Ask the Pediatrician

Q1: Tell me more about the importance of “family meal time.”

Having family meals regularly can have many positive effects that extend far beyond the nutritional advantages. Being able to connect together on a daily basis to hear all about the events of your child’s day—both the good and challenging portions—is essential for emotional health. It can serve as a time to build up your kids and encourage them. This is a good practice to start when your children are young, even though it can be far easier to just have the “drive-thru experience.” It can be a time to add a little needed teaching and perspective into the life experience of your children. It will also provide an opportunity for some real interaction, as the rest of their contacts are becoming increasingly limited to Facebook, Twitter, and texting with their friends.

It is important to emphasize that the television, streaming video, etc., Smart phones, texting, social media sites, etc., should not be invited guests to your family meal time to prevent interference with the person-to-person interactions.

Finally, from a nutritional perspective, everyone tends to eat healthier and in more appropriate portion sizes during family meals. As a parent, it is easier to provide nutritionally balanced selections when everyone is sitting around the table together. Also, research has shown that when people eat while watching television, they tend to eat more calories than they need and also foods that tend to be less healthy than what they would eat if not influenced by the TV.

If you already have a family mealtime established, this will serve you and your family well going forward. If not, it may take a while to change things around. It is worth it though, and the rewards will reach out for years ahead. Remember, even if you cannot do this every night try to make it the majority of evenings with the majority of family members.

Q2: I am really worried that my toddler is not eating enough but meal times are a real struggle. What can I do?

This is a common situation for parents of children between one and three years of age. To answer this concern, it may be helpful to try to “view the world” from your toddler’s perspective. It is also important to make a distinction between calories and nutrition, because it is the latter that is important to focus on and not just the calories that your child is eating on a day-to-day basis.

Rest assured, with rare exception, children do not let themselves starve. They also do not let themselves go thirsty. If they are hungry or thirsty, they will eat and drink what is available for them. On the other hand, if they are “calorie satisfied,” they will not eat or will eat only things they really like.

Another important consideration is that your toddler does not need many calories to supply their energy and growth needs. After the first 12 months of life, a child’s growth rate really slows down, as does their calorie needs to support that growth. Because their bodies are also small (20 to 30 pounds) their calorie needs to supply their daily energy needs are also small. Growth and energy needs together may only require 500 to 600 calories each day for an 18-month-old.

It is very easy for your child to reach that amount. If your toddler really “loves” yogurt, his or her entire calorie needs for  a day can be satisfied through consuming three six-ounce containers of low-fat yogurt—approximately 550 calories. If you add eight ounces of juice—another 100 calories or so—and a small package of French fries—about 230 calories—your toddler isn’t undereating at all, but may actually be overeating. Their nutrition is not great, but they are no longer hungry.

Added to this is the fact that for a toddler, food is much more than just the calorie content. It is an opportunity to explore tastes, shapes, textures, temperatures, and how to handle food. Eating becomes a total body sensory experience. Spreading mashed potatoes with gravy all over may be a new and exciting experience for a toddler, just to see what happens. The same is true with pouring milk out of a cup, or throwing oatmeal to see how far it can go.

Two other important features of toddlers are their desire for attention and their new ability to influence the world around them—both of which can cause challenges at mealtime. If refusing to eat causes a parent to pay more attention, then that is a behavior that is being reinforced from a toddler’s perspective, even if it is negative attention from the parent’s perspective. If the family’s pet dog is a very animated recipient of morsels that come raining down from a toddler’s high chair, then there will likely be food coming down just to see the dog react.

In summary: toddlers will not let themselves starve, so optimize the nutrition of the calories that they do eat. Toddlers are not trying to be “naughty,” but they do love any and all attention, even if it is intended as negative attention from the parent’s perspective. And, if all else fails, vitamin supplements can fill a number of gaps in your child’s nutritional intake.

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to