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Eating Problems

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by Stephen Brian Sulkes, MD

Eating problems range from age-appropriate variability in appetite to serious or even life-threatening eating disorders (see Eating Disorders) such as anorexia nervosa, bulimia nervosa, and binge eating. Eating problems also can result in overeating and obesity (see Obesity). Parents of young children are often concerned that a child is not eating enough or eating too much, eating the wrong foods, refusing to eat certain foods, or engaging in inappropriate mealtime behavior (eg, sneaking food to a pet, throwing or intentionally dropping food).

Assessment includes problem frequency, duration, and intensity. Height and weight are measured and plotted on appropriate charts. Often, when parents are shown charts that show the child is growing at a normal rate, their concerns about eating often diminish. Children should be assessed more thoroughly for serious eating disorders if

  • They voice persistent concerns about their appearance or weight

  • Their weight decreases

  • Their weight begins to increase at a noticeably faster rate than their previous growth rate

However, most eating problems do not persist long enough to interfere with growth and development. If children appear well and growth is within an acceptable range, parents should be reassured and encouraged to minimize conflict and coercion related to eating. Prolonged and excessive parental concern may in fact contribute to subsequent eating disorders. Attempts to force-feed are unlikely to increase intake; children may hold food in their mouth or vomit. Parents should offer meals while sitting at a table with the family, without distractions such as television or pets, and show little emotion when putting the food in front of children. Food should be removed in 20 to 30 min without comment about what is or is not eaten. Children should participate in cleaning up any food that is thrown or intentionally dropped on the floor. These techniques, along with restricting between-meal eating to one morning and one afternoon snack, usually restore the relationship between appetite, the amount eaten, and children’s nutritional needs.

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