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Does Your Preschooler Have a Drinking Problem? by William Wilkoff M.D. F.A.A.P. At least once a day I find myself sitting down with the parent of a young child who has a serious drinking problem. Often the family is unaware of the problem and surprised that their busy pediatrician is eager to take a few extra minutes to help them find a solution. Fortunately, I am not talking about alcoholism, although in some communities substance abuse is creeping into the grade schools. The drinking problem that is most common among preschoolers involves the excessive consumption of juice and milk. The scenario often unfolds when a parent complains that their three year old is a picky eater. Of course finicky eating is a common behavior in this age group. It just seems to come with the territory. Unfortunately, most parents find it difficult to watch their child leave the dinner table not having eaten a crumb. Some may resort to fixing their child’s favorite foods when they turn up their noses at what the rest of the family is eating. Other parents may attempt bribery or threats in an unsuccessful attempt to get their child to eat. For the most part picky eating is not a behavior that can be cured by anything other than time and patience. However, many children eat poorly because they are drinking an excessive amount of fluid. When appropriate limits are placed on their fluid intake their appetites may improve dramatically. The explanation is obvious when you think about it. If your child’s stomach is always full of liquid, even if it is just water, he won’t feel hungry for solid food. If the fluid is high in energy, in other words if it contains large amounts of sugar or fat, it will further blunt his appetite. You might think that your child’s body would somehow sense that overdrinking was not compatible with good nutrition. Unfortunately it doesn’t and you may need to step in and make some simple rules to keep his drinking safely in check. Limit milk intake to one glass (4-6 ounces) at each meal. Your child probably needs much less milk than you think. If he eats cheese, yogurt and ice cream along with two or three glasses of milk that is plenty. Anymore than this is likely to fill him up so that he won’t be hungry for his meals. Milk is good food, but you can have too much of a good thing. Limit juice to one glass mid-morning and one glass mid-afternoon. These should come at very specific times that are part of your child’s routine, such as "just after Mister Rogers" or "just before we walk to the mailbox." Many parents feel that they are helping keep their child healthy by offering plenty of natural juices. Juice is certainly preferable to soft drink, but again your child can have too much of a good thing, especially if he is a picky eater. By assigning specific times for juice, you will make it easier for yourself to withstand the whining and begging when your child wants more juice. If you tell him "Not, now later," he will be back in five minutes with the same request. Your preschooler can’t tell time, but he understands when his favorite TV show comes on each day. Unlimited water. This simple rule will protect your child from becoming dehydrated. If your child claims to be thirsty but refuses to drink water, you know that he really isn’t thirsty. He just wants something sweet. All drinking is to be done at the table or in a high chair. Some children will even drink water to excess. This guideline will help curb that tendency because your child will have to decide if he wants to stop playing or watching TV to have something to drink. If he is truly thirsty he will be willing to take a break. This rule will also put an end to the unfortunate habit of having a "wander" bottle or cup. These amount to nothing more than an "all-day-sucker" in a liquid form. They are a deterrent to good eating habits, because the child who is always taking a little hit from his bottle or cup may never really get hungry enough to eat when it is mealtime. No soft drinks, sports drinks or flavored teas. These beverages offer nothing more than sugar and water. Milk and juice in appropriate amount provide many other nutrients that should be important components of your child’s complete diet. If your child has become accustomed to unlimited drinking you may find that the first two or three days after you introduce these rules are punctuated by squabbles and bouts of whining. Hold the line. As long as you are offering him water in unlimited amounts your child will do just fine. If the begging and pleading becomes too annoying you may need to resort to sending your child to his room for a "time-out" until he stops whining. If you are consistent and resist the temptation to negotiate you will find that your child will accept the new drinking rules quickly. The improvement in his eating habits may not be quite so prompt or dramatic. However by putting an end to your child’s drinking problem you will have taken a giant step forward by allowing his natural appetite to emerge from the flood of milk and juice in which it had sunk. If your child relies on a bottle as a sleep-aid or pacifier you will need to take a more gradual approach to overdrinking. Begin by reducing the amount in the bottle by a half an ounce every three days. When the volume is down to two ounces of juice or milk, begin to dilute this gradually by a quarter ounce every three days until your child’s bed bottle contains only two ounces of water. This "wet pacifier" won’t interfere with his appetite and presents no hazard to his teeth until his permanent ones are erupting. Most children will have discarded their water bottle long before that. When your next child comes along promise yourself that you won’t use your breast or a bottle to put him to sleep. When he is old enough to hold a bottle don’t relinquish it to his control. Remember, it is your bottle not his. This simple rule can help your child from developing a drinking problem and may even prevent him from becoming a notoriously picky eater.
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