It’s dinner time. You sit down to eat with your four-year-old daughter as you do every evening, and begin to feed her, putting one spoonful at a time into her mouth while you talk to her to distract her. If you are lucky, the meal will be over in 15 minutes, otherwise it could extend well beyond half an hour.

Is it appropriate for a parent to feed a four-year-old in this way?

According to Ms Jo Chen, Senior Occupational Therapist, and Ms Stacy Tan, Senior Speech Language Therapist, at the Rehabilitation Department, KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group, a four-year-old child should be able to sit down and use a spoon independently, and self-feed, by this age.

“Overall, your child should be self-feeding by the age of four with very minimal help from caregivers. There should be minimal spillage of solid foods outside of your child’s plate. However, your child may still have difficulties managing soup with a spoon,” they say.

Feeding milestones for children

Babies should start weaning from 6 months. By the time they are 12 months old, they should be able to eat most soft foods (e.g. papaya, bread, macaroni). By 16 months, toddlers should have been weaned off baby foods (such as mashed or blended foods). By the age of two, a child should have the skills to chew and swallow most adult foods such as meat, rice and noodles.

When children are two years old, they may require modifications to the food, such as cutting foods (e.g. meat) into smaller pieces.

When they reach four years, this modification should no longer be necessary and children should be able to eat normally with the rest of the family, using a spoon.

Keeping a 30-minute time limit for your child's meals

Keeping to a time limit of 30 minutes for your child’s meal is advisable, say Ms Chen and Ms Tan.

“Some children take a long time to finish their meals because they run around or play during mealtimes. The energy that they take in during that time may not be enough for adequate growth. This could result in inadequate weight gain. Extended mealtimes often cause frustration for both the parent and child, resulting in negative experiences towards feeding,” they say. “Mealtimes should be pleasurable.”

What to do at mealtimes

  • Encourage your child to sit at the table with the family when eating
  • Minimise distractions in the environment (e.g. switch off the TV)
  • Use words of affirmation (e.g. "You can sit nicely at the table")
  • After 30 minutes, end the meal and encourage your child to help clean up

You can offer a snack or another meal some time later if your child feels hungry.

Children should eat a variety of foods across all major food groups

For normal growth, a child should eat a variety of foods from different food groups – carbohydrates, proteins, vegetables, fruits, dairy. Ms Chen and Ms Tan say that a child may receive inadequate nutrition if he or she consumes a limited variety of foods.

“A child with feeding difficulties may choose to only eat foods from a particular food group (e.g. mostly carbohydrates, minimal protein / vegetables) or foods of a particular taste / texture (e.g. mostly fried foods). These behaviours may lead to the child receiving inadequate nutrition for growth. A dietician is able to determine if the child is receiving balanced nutrition and if any supplementation is required,” they say.

They advise consulting your child’s paediatrician if you notice the following behaviours in your child:

  • Eats less than 20 different foods
  • Avoids all foods of a specific texture or food group
  • Has poor weight gain
  • Experiences ongoing choking, gagging, coughing or vomiting during mealtimes
  • Experiences difficulty transiting to solid foods by 12 months
  • Has not weaned off most baby foods by 16 months
  • Extended mealtime duration (i.e. more than 30 minutes)

Feeding clinic services targeting children who have not achieved age-appropriate feeding skills are available at the Rehabilitation Department at KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group. This multi-disciplinary feeding clinic is run by speech-language therapists and occupational therapists.

Ref: T12