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Eating Problems in Children

By

Stephen Brian Sulkes

, MD, Golisano Children’s Hospital at Strong, University of Rochester School of Medicine and Dentistry

Last full review/revision Aug 2021| Content last modified Aug 2021
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Eating problems range from age-appropriate variability in appetite to serious or even life-threatening eating disorders Introduction to Eating Disorders Eating disorders involve a persistent disturbance of eating or of behavior related to eating that Alters consumption or absorption of food Significantly impairs physical health and/or psychosocial... read more such as anorexia nervosa Anorexia Nervosa Anorexia nervosa is characterized by a relentless pursuit of thinness, a morbid fear of obesity, a distorted body image, and restriction of intake relative to requirements, leading to a significantly... read more , bulimia nervosa Bulimia Nervosa Bulimia nervosa is characterized by recurrent episodes of binge eating followed by some form of inappropriate compensatory behavior such as purging (self-induced vomiting, laxative or diuretic... read more , and binge eating Binge-Eating Disorder Binge-eating disorder is characterized by recurrent episodes of consuming large amounts of food with a feeling of loss of control. It is not followed by inappropriate compensatory behavior,... read more . Eating problems also can result in overeating and obesity Children Obesity is excess body weight, defined as a body mass index (BMI) of ≥ 30 kg/m2. Complications include cardiovascular disorders (particularly in people with excess abdominal fat), diabetes mellitus... read more (see also Obesity in Adolescents Obesity in Adolescents Obesity is now twice as common among adolescents than it was 30 years ago and is one of the most common reasons for visits to adolescent clinics. Although fewer than one third of obese adults... read more ).

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 (see also Avoidant/Restrictive Food Intake Disorder Avoidant/Restrictive Food Intake Disorder (ARFID) Avoidant/restrictive food intake disorder is characterized by restriction of food intake; it does not include having a distorted body image or being preoccupied with body image (as occurs in... read more [ARFID]), 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 (see growth charts from the World Health Organization [birth until age 2 years] and growth charts from the Centers for Disease Control and Prevention [after age 2 years]). 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 or plateaus at an age when growth and weight gain are expected.

  • 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 minutes 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.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

  • World Health Organization: Growth charts (birth until age 2 years)

  • Centers for Disease Control and Prevention: Growth charts (after age 2 years)

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