Food Battles with a Four-Year-Old

Dear Dr. Bill:

Our daughter is nearly 4 years old and she does not eat well. My wife and I never let her snack outside of meal time, and we have three healthy meals every day. Our daughter does pretty well feeding herself at breakfast, probably because she has a lot of choices about what she can eat.

But dinnertime has become a major pain. We keep her in a high chair because she will get down and want to sit in someone's lap. She refuses to feed herself, and we often have to remind her to chew and swallow after we've put food into her mouth. We've tried putting dinner in the refrigerator to serve the next morning, but it's frustrating that she will sit for hours even after we've left the table. We really want her to be a part of our family activities.

My wife and I disagree on how to handle this. I see this refusal to eat as disobedience; but my wife doesn't want to punish our daughter over food because she's afraid it will lead to an eating disorder down the road. What do you think we should do?

— Eric

Dear Eric:

Given your description, the first thing I would suggest is to have your daughter evaluated by her pediatrician. A four-year-old who has difficulty chewing and swallowing food may be suffering from some sort of motor skills problem or developmental delay. If that's the case, your physician may refer you to an occupational therapist or a specialized "feeding clinic" at a local children's hospital.

However, if your pediatrician gives your daughter a clean bill of health and believes this problem is simply an act of defiance, then you and your wife will need to get on the same page regarding how to proceed. Your wife can rest easy — responding to your daughter's mealtime willfulness with appropriate consequences will not cause her to have an eating disorder later in life.

You'll need to begin to set firm guidelines with your daughter regarding what she eats, how she eats, and how long it takes her to finish her meal. There is nothing wrong with giving her a choice between two equally nutritious options — for example, letting her choose between beans and broccoli. But don't allow her to choose between beans and crackers.

Regardless of how much she protests, don't give in to her demands to feed her or hold her in your lap while she's eating. Give her clear, simple instructions regarding what is expected of her. If she resists, give her a verbal warning. If she continues to act defiantly, take her to her room and make her serve a time-out. A good rule of thumb is to require a child to serve one minute of time-out for each year of their age. So in her case, that would involve a four-minute time-out.

Also, when dinner is over, it's over. Give her a reasonable amount of time to finish her meal, using a kitchen timer to signal when her time is up. If she doesn't eat her food, put it the fridge as you've been doing, and serve it to her for breakfast the next morning. If she complains that she's hungry later in the evening, you can give her a glass of water, but whatever you do, don't give her a snack.

Again, it's critical that you and your wife agree on how to respond to this issue and that each of you is willing to follow through. If not, the problem will persist and your frustration level will only increase. A year from now, you'll have a five-year-old with the same eating issues.

By the way, pediatricians Laura Jana and Jennifer Shu have written an excellent book on this topic called Food Fights. You can order it through major online booksellers.

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