Portion Sizes for Children: How Much is Enough?

It can be difficult to know exactly how much food your child should eat, especially when you aren’t sure if you can trust that he understands his hunger and satiety cues because he has been tube fed for the majority of his life. So today, I wanted to offer some insight into what and how much to offer your child so that he might re-establish healthy “full” and “hungry” cues.

When serving your child a meal or snack, it is important not to offer too much food or too many choices because this can be visually overwhelming. Try using a salad plate rather than a dinner plate for toddlers.  An easy rule of thumb when determining how much food to serve is to look at the size of your child’s hands.  The amount of protein (chicken, fish, beef, beans/lentils, eggs, etc.) should be able to fit into one palm, and the amount of whole grain (rice, pasta, bread, cereal, pancake, etc.) should be able to fit into their other palm.  The amount of fruit should be the size of the fingers on one hand and this same rule applies for veggies on the other hand.  So, for toddlers, this can be just a couple of teaspoons or tablespoons of food from each food group placed onto their plate.  Serve their plate with a glass of milk or milk-alternative beverage and you have a beautifully balanced meal for your child.

If you have a child that is “finicky” or “selective” with what he chooses to eat, it is still recommended that you offer a balanced diet that includes a variety of foods because it can take a lot of visual and tactile exposures before your child may feel comfortable enough to put the food into his mouth for a taste.  If you never offer fruits or veggies or proteins because you assume that he won’t like them, then he will never have the chance to learn to like them.

During a tube wean, our eating expectations evolve over time.  So, let’s look at a hypothetical wean plan in order to better understand how this evolution might progress. During step 1 of this hypothetical wean, the volume and calories of formula are reduced. However, at this stage, we do not expect children to eat an equivalent amount of food to make up for this reduction.  During step 1, our goal is simply to create appetite and interest in eating.  We want your child to explore foods and have positive interactions, which might just be a few nibbles each offering. And that is ok.  We still want your child to eat regular meals and snacks on a schedule.  If your child doesn’t each much or anything at a designated eating time, don’t give in to the temptation of offering him food all throughout the day as creating a grazing pattern will sabotage appetite and prevent growth.

During step 2 and 3 of the wean, this evolution progresses, and we expect children to find their appetite and eating rhythm as tube feeds are further reduced.  But it takes time for these things to happen and we don’t expect eating to improve overnight, but rather gradually over the course of the wean.  During this progression, you should start to see some preference emerge for flavor and/or texture.

When we reach step 4 of the wean and tube feeds have been discontinued, your child will show you hunger cues and the quantity of food consumed will continue to build over time.  This is usually the time when parents become concerned that their child isn’t eating enough volume of solid foods.  The concern is real, and often stems from anxiety and past trauma – and that is ok.

When you are used to feeding your child a liter of formula or blended foods via tube each day and you get to this step of the wean and they are just eating tablespoons of table food each offering, it can seem like this isn’t enough. But here, we have to remind ourselves that it isn’t a direct correlation that the volume of liquids you were feeding before have to be matched with an equivalent amount of food.  Table foods are more calorically dense so the amount toddlers need is much less than what they needed from formula.

Lastly, as a general rule of thumb, oral eaters should get about 80% of their calories from food and 20% of calories from milk or milk-alternative beverages. So, if your child’s estimated energy needs are 1200 kcal/day, then we would want around 1000 calories to come from foods and 200 calories to come from milk.This breaks down to 250 food calories at breakfast, lunch, and dinner and 125 food calories for two snacks during the day and drinking 4 oz of whole milk with each meal for 12 oz/day.But remember, this is a goal to be reached over time. Rome wasn’t built in a day, and neither is a full and well-rounded eater. So trust the process, trust your team, and trust your child. You both will get there!

Lisa Grentz, MS, RD, CD, Dietitian