Nutritional Rehabilitation Protocol (NRP): Meal Support Strategies for Caregivers

Important Information:

Meal and snack times can be very stressful for your child. We want to decrease stressors as much as possible. Even with support, your child may get upset during meals. Recovery takes time. The best thing you can do is to be there for them and offer support. Nobody is perfect, the only way you will find out what works best for your child is to try! 

Meal Support Strategies:

Here are some helpful tips to support your child in finishing their meals and snacks.

• Stay calm. Your child may be upset during meals, so it is important for you to do your best to keep emotions out of eating periods. Your child is watching how you react to their eating. 

• Do not negotiate during meals and snacks. Your child may come up with many ways to try to convince you that they do not need to eat what is on their plate. They have the option to complete the food or complete the supplement. Reasoning and negotiation are likely to cause anger and emotional upset. It is important to keep meals calm. 

• If your child continues to ask why they need to eat, how many calories they need to eat, what their weight is, or other conversations that seem unhelpful, we suggest ending that conversation by saying “This is not a helpful conversation, we need to change the topic to something else.”

• Please do not make any comments about your child’s weight or appearance. Please do not make any comments about their food (including the quality, size, texture, healthiness) during or after meals and snacks. 

• Encouraging statements can be helpful if your child is struggling. For example, “I believe in you,” “I love you,” “I know you can do this”.

• Keep conversations low stress during meals. We want to keep meals and snacks as calm as possible. Ask your child what they would like to discuss or what you can do to help support them. Sometimes your child will know exactly what they need, and we want to support them in asking for their needs to be met. 

• Keep all comments brief, matter of fact, and without emotion. For example “Let’s take a bite of _____” or “I want you to take a drink”.

• Mechanical eating can be a helpful tool for patients who report high emotional stress while eating. Mechanical eating encourages patients to take step by step behaviors to complete meals. For example, “I want you to pick up your fork. Now let’s move your hand closer to the plate. I want you to pick up a bite of food with your fork. Put the food into your mouth, chew, and swallow.” These statements may seem too simple, but we know that starved brains sometimes need to hear other people guiding them through meals. Keep your instructions brief and direct.

• Provide occasional reminders about the time limit for the meal or snack. For example, “You have 20 minutes left to finish your lunch.”

• Sometimes distraction can help your child to get through a meal. However, if distraction is slowing down the process of eating, then this might not be the best strategy. 

Reviewed on February, 2025 by Jonathon Pletcher, MD