Getting children to eat often can be a challenge. When they have cystic fibrosis, this can be a real source of concern.

Positive reinforcement and engagement can go a long way to bringing peace back to the dinner table. If you are becoming frazzled by daily battles, try some of these tips.

Make Mealtimes Structured

• Have three meals and three scheduled snacks every day at about the same time.
• Let your child know that it is time to eat. Say, “It's breakfast time,” rather than asking if they want breakfast now.
• Reduce distractions — no TV, toys, books or games at the table.
• Sit at the table with your children. Relax and enjoy being together.
• Limit the length of the meal to 20 minutes.

Reinforce and Reward Good Habits

• Notice when your child takes a bite of food and compliment him or her right away. In fact, compliment everything associated with doing the right thing at mealtime, including coming to the table when called.
  • “You came to the table when mommy asked. I love that!”
  • “You took your enzymes so fast! Great job!”
  • “You picked up your fork! Yahoo!”
  • “Daddy loves it when you take one bite after another!"
  • “Good job drinking your milk. That will make you big and strong.”
• Answer questions and chat with them when they start eating. Ignore them -- look at another family member or your plate — if they are talking instead of eating, complaining about food choices, playing with food, or angling for a different meal. You want to teach them that they get attention for eating what you offer.
• Don't coax them, negotiate (“If you take one more bite … ”) or become a short-order cook and make them something else.
• Reward good habits at the end of the meal with a non-food treat. Children love a pat on the back, kisses, and hugs.

Make sure everyone at the table knows ahead of time how to respond to your child during mealtimes. Getting different responses from people will confuse your child and slow down his or her ability to learn what is expected at mealtime.

Give Choices

• Do not try to trick your child by hiding new or disliked foods in foods he or she likes.
• Let young children choose whether to open their enzyme capsules or have you do it for them.
• Allow your child to choose between two high-energy/high-calorie additions to food (e.g., extra cheese, extra butter, or both).

Make Food Fun

There are many ways you can put the fun back into mealtime. Check in with your CF dietitian who may have ideas that have worked with other families, or ask to be connected to another parent who has found ways to improve eating.

For young children, play with food presentation by making “food animals.” Get ideas online by searching for “food presentation for toddlers and images.”

Take older children to the grocery store to help pick out food they might like. Create games, such as a “calorie contest” to test their food knowledge and get them thinking about meals in a different way. In this game, have your child guess the number of calories and grams of fat are in a particular food. Reward them when they get an answer correct.

Another game could be tied to calcium intake. Show your child pictures of two food items and have your child choose which one has more calcium.

Have an indoor picnic or make a pretend restaurant.

How to Introduce New Foods to a Toddler

Did you know it takes children up to 8 to 12 times (and sometimes more) before they develop a liking for a food? Most parents stop trying a new food after three or four times. Offering foods many times can increase the likelihood that your child will start liking them.

When your toddler refuses to eat something:

1. Do not react. Respond by breaking eye contact and not talking about eating the food.
2. Offer the new food in small amounts (such as a teaspoon).
3. Do not remove the food from your child's plate. Even if your child does not eat it, just having it on the plate is a good way for your child to get used to the food and increase the chance that he or she will try it.
4. Praise your child for touching, trying, and eating the new food.
5. Do not force your child to swallow a food once it is in his mouth. This can make him afraid to taste new foods. Let him spit it out, and then praise him for trying something new. (“I like how you tried a new food; you are very brave!”)
6. Instead of labeling a food as one your child “doesn't like,” try calling it one that “he is not old enough for yet.” You can say: “I like the way you tried [name of food]. It does not look like you are old enough for [name of food] yet.”
7. At the end of the meal, remove your child's plate. Do not offer food again until snack time. Your child will catch up for the missed food then.

How to Manage Sick Days

Refusing food often happens on days that your child is not feeling well. Because children with CF can lose weight quickly, it is important to have a plan for managing sick days. Check in with your CF dietitian first to find the best ways to get your child to eat, and then use these tips:

• Offer high-calorie foods that you know your child likes, rather than a new food. Shakes and smoothies may be good choices.
• Offer your child an extra reward if he or she finishes a meal or snack. Because your child will not feel like being active, watching a movie may be an option.
• Once your child starts to feel better, be sure to slowly increase the amount of food you give and how much you expect him to eat.

Tube Feeding Can Restore Family Dynamic

If nothing seems to help and mealtime continues to be a challenge, talk to your CF care team about the possibility of a gastronomy tube, which also is known as a “G-tube.”

In tube feeding, a tube is inserted directly into the stomach through a small port that is surgically implanted. Some people choose a high-calorie liquid to go into the stomach or intestine at night. The tube is disconnected during the day and closed. Other people use a syringe to administer portions of the high-calorie liquid at different times throughout the day. There are many different approaches to using the tube, and there is no perfect way.

Tube feedings supplement eating during the day. Parents report that tube feeding removes the stress and tension at mealtimes, increases their child's weight faster and helps the family focus on better things, such as strengthening family relationships.

If You Have Depression

A 2016 study showed that if a parent caregiver has depression, their children with CF are less likely to take their enzymes.1 If you have a child with CF and are experiencing symptoms of depression, please talk to your health care provider about treatment.
 

¹ Barker DH and Quittner AL. Parental Depression and Pancreatic Enzymes Adherence in Children With Cystic Fibrosis. Pediatrics. 2016;137(2):e20152296