carefully and consider investigation.

What is reassuring in your daughter’s situation is that although she did not gain weight in six months, she has continued to grow in height, and that she is healthy, and her development is normal. Most children gain weight slower between 1 to three years of age, when they start walking and running. Many of them are too busy to eat, and food consumption sometimes drops off at this stage. Although they don’t gain as much weight, they often continue to grow in height and in the size of the head. This is normal, but it often makes parents worry.

As a result, many parents would feed their children with anything that they want, and at any time that they would open their mouth. Because they are busy, some children prefer to drink milk or juice to fill their stomach quickly, and then go back to play. If this is within a relatively short time before their meal, they are not hungry and would stop after a few bites. Of course this will make any parent worried. These parents would do anything, and feed these children with anything, healthy or not as healthy, as long as they would eat.

This is where processed foods come in. They are often made more attractive than home-cooked meals. Children may have seen them advertised on TV, and we all know how commercials can affect children. There are often additives in these foods to make them taste good. For busy parents, it is just a lot faster to warm up these processed foods in microwave instead of cooking from scratch. Some families get into the habit of eating in fast food restaurants. Of course the food tastes good, but we all know this is one of the reasons why we are dealing with more obesity in our society.

You need to understand a few basic concepts here. Most of the time, children will eat when they are hungry. If they are not hungry, you will need to use a lot of coercing to make them eat. As I often tell the parents in my office, there are no children in third world countries who are hungry and would refuse food. We live in a society with over-supply of food; children are offered many food choices when they are not that hungry, and they will pick and choose what they like. As a result, we have picky eaters that refuse fruits and vegetables, some would refuse meat but love hot dogs (and we all know that hot dogs are unhealthy). Some children don’t like certain texture or taste, but if they are really hungry, most children will eat what is offered to them.

So, the first thing that you can do is make sure that your daughter does not get too many treats or fill her stomach with milk or juice before her meals. It is a good idea to get her into the habit of three meals a day, and have her sit down with the rest of the family at the dinner table, not in front of a television. This will reduce distraction so that everyone enjoys a well-balanced home-cooked meal. Offer a variety of healthy food choices, including carbohydrate (like potatoes, pasta, and rice), vegetables, as well as some meat. It is the balance of all these food groups that makes a healthy meal. If she tends to drink all her milk before eating, then offer her water when she eats, and allow her milk after she has finished her meal. Since you are still breastfeeding her, you can do this after she has finished eating.

If she is not hungry and refuses to eat, put away the meal, but don’t offer her any other food or milk to drink. If she is thirsty, let her drink water. Sooner or later, she will get hungry, then warm up her meal and offer it to her. When she is hungry, she will eat. If some of the food is too hard for her to chew, you will have to cut it up into more manageable size.

Sometimes getting a child to eat what you offer is a test of will-power. Many parents give up quickly because they are terrified of their child going to bed hungry. The fact is, if she is hungry, she will eat the food that you offer. If she is not hungry, she is more likely to choose the food that taste good, which may not be the healthy choice.

I hope this can relieve some of your worry and help you manage this rather difficult situation.