Nutritional Disorders Telehealth Network Project

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Mealtime Structure/Schedule

Providing a consistent environment and a fixed daily schedule of meals and snacks.  
Background Education for Providers
Children, similar to adults, often benefit from a fixed schedule of activities across the day. When meals are set at fixed times each day, children become accustom to the routine and are comforted by the predictability of the similar characteristics of each meal. Further, children will develop a predictable pattern of hunger that coincides with the schedule of meals and snacks, which in turn motivates the child to feed.
Families should also have a feeding environment which is free from distractions, which has appropriate seating for the child, and allows the adult caregiver the ability to monitor feeding for the duration of the meal. Children typically feed best when eating at a table with food placed in front of them for the duration of the meal. At minimum, the child should be supervised one–to-one throughout the meal by a responsible adult. Ideally, the adult supervising the feeding is also eating so that they are able to model appropriate feeding behaviors for the child. The feeding environment should be free of distractions (e.g., no toys or TV at the table) as this will help the child to focus on the task of eating as well as focus their attention on the adult supervising the meal. The child should be seated so that they are comfortable and secure (with safety strap as appropriate).
Children should only be offered foods and beverages at specified meal or snack times. However, water should be offered and encouraged throughout the day. Children should learn that meal times are finite and that opportunities to feed in a given day are limited to the fixed schedule. Studies have shown that children who adopt a grazing meal pattern (e.g. frequent intake of small portions of food and caloric beverages through the day) take in fewer nutrients in a 24 hour period when compared to children that eat on a fixed schedule. Specifically, grazing reduces appetite and intake secondary to disruption of the hunger and satiation cycle.  Without intervention, the grazing child will chronically under meet his/her nutrition needs to support appropriate growth and development. 
Finally, unstructured feeding patterns can result in ambiguity as to who controls the food selections. If a child is granted even occasional control of menu selections, this may result in periods of great conflict when the adult caregiver attempts to introduce new or non-preferred foods. Children may erroneously conclude that they are in control of food choices and that they are entitled to select whatever foods they wish. Unfortunately, caregivers that encounter significant resistance when selecting new or non-preferred foods may defer their authority over the meal to ensure that their child eats something.
Ultimately, the parent may lose all ability to control the mealtime environment (food selections, meal schedule, meal duration).
Potential negatives: Tantrums, begging, sneaking snacks. 
Not every family is able to follow the same feeding schedule due to logistics, culture, or regular family practices. 
Instructions for Providers
The use of schedule and environmental factors to increase the positive effects of mealtime include: promoting appetite improving intake, providing a mealtime environment that minimizes distractions, promoting parental control, and improving overall nutrient intake. 
Before Meals
  • Avoid eating between scheduled meals and snacks. Do not allow children to graze on snacks or juice throughout the day. This way your child can come to the table hungry.
  • Try to have meals and snacks around the same time every day. Keeping to a routine every day can be hard, but try to keep to routine on most days.
  • Make one meal for the family (with at least one item that your child enjoys) and expect that everyone eat what has been made (or they don’t eat at that meal). Do NOT act as a “short order cook!”
During Meals
  • Turn off the TV and put all toys and other distractions in a different area.
  • Eat all meals and snacks at a table with your child seated in a chair that fits him/her. Do not allow children to wander around the house with food /drink
  • Meals should last a maximum of 20 to 30 minutes. Younger children (under 5) may have 15 to 20 minute meals.
  • As often as possible, try to have family meals.
  • Offer solid food before liquids and oral feeding before tube feeding.
Ending Meals
  • Release your child from the table after the time is up (remember 20 to 30 minutes for kids over 5 and 15 to 20 minutes for kids under 5). Do not try to make a child sit at the table “until their plate is clean.”
  • Try to release your child from the table before he/she begins to whine, cry, or tantrum. It is best to end on a success!
  • Try to end meals on a positive note. An example could be your child taking one last bite or sip.
Supplemental Materials
© 2015 Medical College of Wisconsin
Page Updated 04/15/2014