The caregiver interview regarding feeding history and habits provides some information about a child’s intake patterns and food preferences; however, it focuses mainly on behavior patterns involved in feeding problems rather than on the precise content of intake. More specific information about the child’s food and fluid intake is needed to assess the nutritional adequacy of the child’s diet.

Nutrient intake can be examined by first interviewing the caregiver about a child’s diet for a typical day using focused questions, such as “When does the child first have something to eat?” (Pipes et al., 1993). This sample will provide an indication of whether the child is receiving appropriate nutrients and whether the parents have knowledge of appropriate nutrition and food preparation procedures. Nutritionists look for signs that the child is at nutritional risk, such as inappropriate preparation of infant formula, too little or too much milk intake, excessive use of vitamin supplements, refusal of an entire group of foods, or developmentally inappropriate food textures (Krug-Wispe, 1993; Pipes et al., 1993; Queen, 1984). If the child appears to be at nutritional risk, then more precise information should be obtained through recordings of actual food intake.

Food diaries kept for a 3- or 7-day period are the most common method of quantitatively assessing intake. The caregiver is instructed to measure and record everything that the child consumes. Typical forms include a place to record when the food or drink was consumed, the type of food, the method of preparation, and household measures (fractions of measuring cups, level teaspoons, or tablespoons) of food consumed. Recipes for mixed dishes should accompany the food records. Vitamin and mineral supplements also should be recorded.

Food intake then is evaluated with regard to total caloric intake, protein, vitamins, and minerals for the child’s weight or age, using standard Recommended Daily Allowances established by the U.S. Food and Drug Administration. Computer software programs (e.g., Food and Nutrition Information Center, 1992) are available for calculating the nutritional adequacy of diets. Nutritional excesses or deficiencies may call for intervention under the supervision of a nutritional specialist.

As a general guide, it can be helpful to compare a child’s diet to recommended daily servings of each food group for typically developing children of different ages. Figure 3.3 [not available] shows a sample chart from a pamphlet entitled A Food Guide for the First Five Years, published by the National Live Stock and Meat Board (1992). As stated in the guide, the pamphlet material has been reviewed favorably by the American Academy of Family Physicians Foundation and the American Academy of Pediatrics. Minimum serving sizes for children are defined in the guide as 1 measuring tablespoon of cooked food for each year of a child’s age. Expected intake obviously would vary from the norm for children on hyper- or hypocaloric diets.

One limitation of food diaries is that there is a likelihood of substantial inaccuracy in reporting: Even motivated parents forget to document information, miscalculate amounts, or simply do not notice some aspects of a child’s food consumption. More precise records can be obtained for actual intake during the feeding evaluation by weighing food before and after the meal or by counting actual bites eaten (Linscheid, 1992; Riordan, Iwata, Finney, Wohl, & Stanley, 1984). These methods also can be used by feeding professionals during ongoing monitoring of a child’s progress in feeding sessions. In addition, parents may be taught to provide more accurate reports of food consumption using food scales or plastic food models, which provide standardized reference points for estimating the size of servings (Stark et al., 1990; Turner et al., 1994).


References

Food and Nutrition Information Center. (1992). Microcomputer software collection. Beltsville, MD: U.S. Department of Agriculture.

Krug-Wispe, S. (1993). Nutritional assessment. In P.A. Queen & C.E. Lang (Eds.), Handbook of pediatric nutrition (pp. 26–82). Rockville, MD: Aspen Publishers, Inc.

Linscheid, T.R. (1992). Eating problems in children. In C.E. Walker & M.C. Roberts (Eds.), Handbook of clinical child psychology (2nd ed., pp. 451–473). New York: John Wiley & Sons.

National Live Stock and Meat Board. (1992). A food guide for the first five years [Brochure]. Chicago: Author, Educational Department.

Pipes, P.L., Bumbalow, J., & Glass, R.P. (1993). Collecting and assessing food intake information. In P.L. Pipes & C.M. Trahms (Eds.), Nutrition in infancy and childhood (5th ed., pp. 59–86). St. Louis: C.V. Mosby.

Queen, P.M. (1984). The evaluation of nutritional status. In R.B. Howard & H.S. Winter (Eds.), Nutrition and feeding of infants and toddlers (pp. 167–208). Boston: Little, Brown.

Riordan, M.M., Iwata, B.A., Finney, J.W., Wohl, M.K., & Stanley, A.E. (1984). Behavioral assessment and treatment of chronic food refusal in handicapped children. Journal of Applied Behavior Analysis, 17, 327–341.

Stark, L.J., Bowen, A.M., Tyc, V.L., Evans, S., & Passero, M.A. (1990). A behavioral approach to increasing calorie consumption in children with cystic fibrosis. Journal of Pediatric Psychology, 15, 309–326.

Turner, K.M.T., Sanders, M.R., & Wall, C.R. (1994). Behavioural parent training versus dietary education in the treatment of children with persistent feeding difficulties. Behaviour Change, 11, 242–258.