Appetite Slump in Toddlers
by Roland Larrabee, M.D.

Much is written about the epidemic of childhood obesity, but upon occasion, parents become concerned because their child “isn’t eating.” Between 1 and 5 years old, it is normal for a toddler's appetite to slow down. It will probably seem like your child doesn't eat enough, is never hungry, or won't eat unless you spoon-feed her yourself. As long as your child's energy level is normal and she is growing normally, your child's appetite is most likely naturally slowing down.
Babies may gain ~15 pounds during their first year. Between 1 and 5 years of age many children normally gain only 4 or 5 pounds each 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 fewer calories and seem to have a poorer appetite (this is called physiological anorexia). How much a child chooses to eat is controlled by the appetite center in the brain. Kids eat as much as they need for growth and energy.
Many parents try to force their child to eat more than they need to because they fear that their poor appetite might cause poor health or a nutritional deficiency. This is not true, and forced feedings actually decrease a child's appetite.
Once you allow your child to be in charge of how much they eat, the unpleasantness at mealtime and your concerns about their 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.
Put your child in charge of how much he eats at mealtime. Trust your child's appetite center. Children eat as much as they need. Your child's brain will make sure they eat enough calories for normal energy and growth. Serve well-balanced meals. If your child is hungry, they will eat. If not, they will be by the next meal. Even reminding them to eat or to eat more will work against you.
Allow one small snack between meals. The most common reason for some children never appearing hungry is that they have so many snacks that they never become truly hungry. Be sure your child arrives at mealtime with an empty stomach. Offer your child no more than two small snacks of nutritious food each day, and provide them only if your child requests them. Keep the size of the snack to 1/3 of what you would expect them to eat at mealtime. If your child is thirsty between meals, offer water. Limit the amount of juice your child drinks to less than 4 to 6 ounces each day. Let your child miss snacks if they choose and then watch the appetite return. Even skipping an occasional meal is harmless.
Never feed your child if they are capable of feeding themself. Parents of a child with a poor appetite will tend to pick up the 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 himself (usually 12 to 15 months), never again pick it up for him. If your child is hungry, he will feed himself. Forced feeding is the main cause of eating power struggles.
Offer more finger foods. Finger foods can be started at 6 to 8 months of age. Such foods allow your child to feed themself at least some of the time, even if they are not yet able to use a spoon.
Limit milk to less than 16 ounces each day. Milk contains as many calories as most solid foods. Drinking too much milk or juice can fill kids up and dull their appetites.
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, they are more likely to finish it and gain a sense of accomplishment. If your child seems to want more, wait for them to ask for it. Avoid serving your child any foods that they strongly dislike (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 control.
Avoid conversation about eating. Don't discuss how little your child eats in their presence. Trust your child's appetite center to look after their 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 mealtime.
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 them. Some offer the child snacks at 15- to 20-minute intervals throughout the day. Others permit snacks that are larger than a regular meal. 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.
The main way to prevent feeding struggles is to teach your child how to feed themself at as early an age as possible. By the time your child is 6 to 8 months old, start giving them finger foods. By 12 months of age, your child will begin to use a spoon and they should be able to feed themself completely by 15 months of age.
When you feed your child (before they are old enough to feed themself), you can wait for your infant to show you when they are ready to eat (by leaning forward, for example). Let them pace the feeding themself (for example, by turning their head). Do not put food into a child's mouth just because they have inadvertently opened it. Do not insist that your child empty the bottle, finish a jar of baby food, or clean the plate.
Call during office hours if:
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Your child is losing weight.
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Your child has not gained any weight in 6 months.
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Your child also has symptoms of illness (for example, diarrhea or fever).
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Your child gags on or vomits some foods.
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Someone is punishing your child for not eating.
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Following these guidelines has not improved mealtimes in your house within 1 month.
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You have other questions or concerns.
Dr. Larrabee is Associate Director of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.