“Is my child eating enough?”
It sounds like a simple question, but for many parents, particularly parents of children living with disability or developmental delay, the answer isn't always obvious.
We naturally look at how much food disappears from the plate. But good nutrition in childhood is about more than portion size.
We also need to think about growth, energy, nutrients, hydration and the development of eating skills.
Is your child growing along their expected trajectory? Are they progressing through different food textures? Can they communicate hunger and fullness? Are they developing the skills to drink, use utensils and eventually participate in choosing and preparing food?
These are all pieces of the nutrition puzzle.
Eating is actually a developmental skill
We don't always think of eating as something children have to learn.
But consider everything involved in eating a family meal.
A child needs to sit in an appropriate position, pick up food or use utensils, bring it to their mouth, bite, chew, move food around their mouth and swallow.
At the same time, they're processing smells, tastes, temperatures and textures.
Eventually they also learn to recognise hunger and fullness, communicate what they want, make food choices and become increasingly independent.
That's an enormous amount of development happening around the dinner table.
What feeding milestones might look like
There is a wide range of normal development, so milestones are a guide rather than a test your child needs to pass.
During the first year, babies typically progress from breast milk or infant formula towards complementary foods at around six months when developmentally ready. They begin exploring tastes and textures and gradually develop skills such as bringing food towards their mouth and drinking from a cup with assistance.
During the toddler years, children usually become increasingly involved in feeding themselves. Finger feeding develops, spoon and cup skills improve and children become more capable of managing a variety of appropriately prepared family foods and textures.
This is also the age when food refusal can suddenly become much more noticeable. A toddler who happily ate almost anything may start saying no. That doesn't necessarily mean something has gone wrong. Developing independence includes discovering the power of “no.”
Through the preschool years, children generally become increasingly independent with utensils and drinking and participate more in family meals. They can also begin helping with simple food tasks such as washing vegetables, stirring ingredients or choosing between two appropriate options.
By school age, food skills extend well beyond chewing and swallowing. Children can gradually participate in choosing snacks, packing lunchboxes, preparing simple foods and learning basic concepts about food, hygiene and kitchen safety.
For children with disability or developmental delay, these skills may emerge differently, require adaptation or develop over a longer period.
The important question isn't necessarily “Is my child doing exactly what another child their age is doing?”
It may be more useful to ask:
“Are their skills continuing to develop?”
But how do I know if they're actually eating enough?
This is where we need to look beyond a single meal.
Children's appetites can be surprisingly inconsistent. They may eat an enormous breakfast and barely touch dinner. Growth spurts, illness, activity and development can all influence appetite.
Instead, we look at patterns over time.
Growth is one important piece. Weight and height plotted over time can tell us much more than one measurement in isolation.
We also look at what the child is actually eating.
Are they getting adequate energy and protein for growth and activity?
Are there reliable sources of iron?
What about calcium?
Are they eating fruit and vegetables?
Are they getting enough fibre?
Are there sources of essential fats in their diet?
And are they drinking enough?
A child can eat quite a lot of food while still having nutritional gaps if their diet is very restricted.
Conversely, a parent may worry that their child eats small portions when those portions are actually appropriate for their size and needs.
Milestones aren't just about food
There are some everyday skills that can tell us a great deal about a child's relationship with eating.
Can they indicate hunger?
Can they communicate that they've had enough?
Can they drink independently?
Can they sit comfortably for a meal?
Can they manage the textures being offered?
Can they feed themselves at least partly?
Can they make a simple food choice?
As children grow, we can also ask whether they're beginning to participate in the jobs surrounding food.
Putting something in the shopping trolley counts.
Washing a piece of fruit counts.
Helping make a sandwich counts.
Choosing tomorrow's breakfast counts.
Nutrition independence develops gradually.
When might it be worth getting some help?
One missed milestone doesn't necessarily mean there is a problem.
But a pattern of difficulties deserves attention.
I would want to look more closely if a child is losing weight or not growing as expected, has an extremely limited range of foods, regularly coughs or chokes while eating, struggles to progress through textures, has ongoing constipation or diarrhoea, appears unusually tired, has suspected nutrient deficiencies or finds mealtimes consistently distressing.
Losing previously established feeding skills is also something that should be investigated.
Concerns about chewing or swallowing should be assessed by an appropriately qualified health professional rather than managed simply by changing foods at home.
For children with disability, the pathway may look different
A milestone shouldn't become a deadline.
Some children need additional time, equipment, modified food textures, communication supports or assistance to develop eating skills.
For another child, independence may look different altogether.
Perhaps they will always need somebody else to prepare their meal but can learn to choose between two options.
Perhaps they cannot make a sandwich independently but can spread one ingredient.
Perhaps they communicate “more” and “finished” without using spoken words.
Those are meaningful food skills too.
Look at the whole child, not just the empty plate
So, is your child eating enough?
The answer isn't determined by whether they finished dinner tonight.
We look at their growth over time, the nutritional quality and variety of their diet, their energy and wellbeing, their feeding abilities and whether their skills are continuing to develop.
For children living with disability, that assessment sometimes needs to be individualised even further.
Because the goal isn't to make every child eat in exactly the same way.
It's to help each child get the nutrition they need to grow while developing as much confidence, ability and independence around food as possible.
The Cooroy Dietitian
Practical nutrition support for children and families.
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