Ho, TP

HKU Scholars Hub

Title Management of children refusing to eatAuthor(s) Ho, TPCitation Hong Kong Practitioner, 1998, v. 20 n. 5, p. 291-292Issued Date 1998URL http://hdl.handle.net/10722/45310Rights Creative Commons: Attribution 3.0 Hong Kong LicenseCLINICAL CHALLENGEManagement Of ChildrenRefusing To EatQuestion:I often have mothers complaining that their otherwisenormal children are refusing to eat. What is the best wayto manage these cases ?Comments:Eating behaviour is the result of a complex interplaybetween physical, emotional, and social factors. Thoughthe research literature is more interested in the eatingdifficulties found in mentally handicapped children orthose suffering from metabolic, gastrointestinal, orneurological diseases, the present commentary focus oneating refusal found in physically normal children.AssessmentAdequate history taking should include the following:• Clarify the nature of complaint: what food is refused,how often, for how long.• Clarify the type and amount of food (preferablyestimate calorie) intake each day.• Clarify any associated meal time problems like eatingvery slowly, very choosy in food, spitting, disruptivebehaviour during meal time (leaving seat, whining,tantrums etc), insisting to be fed by caretakers etc.• What preceded the onset of eating refusal?• How did the caretakers (sometimes grandparentscould be more problematic) cope with the refusal toeat?• Assess the mother's emotional state and her beliefabout nutrition or eating.• Assess the child's emotional and behavioural well-being.It is important to check the nutritional status anddocument the growth parameters of the child. For furtherassessment you may consider food diary and observationof parent-child interactions during meal time.Common problemsProblematic handling include:• irregular meal time and inappropriate amount of food;• unrestrained access to food in between meal times;• excessive instructions to eat and often associated withthreats and accusations;• failure to attend or reward appropriately when childeats properly;• excessive bargaining, yield to requests, andsometimes chasing after the child to feed when he/she refuses to eat.Food refusal after an incident of choking has beenreported. This can be identified by an acute onset, obviousprecedent, and associated phobic features. Complaints ofeating refusal in an otherwise normal child may arise froman overanxious, obsessive mother. Sometimes refusal toeat is just part of an underlying disturbances in the childlike anxiety disorders, depression, or attention deficithyperactivity disorder. Prepubertal anorexia nervosa hasbeen documented in children as young as age 8. Cases ofchildren refusing to eat, walk, talk, or care for themselveshave been reported to be associated with sexual abuse.Extreme food fads are sometimes found in children with291Children Refusing to Eatautistic disorder. If the complaint of eating refusal occursin a child with delays in physical, intellectual, and/orsocial development, psychosocial dwarfism should beconsidered.TreatmentTreatment of eating refusal as part of an underlyingemotional or behavioural disorder in the child is beyondthe scope of the present commentary. Sometimes, a referralis required. However, advice on handling of mono-symptomatic food refusal is often necessary. Dependingon the assessment, the following may be considered:• Try to provide a non-distracting meal timeenvironment and do not let the child eat whilewatching TV.• Children, like adults, have their favourite food anddislike others. As long as they have a balanced dietand their nutritional state is alright, undue pressureto eat every food item the parents want is counterproductive. The parents should be counselled. If thechild is too selective on food, gradual introduction ofdisliked food, blending or mixing it with favouritefood items often helps. Alternatively, the child maybe asked to try some disliked food before he/she canenjoy the favourite food items.• A clear explanation is necessary especially in case ofobsessive and anxious mother. Acknowledging theiranxiety and clarifying their irrational anxious beliefoften helps. Avoid further painful and invasivephysical investigations because these will escalatetheir anxiety and often aggravate the problem.Set up a clock to remind the child the time requiredto finish meal. Remove the dish when the time is up.No extra food should be provided in between meals.Repeat the procedures in the next meal.Give reward (can be ice cream or favourite games)and extra attention (a word of appreciation or praisespecifically on the child's appropriate meal timebehaviour) when the child eats properly. Manyparents may report they have tried, but often they doit erratically. The key to success is persistence,regularity and consistency.Disruptive meal time behaviours should be dealt within a calm and non-coercive manner. Remove the dishand clearly instruct the child to eat properly. Ifnecessary, remove the child from the table or time outmay be required. Chasing after the child to feed themis often unwarranted and perpetuates the problem. •The comments havebeen prepared by Dr. T.P. HO, MD, MRCPsych,FHKAM(Psych)Consultant Child PsychiatristDepartment of PsychiatryQueen Mary Hospital292

Management of children refusing to eat

http://hub.hku.hk/bitstream/10722/45310/1/34110.pdf

Management of children refusing to eat

Abstract

Similar works

Full text

Available Versions

HKU Scholars Hub