Dr. Komaroff, 3-27-12: Let kids decide how much to eat at meals

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DEAR DOCTOR K: I have a 2-year-old and a 4-year-old. The younger one barely eats anything, and the older one is a picky eater who refuses to try new foods. Please help!

DEAR READER: I can't tell you how many parents of young kids ask me about their children's eating habits!

It's common to notice a decrease in appetite starting around a child's first birthday. That's because children start growing a little more slowly, and therefore need less fuel. During the first year, a child becomes three times as big. But by the end of the second year, kids are only four times as big as they were at birth.

Kids know how much fuel they need. You don't need to count calories. Your toddler has a good sense of his own energy needs. You may find that one day your toddler eats more than you expect, while the next day he seems to eat next to nothing. He will eat enough to keep himself healthy and active. Here's my advice:

Provide a variety of nutritious food choices. Then let your child pick and choose what and how much he wants to eat from his plate. If he refuses to eat, that's OK -- he'll be hungry for his next meal or snack.

Don't let your child fill up on liquids, or he will have no appetite for other foods. A child needs only 10 to 16 ounces of milk per day.

Avoid bargaining ("If you eat your vegetables, you'll get a cookie") or insisting ("Just one more bite"). These techniques can actually backfire and make your toddler eat even less.

When your toddler says he's done with his meal, let him get down from the table. But don't offer his favorite treats to make up for what he didn't eat of his meal.

Toddlers and preschoolers are notoriously picky eaters. Introducing new foods can be a particular challenge.

Try serving a very small portion of the new food next to something you know your toddler likes. Don't force your child to try it and don't make an issue out of it. Let your child see you enjoying the new food. You may need to introduce a new food 10 or more times before your child will accept it. Be patient but persistent.

My Harvard colleague, pediatric nutrition expert W. Allan Walker, puts it simply: Your kids are responsible for determining how much they need to eat at any one time and determining when they are full. You are responsible for choosing which foods your child eats and determining the environment in which food is eaten.

If your picky eater starts to fall below the normal growth curve, that is reason for concern. But if your picky eater is still growing normally, and if the food he eats is healthy food, don't worry about his being picky. Toddler knows best.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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  • My twin boys are happy, healthy and very active 2 1/2 year olds. But they eat next to nothing. Between the 2 and 2 1/2 year doctor visits one of them dropped a pound and the other had only gained 1/2 a pound. They do love most fruit, but that is about it (other than the obvious cookies etc.) Before bed I give them cups of pediasure just to get some calories in them. For the most part they drink a cup of juice (watered down) and a little water during the day just when they ask for it. I have tried making the meals more visually appealing. I have tried giving a variety. I have tried giving the same things over and over. Nothing seems to get them to eat! What else can I do? Heidi