| Challenge | Possible solutions |
| Family has little or no structure to dietary patterns (few family meals, meals are not eaten at the table, television on during meals, grazing, etc) | Eat meals together as a family, when possible. |
| Emphasize scheduling of meals and snacks. | |
| Avoid skipping meals. | |
| Limit meal-time distractions (eg, television, smartphones, tablets). | |
| Family frequently eats meals away from home | Identify barriers that prevent the family from eating at home more often. |
| Provide meal-planning resources, initially using recipes that are familiar to the family; begin the process of cooking more at home using these recipes. | |
| Assess the type of restaurant and usual selections and discuss alternatives. | |
| Poor dietary quality (lack of fruits/vegetables and whole grains, consumption of whole milk, etc) | Provide education about food groups, discussing the importance of each food group as part of the daily diet. |
| One approach is to discuss the concept of a "balanced plate," focusing on supplying ample vegetables, fruits, and fiber (approximately 1/4 plate each for vegetables, grains, fruits, and protein). Guidance is available at the MyPlate website. | |
| Lacks nutritional knowledge (no label reading, does not make shopping list, etc) | Assess family's level of nutritional knowledge and start by helping them set small goals, such as balancing their plates or providing a variety of foods. |
| When the family is ready, increase goals gradually by discussing which foods should be eaten most often and which foods should be eaten sparingly, as well as teaching the family how to read food labels. | |
| Excessive refined grains (white bread) and simple carbohydrates (sugars) | Emphasize the importance of including fiber in the diet as a means of decreasing hunger and feeling full after eating. |
| Explain that whole grains are digested and absorbed at a slower rate than refined gains and sugars, resulting in a more stable blood sugar, which reduces hunger and is healthier. | |
| High-fat dairy intake | Compare nutritional information of high-fat dairy products with low-fat dairy products. |
| Discuss types of fat: which fats are healthier and which fats should be avoided (ie, saturated fats). | |
| Skipping meals | Emphasize the importance of eating 3 regularly scheduled meals a day to have a healthy weight and metabolism. |
| Explain that skipping meals can lead to increased hunger and excessive eating later. | |
| Start by establishing a small goal to eat just 1 food group at the time that the child would usually skip a meal. | |
| Increase the goal gradually by introducing other food groups as the child is ready; encourage the child to achieve a balanced meal. | |
| Excessive snacking | Set a snack schedule between meals to encourage less grazing. |
| Outline several choices for healthy snacks. | |
| Emphasize the importance of eating a single portion of food from 2 different food groups to encourage fullness until the next meal. | |
| High intake of sugar-sweetened beverages | Discuss empty calories from sugar-containing beverages (including 100% fruit juice). |
| Estimate the number of calories that the child is currently taking from beverages. | |
| Eliminate sugar-sweetened beverages from the home environment. | |
| Suggest low-sugar alternatives for the family to try. | |
| Substitute water or low-fat milk (unsweetened). | |
| Low fruit and vegetable intake | Provide education regarding serving sizes of vegetables and fruits. |
| Discuss the importance of fiber from vegetables and fruits. | |
| Have the family try new vegetables and fruits to increase variety. | |
| Provide quick and easy recipes or products. | |
| Picky eating | Introduce the child to new foods gradually but consistently. |
| Provide the same foods for each family member; no "special orders." | |
| Eat meals and snacks together as a family when possible. | |
| Provide meals and snacks on a predictable schedule. | |
| Encourage, but do not pressure, the child to eat a specific food. The caregivers should continue to offer the same food on >10 occasions even if the child declines to eat it. |
