Eating problems

For some children, a poor appetite may signal psychological or medical problems.

THREE-year-old Justin has a problem with food. He is very picky at mealtimes – he won’t eat most foods and at times, refuses to eat at all. His weight starts to plummet. His worried parents bring him to a paediatrician, who examines the boy and discovers that Justin has gastroesophageal reflux.

A few houses away, food is the least of five-year-old Asha’s interests. She whines whenever she has to eat, looks pale and has little energy to run around and play with her friends.

Children with feeding problems generally insist on eating only one or two types of food for long periods of time or are reluctant to try new types of food. They may also be strongly averse to certain types of food, don’t eat enough or simply refuse to eat.

Research shows that up to 45% of children experience problems at mealtimes. In most cases, these problems do not result in serious, long-term consequences. However, there are instances when a poor appetite is more than just a growing phase and may signal a serious problem.

First of all, you need to establish if your child’s feeding problems are indeed cause for concern. Children with poor appetites do not receive the nutrients needed for growth. As a result, they are underweight.

One way to tell is by regularly charting your child’s height-for-age and weight-for-age on a growth chart. When done over a period of time, these measurements can serve as an indicator of growth disturbances. It will also enable your child’s doctor to ascertain whether your child is under-nourished or overweight.

There are two main causes why your child is not eating as well as he should – psychological disorders and medical causes.

Psychological disorders

Of the two main causes, psychological disorders are the more common of the two. These incorporate behavioural, environmental and psychological problems caused by a variety of factors. For example, some parents may restrict the amount of calories they give their child out of fear that their kid may become fat. Some parents may be feeding their child insufficiently or poorly because of a lack of interest in the child’s welfare. The amount of money a family spends on food and the nutritional value of the foods they buy also affect growth.

Adjustment disorders may cause a healthy child to have a poor appetite. According to psychiatrist Associate Professor Dr M. Swamenathan, adjustment disorders are temporary disorders that follow stressful life events and circumstances. A child expresses anger and rebelliousness by refusing to eat after such incidents.
Another factor is depressive disorders.

“This is common in middle and late childhood,” says Dr Swamenathan. “It is a result of environmental factors either at home or at school. It may include a parent becoming seriously ill, the death of a family member, parental disharmony, being abused, sibling jealousy and harsh parenting. Other factors may include difficulty coping with studies, being bullied and a fear of teachers.”

A rare cause is obsessive compulsive disorders. “This is characterised by disturbing and frightening thoughts that intrude continuously, such as ‘I am going to fail in my exam’ or ‘My mother is going to die’. The child believes that he or she can prevent these bad things from happening by doing a particular action. For instance, ‘If I don’t eat, I will pass my exams and nothing will happen to my mother’,” he explains.

Dr Swamenathan adds that an obsessive compulsive disorder can be identified when a child does some acts repeatedly, such as washing hands, checking the door or light switch or asking the same question over and over again.

A poor appetite can result in children having protein calorie malnutrition, vitamin deficiencies, electrolyte imbalances and deficiencies in trace elements such as magnesium, manganese and zinc. Iron deficiency is a fairly common problem related to poor nutrition.

These factors can lead to a child lacking drive, and becoming disinterested and confused easily, They may also have difficulty concentrating and remembering.

If your child has poor appetites due to psychological disorders, take an empathetic approach to the situation and evaluate it from your child’s point of view. Remember to always show love and concern. Identify areas of stress and institute remedial measures such as spending more time talking to your child.

“Avoid making threats or punishing your child when he doesn’t eat, and reward him for behaviour that is desirable,” advises Dr Swamenathan.

“Try not to force. Instead encourage your child to eat. During mealtimes, make sure your child is seated comfortably at the table and eat alongside him as often as you can. Also, have regularly scheduled meals, and try to make mealtimes as pleasant as possible.”

When it comes to snacks, you need to time them in between meals so that they do not spoil your child’s appetite. Limit fruit juice as it provides empty calories and diminishes an appetite for nutritious meals.
Medical causes

Poor appetites are sometimes caused by medical conditions involving the gastrointestinal system (eg. undetected urine infection, chronic diarrhoea, chronic liver disease), chronic illnesses (eg. cardiac and respiratory disorders), infections (parasites, tuberculosis) and metabolic disorders, which can limit a child’s capacity to make the most of the calories consumed. Consultant paediatrician Dr Zulkifli Ismail says that poor nutrition can cause a child’s immune system to be compromised, making him prone to infections and illnesses.

“Young children need the right nutrients in the right amounts for their brain to develop optimally, particularly during the formative years. So if they aren’t eating well, they aren’t getting the nutrients they need. This can negatively affect their brain development,” says Dr Zulkifli.

Poor nutritional intake can also cause wounds to heal poorly and cause a build-up of toxins in the body, making it difficult for the body to derive nutrients from the food that the child eats.

If you suspect that your child is not eating well due to a medical condition, send him to a doctor for evaluation. Your doctor or paediatrician will examine your child’s diet and eating patterns, and try to establish when and why growth or weight gain has stopped. Your doctor may also look for emotional and social problems for the decrease in growth, and counsel you about family interactions or habits that are damaging to your child’s development.