An 18-month-old male came to clinic for his health maintenance visit. His dietary history showed he drank ~45 ounces of milk a day mainly from a bottle that he was allowed to have during most of the day. His mother complained that he didn’t eat much solid food, and wouldn’t sit down to eat. She noted that she didn’t really stop to eat herself. She would just drive through a fast-food restaurant and eat in the car even if she was not pressed for time. “It’s just something I do,” she said. He was doing well with normal development. The past medical history showed a healthy male. The social history showed him living with his employed mother. There was maternal family support locally. The family did not receive governmental assistance and the mother felt she had adequate resources from her employment. The pertinent physical exam revealed a smiling male with normal vital signs and growth parameters in the 25-50%. His examination was normal including normal appearing teeth.
The diagnosis of a healthy male with inappropriate food intake and behaviors was made. The pediatrician counseled the mother to decrease the total milk intake to 16 ounces/day and to put this into a sippy-cup or regular cup. “Any other fluid he wants can be up to 4 ounces of juice a day or water. All of it should be in a cup. He also should not be walking around with the cup. If he fills up on fluid he won’t eat. He should have 3 meals and a couple of snacks a day and he needs to sit down whenever he eats or drinks. It really does only take a few minutes and you both can have a nice time together talking and eating. It’s also a good break for you during the day. Even if you do have some fast-food, you should eat it as a family, sitting down together. He’ll learn what is expected of him at the dinner table too.” The laboratory evaluation showed a low hemoglobin and hematocrit so he was started on elemental iron.
The patient’s clinical course at 3 month followup found the mother to be proud of having started some of the interventions. She reported that he was only using a sippy-cup and taking only 24 ounces of milk a day. “He cries so much for the milk that I give him more than I should,” she said. “We are sitting down more together though – at least for dinner and most of his snacks when I am with him. When we are at my mom’s house, we have started to have him sit with us for part of our dinner too,” she remarked.
Family meals (FM) are “…occasions when food is eaten simultaneously in the same location by more than 1 family member.” Overall, more frequent family meals are protective for healthy physical and psychosocial functioning across socioeconomic status, race/ethnicity and gender. Why FMs have these protective effects (possibly related to family connectedness) is unclear and additional research is ongoing.
Factors associated with increased FMs include:
- Increased parental education
- Gender – adolescent boys report more FM than adolescent females
- Race/ethnicity – Asian-Americans have more FM than whites who have more than African-Americans. Hispanics have more FMs.
- Children’s ages – younger children have more FMs than older children and adolescents
- Parenting style – mothers who are authoritative have more FMs
The ideal FM environment is one that is positive, without arguments if possible and encourages communication among the family members. There should be no television or other electronic devices (including phones) in the room. Quiet music can help to set a positive mood for the meal. FMs do not have to be long and can be as short as 20 minutes.
Barriers to FMs often cited are work and school/extracurricular schedules, lack of meal planning, not having a regular time set for meals, picky eaters, young children not able to sit through the meal, and family members being hungry at different times. Ways to overcome this include setting the expectations that FMs will occur and family members are expected to participate, making grocery lists, making meals ahead of time for use later, and use of time saving devices such as microwave ovens and slow-cookers. Additional ways to keep the FM a popular and daily event include keeping the conversation fun and light, involving the children in meal preparation and serving foods that the children enjoy. FMs also can expand the types of foods children enjoy and the FM should not turn into a short-order restaurant to prepare separate meals for each person’s tastes.
Eating more frequent family meals has better physical and psychosocial outcomes for children including:
- Consumption of good nutrition including appropriate calories, “… protein, fiber, calcium, iron, folate, and vitamins A, B-6, B-12, C and E….”, and increased servings of fruits, vegetables, grains and calcium-rich foods.
- Healthy body weight
- Body image perception
- Academic grade point averages, commitment to learning, language skills
- Family relationships (e.g., perceived family support, communication, and parental involvement), and connectedness
- Effective communication
- Consumption of poor nutrition including soda consumption and saturated fats
- Disordered eating including less obesity and eating disorders
- Alcohol and substance abuse (including tobacco and marijuana)
- Depression and suicidal thoughts
- Violent behavior
Questions for Further Discussion
1. How often do you personally have family meals?
2. How could you include family meal counseling into your preventative care discussions?
- Disease: Child Nutrition | Family Issues
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Specialty: Nutrition / Dietetics | Psychiatry and Psychology
- Age: Toddler
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for these topics: Family Issues and Child Nutrition.
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
To view videos related to this topic check YouTube Videos.
Berge JM, Rowley S, Trofholz A, Hanson C, Rueter M, MacLehose RF, Neumark-Sztainer D. Childhood obesity and interpersonal dynamics during family meals. Pediatrics. 2014 Nov;134(5):923-32.
Martin-Biggers J, Spaccarotella K, Berhaupt-Glickstein A, Hongu N, Worobey J, Byrd-Bredbenner C. Come and get it! A discussion of family mealtime literature and factors affecting obesity risk. Adv Nutr. 2014 May 14;5(3):235-47.
Harrison ME, Norris ML, Obeid N, Fu M, Weinstangel H, Sampson M. Systematic review of the effects of family meal frequency on psychosocial outcomes in youth. Can Fam Physician. 2015 Feb;61(2):e96-106.
DeGrace BW, Foust RE, Sisson SB, Lora KR. Benefits of Family Meals for Children With Special Therapeutic and Behavioral Needs. Am J Occup Ther. 2016 May-Jun;70(3):7003350010p1-6.
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital