Feeding disorders come in many forms and severity and are reported in 50 to 60 percent of toddlers and children by mothers surveyed worldwide.
International pediatrics experts provided clinical guidelines to local pediatricians based on an ongoing multidisciplinary program to address feeding difficulty.
Dr. Russell James Merritt, medical director for nutrition support at the Children’s Hospital of Los Angeles, said that “feeding difficulty” is an umbrella term for seven specific mealtime disorders touching on underlying psychological and physical problems of both children and parents.
Four of these are associated with poor appetite per se and some have strong elements of parental influence or intervention. A parent concerned with the less-than-optimal growth and development of a child might develop a false perception that the child has poor appetite. Or a child that is apathetic or withdrawn and picks on his food might just be modeling the behavior of a depressed or distraught parent.
On the other hand, some children can also be too vigorous and busy to feel normal hunger pangs. There are those who eat only certain food, the picky eaters.[pq]Among Filipino children, local market-research surveys indicate a marked preference for fast food and fried food.[/pq]
Children may also develop feeding disorders because physical problems, both past and present, inhibit them from eating. These include:
- Children who have had choking spells or had medical problems which necessitated intravenous feeding may develop a fear of feeding or may not know how to eat at all.
- Among infants and younger children, colicky pain can disrupt normal feeding behavior.
- Children suffering from diseases such as swallowing problem, intestinal reflux, and allergies are thus physically prevented from taking in food properly.
According to Merritt, these problems can seriously impact the development of the child in different ways. “When these disorders become severe, they can affect how the kid relates to the family and vice versa and can limit the child’s growth,” he says.
Merritt cited studies showing that children identified with feeding problems are three times more likely to have slow weight gain and to have a mental-development index much lower than that of healthy eaters.
Anxious parents can aggravate the problem by forcing the issue, and it is noted that parental concern increases as child grows up. “It becomes a vicious cycle when the parent becomes pushy with a child who doesn’t eat much. The more the parent pushes, the less the child eats,” said Merritt.
Even social relations outside the home can be compromised. “They can’t eat around their peers because they can’t eat the same food. In some instances, they feel stigmatized and feel like they’re very different,” Merritt noted.
For pediatricians, he talked about the importance in zeroing in on a specific disorder. “It is now possible to come up with a more structured evaluation of feeding problems and more specific diagnosis and oftentimes, that includes a nutritional supplement.”
There are a number of red flags that can help pediatricians identify the medical aspect of the feeding problem. However, feeding disorders can coexist, so a pediatrician should not only be able to treat the medical problem but deal with nonmedical issues concerning loss of appetite and food selectiveness.
With good professional guidance, parents can do a lot to address the nonmedical aspect of the feeding difficulty. Pediatricians can educate parents to avoid being pushy, model good eating behavior for their kids, and provide other ways to improve the child’s nutritional intake.
Merritt recommends specific measures that can be adopted for particular disorders:
- Parents unduly concerned over their child’s growth can be educated on what normal growth and nutrition is.
- For vigorous children who don’t know when they’re hungry or full, a structured eating pattern has to be devised.
- Equal attention should be given to both parent and child in a situation where the child’s appetite problem is borne of apathy and social withdrawal.
- Mothers with colicky children require careful attention and lots of support to help them overcome this difficult phase.
Grace Roxas – Morrisey
Originally printed in the July 2009 Edition of Medical Observer