Clinical Reference Systems: Pediatric Advisor 10.0
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CHARACTERISTICS OF A CHILD WITH A NORMAL DECLINE IN APPETITE

• It seems to you that your child doesn't eat enough, is never hungry, or won't eat unless you spoon-feed her yourself.
• Your child is between 1 and 5 years old.
• Your child's energy level remains normal.
• Your child is growing normally.

CAUSE

Between 1 and 5 years of age many children normally gain only 4 or 5 pounds each year even though they probably gained 15 pounds during their first year. Children in this age range can normally go 3 or 4 months without any weight gain. Because they are not growing as fast, they need less calories and they seem to have a poorer appetite (this is called "physiological anorexia"). How much a child chooses to eat is governed by the appetite center in her brain. Kids eat as much as they need for growth and energy.

Many parents try to force their child to eat more than she needs because they fear that her poor appetite might cause poor health or a nutritional deficiency. This is not true, however, and forced feedings actually decrease a child's appetite.

EXPECTED COURSE

Once you allow your child to be in charge of how much she eats, the unpleasantness at mealtime and your concerns about her health should disappear in a matter of 2 to 4 weeks. Your child's appetite will improve when she becomes older and needs to eat more.

HELPING A POOR EATER REDISCOVER HER APPETITE

1. Put your child in charge of how much she eats.

   Trust your child's appetite center. The most common reason for some children never appearing hungry is that they have so many snacks and meals that they never become truly hungry. Offer your child no more than two small snacks of nutritious food each day, and provide them only if your child requests them. If your child is thirsty between meals, offer water to quench her thirst. Limit the amount of juice your child drinks to less than 6 ounces each day. Let your child miss one or two meals if she chooses and then watch her appetite return. Skipping a meal is harmless.

2. Never feed your child if she is capable of feeding herself.

   Parents of a child with a poor appetite will tend to pick up her spoon, fill it with food, smile, and try to trick the child into taking it. Once your child is old enough to use a spoon by herself (usually 12 to 15 months), never again pick it up for her. If your child is hungry, she will feed herself. Forced feeding is the main cause of eating power struggles.

3. Offer finger foods.

   Finger foods can be started at 6 to 8 months of age. Such foods allow your child to feed herself at least some of the time, even if she is not yet able to use a spoon.

4. Limit milk to less than 16 ounces each day.

   Milk contains as many calories as most solid foods. Drinking too much milk can fill kids up and dull their appetites.

5. Serve small portions of food--less than you think your child will eat.

   A child's appetite is decreased if she is served more food than she could possibly eat. If you serve your child a small amount on a large plate, she is more likely to finish it and gain a sense of accomplishment. If your child seems to want more, wait for her to ask for it. Avoid serving your child any foods that she strongly dislikes (such as some vegetables).

6. Consider giving your child daily vitamins.

   Although vitamins are probably unnecessary, they are not harmful in normal dosages and may help you relax about your child's eating patterns.

7. Make mealtimes pleasant.

   Draw your children into mealtime conversation. Avoid making mealtimes a time for criticism or struggle over control.

8. Avoid conversation about eating.

   Don't discuss how little your child eats in her presence. Trust your child's appetite center to look after her food needs. Also, don't praise your child for eating a lot. Children should eat to please themselves.

9. Don't extend mealtime.

   Don't make your child sit at the dinner table after the rest of the family is through eating. This will only cause your child to develop unpleasant feelings about mealtime.

10. Common mistakes.

    Parents who are worried that their child isn't eating enough may start some irrational patterns of feeding. Some awaken the child at night to feed her. Some offer the child snacks at 15- to 20-minute intervals throughout the day. Some try to make the child feel guilty by talking about other children in the world who are starving. Others threaten, "If you don't eat what I cook, it means you don't love me." Some parents force their child to sit in the high chair for long periods of time after the meal has ended. The most common mistake is picking up a child's spoon or fork and trying various ways to get food into her mouth.

PREVENTION OF FEEDING STRUGGLES

The main way to prevent feeding struggles is to teach your child how to feed herself at as early an age as possible. By the time your child is 6 to 8 months old, start giving her finger foods. By 12 months of age, your child will begin to use a spoon and she should be able to feed herself completely by 15 months of age.

When you feed your child (before she is old enough to feed herself), you can wait for your infant to show you when she is ready to eat (by leaning forward, for example). Let her pace the feeding herself (for example, by turning her head). Do not put food into a child's mouth just because she has inadvertently opened it. Do not insist that your child empty the bottle, finish a jar of baby food, or clean the plate.

CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:

• Your child is losing weight.
• Your child has not gained any weight in 6 months.
• Your child also has symptoms of illness (for example, diarrhea or fever).
• Your child gags on or vomits some foods.
• Someone is punishing your child for not eating.
• Following these guidelines has not improved mealtimes in your house within 1 month.
• You have other questions or concerns.