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Ask a Doctor: Nutrition 101

by Deborah Borchers, M.D. November/December 2003

Q: How can I make sure that my child is properly nourished and develops healthy eating habits?

A: Food, glorious food! One of the many tasks of parenthood is to teach healthy eating. Whatever the age when they join their family, a child may be undernourished, overweight, or average in size. New adoptive parents often need to meet a child’s unique nutritional needs while simultaneously enhancing their attachment to the family.

Nutritional changes should be gradual, rather than abrupt. Babies may benefit from continuing the same formula they had been fed in their birth home, previous foster home, or orphanage. Although many health care providers recommend that children be weaned from the bottle at 12 to 15 months, children who’ve gone through many transitions may benefit from keeping their bottle for comfort until they are older. (For dental reasons, however, infants and toddlers should not be given propped bottles, bottles in bed, or bottles with anything but water with which to walk around.)

For many of us, food provides comfort. Yet, for children who lived in institutions, feeding time may have been void of warmth and nurturance. Bottles may have been propped or given at arm’s distance. Portions may have been controlled or even withheld as punishment. Excessive soda, candy, or fast foods, may have been rewards. Changing a child’s eating habits can take time.

Food selections for older children should be modified gradually. One way is to encourage children to assist in the preparation of meals, especially when new foods are being introduced. Combine new, nutritious foods with old favorites. If children are hesitant to try unfamiliar foods, continue to offer them. Keep in mind that most children will not try a new food until it has been offered ten to fifteen times. Remember that the appearance of food is frequently more important to a child than its taste. Healthy foods sometimes need to be disguised or blended in with old favorites.

In general, children should be given choices from a number of healthy foods each day. With many children, changing the setting in which they eat may be as important as changing the diet. Meals should be relaxing and enjoyable, providing fun, not fights. Consider using tablecloths, placemats, or napkins picked out by the child. Mealtime should mean eating and family time, with no TV, headphones, reading, or phone calls.

Other guidelines for nutritional health:

  • Be flexible. It may be inappropriate to change the mealtime environment soon after placement. Strict insistence on routine will only set up ongoing food and nutrition struggles. Forcing children to clear their plate may lead to unhealthy eating habits later in life.
  • Look at the long-term goal, rather than the intake at each meal. Even as a child learns to make better food selections, there will still be days when he does not want to eat or doesn’t want to choose healthy food. Positive feedback on “good” days will prevent food issues from interfering with overall adjustment.
  • For some children, textures of food is an issue. Pureed food may help them adjust to different consistencies. Food pieces may be gradually introduced. Children uncomfortable with spoon-feeding or forks should be allowed more freedom with finger feeding. If problems with textured foods or table utensils persists, referral to a speech therapist or occupational therapist for oral-motor therapy should be considered.
  • Poor dental hygiene and undiagnosed tooth and gum disease may interfere with eating habits. All children over the age of one should have routine dental examinations. Parents should share information about the child’s past medical history and previous malnutrition. Dental care should be especially aggressive for children who lived where water is not fluorinated.
  • A child who was previously deprived of food may gorge at meals or hide food for later. Explaining that food is plentiful in his new home may not be enough. Consider giving such children food to eat whenever they want it. This behavior may be gradually extinguished by allowing a child to carry a bag of food around, or by placing a basket of non-perishable food in her room.
  • Remember food recommendations by the numbers: 5 servings a day of fruits and vegetables, 3 a day of dairy products. The number of servings recommended does not vary by age, just the portion sizes. The average toddler serving size is one-quarter of an adult serving. Nutrition labels are helpful with content of foods, but the printed portion sizes are mainly for older children and adults. Milk intake for toddlers should not exceed 16-24 ounces per day. Unless advised otherwise by a medical or nutritional specialist, infants should continue formula or breast milk until a year of age; low fat milk should not be introduced until after age two.
  • Limit juice and sweetened drinks. Many children love juice, but even 100% juice drinks are not good in excess. For younger children, juice should be limited to 4 to 6 ounces per day.

With time, patience, and flexibility, most children will improve their eating habits, while learning important lessons for a lifetime of good health.

Deborah Borchers, M.D., is a founding member of the American Academy of Pediatrics Section on Adoption and Foster Care, and the mother of three children adopted internationally.

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