Assuring Pediatric Nutrition in the Community


Assessing Nutritional Status - Feeding-Related Behavior

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Why should I assess behaviors related to feeding?
Evaluating behavior-related problems
Evaluating parent and child interactions
Evaluating environmental factors
Evaluating physiologic problems

Why should I assess behaviors related to feeding?
Behavior-related feeding problems can prevent a child from receiving adequate nutrition and can be extremely frustrating to parents and children. Unpleasant mealtimes will further deter a child from eating, making parents more anxious and mealtimes even more unpleasant.

What should I evaluate when assessing behavior-related problems with feeding?
Observing behavior at mealtime yields a wealth of information. If observation of an actual meal or snack is not possible, parents should be asked detailed questions about the mealtime environment. Interactions between parent and child, environmental factors, and physiologic problems can influence feeding behavior.

How can interactions between parent and child influence a child’s eating habits?
Parents can place too much emphasis on the importance of a child eating "enough." This is especially common among families with a child who has experienced growth problems. A child can sense a parent’s anxiety, become anxious, and refuse to eat.

Children may see eating as a way to please parents and may eat more than they need in order to receive positive reinforcement. This creates an unhealthy relationship with food and eating.

Some children may see refusing to eat as a means of getting attention. For example, parents may not notice that a child is eating, but will focus a great deal of attention on a child when he does not eat.

Struggles between child and parent over what and how much is eaten are often results of a child’s desire for independence. Balance of power is important.

How can environmental factors contribute to problems with mealtime behavior?
Noises during mealtime can distract children. Ask parents about the mealtime environment:
does the family eat at a table? Is the television on during meals?

It can be distracting if other family members are involved in activities other than eating when the child is eating or being fed. Not all families eat together, but children should not eat alone—mealtime is an important opportunity for children to learn social skills.

How do physiologic problems contribute to problems with mealtime behaviors?
It is logical for a child who experiences pain (e.g., because of gastroesophageal reflux) when eating to refuse to eat—this may be her only way of communicating, "That hurts." Even after the pain has resolved, she may refuse to eat because of the association between eating and physical pain.

Children who were tube-fed or have experienced medical procedures around the face and mouth are likely to have developed aversions to oral stimuli. These types of problems are often treated behaviorally.

Physical barriers to feeding (e.g., limited self-feeding skills) can be frustrating to a child and lead to a refusal to eat.


Nardella M, et al. Nutrition Interventions for Children with Special Health Care Needs. Washington State Department of Health. 2002.

Trahms CM and Pipes PL. Nutrition in Infancy and Childhood, 6th edition. WCB-McGraw Hill. 1997

Nevin Follino N, ed. Pediatric Manual of Clinical Dietetics, 2nd ed. American Dietetic Association. 2003.

Satter E. How to Get Your Kid to Eat… But Not Too Much. Bull Publishing, 1987.

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