Getting children to eat healthy meals can be a challenge. For parents of a child with cystic fibrosis, this can be a real source of stress. Below are some things that parents can do to help children eat well to stay healthy.

Remember to also talk with your CF care team for support and suggestions. It may be helpful to talk with the dietitian, nurse, social worker, or psychologist.

Make Mealtimes Structured

• 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 phones, tablets, TV, toys, books, or games at the table.
• Sit at the table with your children. Relax and enjoy being together.
• Limit the length of meals to about 30 minutes.

Keep Mealtimes Positive

• Be a positive example. Children learn healthy eating by watching their parents. Eat a variety of foods from all food groups. Try new foods together with your child.
• Praise your children when they are eating well. 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.”
• Reward good habits at the end of the meal with a non-food treat. Children love a pat on the back, kisses, and hugs.
• Do not pressure your child to try a new food, take more bites, or finish their plate. Do not coax or beg your child to eat or punish them for not eating. Do not negotiate (“If you take one more bite …”) or cook them something else.
• Do not get discouraged if your child does not try a new food. Keep offering it again at future meals.
• Do not try to trick your child by hiding new or disliked foods in foods he or she likes.
• Avoid calling foods good or bad. Instead, talk about why you like the food. Talk about how the food looks, smells, feels, and tastes.

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

Let Kids Participate and Have Fun

• Give choices. Rather than asking “Do you want a vegetable with lunch,” ask “Do you want carrots or cucumbers with your lunch?” Let young children choose whether to open their enzyme capsules or have you do it for them.
• Ask your child to help you plan meals and snacks for the week.
• Encourage your child to join you in the kitchen for age-appropriate cooking activities. Children may be more likely to try a food if they help prepare it.
• Take older children to the grocery store to help pick out food they might like.
• For young children, play with food presentation by making “food animals.” Get ideas online by searching for “food presentation for toddlers.”
• Have an indoor picnic or make a pretend restaurant.

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

Dealing With Emotions and Attitudes

• Try not to worry if a meal ends and your child has not eaten much. They will eventually get hungry and can eat at the next meal or snack time.
• Have a relaxed discussion with your child about the importance of healthy eating. Talk about this at a time other than meals or in CF clinic.
• Give your child an opportunity to talk about their feelings about having CF and how CF affects what they eat.
• Ask your CF care team for support and advice.

How to Introduce New Foods to a Toddler

Did you know children may need to try a food 10 to 15 times or more before they start liking it? Offer foods many times to help your child learn to like new foods.

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 can 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 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. If your child does not feel like being active, watching a movie may be an option.
• Once your child starts to feel better, slowly increase the amount of food you give.

Tube Feeding Can Help

If nothing seems to help and mealtime continues to be a challenge, you can talk to your CF care team about the possibility of a feeding tube.

In tube feeding, a tube is inserted directly into the stomach or small intestine. Liquid food goes through the tube. Tube feedings are typically used to supplement eating, not replace it. Tube feeding plans can be set up in different ways depending on nutrition needs, daily routines, and personal preferences.

Tube feedings can bring benefits and challenges for families. Some parents report that tube feeding removes stress and tension at mealtimes, increases their child's weight faster, and helps the family focus on other things, such as strengthening family relationships.

Read Consider Tube Feeding to learn more, and talk with your CF care team. Together you can review options and decide whether tube feeding would be helpful. 

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 Depression is a health condition that can be treated. If you have a child with CF and are experiencing symptoms of depression, talk to your health care provider about treatment options.
 

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