Mothers in rural India will rarely consult a doctor
because their children are not eating enough, but almost 50% of urban mothers will bring their children to a paediatrician
because they worry they are not eating enough.
If your preschooler is not eating enough, but is
otherwise active and full of life, there is probably nothing wrong with him. I would certainly be worried if a newborn baby
suddenly stops suckling. If he has thrush (curd-like
white patches which do not come off easily) inside his mouth,
a simple treatment will set matters right. Otherwise, a
severe infection may be cooking which needs urgent attention.
CAUSES: In case you are worried that your child weighs less than those around him, keep in mind that the child
who was small at birth (though he was born at the expected
time) is likely to remain small. Also, his size will mimic
yours or your husband’s. If you are concerned that your child’s
weight gain and appetite seems to be less in the second 6 months than in the first 6 months, remember that an average
breastfed infant may gain about 20 to 30 gms of weight
per day in the first 3 months, about 15 gms between 3 and 6
months and even less in the next 6 months.
The bulk of the cases of anorexia belong to the age
group of 1 to 3 years, and usually parents of first children will
bring them in to be examined. In these cases, the mother has usually tried all possible methods to make the child
eat, and he has rebelled. Your anxiety probably transfers itself
to your child.
An older child or an adolescent who is losing weight (weighed on the same scale at intervals) or one who gets
tired easily and appears unwell and listless may also need a thorough check-up and investigations. He may, for
instance, be anaemic or may have diseases like jaundice (due to infection of his liver), tuberculosis or a urinary
infection.
TREATMENT: Work with a baby’s natural appetite. Just
as a baby suckles as much milk as he needs at the breast, a child will usually eat when he is hungry. No intervention is
required as long as he is otherwise healthy.
Remember that a toddler likes to play with his food. Nearer his first birthday, he will show interest in
feeding himself. If permitted, he will enjoy doing so though he makes a mess and manages to put hardly
anything in his mouth. A clever mother allows him to learn to manage by himself. In between, she assists him
but makes him feel that he is doing it himself. She does not mind the mess. She knows that the child could be
persuaded to eat more without his messing around, but she avoids the temptation to take over and allows him
to manage with his own fingers or with the help of a spoon. The moment he shows reluctance to eat any
more, she avoids any attempt to make him finish the remaining food. Such a child is likely to create fewer
problems while eating compared to the child of a mother who forces him to eat. Clever handling is
the key.
Offering a child too much of milk or milk products is
not desirable. At times, the milk may have to be stopped for
a couple of months until the child develops healthy food
habits.
Children who don’t eat much at mealtimes should be offered food or feeds more often, say every 2 to 3
hours. If a child does not eat enough of one item, but you feel he
is still hungry, offer him something else — say a fruit or your feed. Try to get the child involved in the preparation of the
meal.
Although some doctors prescribe drugs like
cyproheptadine to stimulate the appetite, I do not recommend these.
Anorexia Nervosa
In adolescence, girls often fall prey to an eating
disorder called anorexia nervosa. The patient gets a compulsive desire to lose weight and becomes emaciated due to
vigorous dieting. Dr. Vibha Krishnamoorthy, an expert on developmental disorders, reveals, “Anorexia nervosa,
though extensively described in the Western world, is now seen in Indian society, especially in the urban middle and upper
classes. The disorder is usually seen in adolescent
girls, though it can be seen in boys as well. The child begins
to diet, or restrict her overall intake excessively,
particularly of fats, resulting in excessive weight loss. It is
accompanied by a distortion in the perception of body image — they always
see themselves as fat or overweight even if they have
lost a lot of weight or are emaciated. The dieting may also be associated with excessive exercise, or the use of
laxatives and forced vomiting to lose weight. Although the exact
cause of anorexia nervosa is unclear, it appears to occur
around the time of adolescence when a girl’s self esteem may be
low. Added to this is the role of the media and societal
pressure and the portrayal of very thin women as acceptable or beautiful.” Such a condition is related to a severe
emotional disturbance and must be taken care of with the help of a psychiatrist or a family
counsellor. Adds
Dr. Krishnamoorthy, “Our goal for our children should include encouraging a healthy diet, and at the same
time, de-emphasising the importance of looks, and building the child’s overall self esteem.”
Indeed, if your child or adolescent looks unwell in addition to going off food, your doctor might like to
have a close look at her to find and treat the other possible
causes of anorexia.
