Beating childhood eating disorders: Mum’s the word

Medical Tribune December 2008 SFX

David Brill

Physicians can help children overcome eating disorders by taking a tactful, measured approach to worried mothers, an international expert said on a recent visit to Singapore.

Some 25 percent of children are thought to have a feeding disorder, the long-term consequences of which can include growth problems and an increased susceptibility to chronic diseases. [J Clin Gastroenterol 2000 Jan;30(1):34-46]

The majority of children, left to their own devices, will simply grow out of it, according to Dr. Benny Kerzner, a professor of pediatrics at the George Washington University School of Medicine, US. The problem, however, can be worsened if the parents’ minds are not put at ease.

"The trouble is the anxiety effect. These parents, even if their kids are doing nutritionally well, bring an intensity to their feeding which becomes a problem. The mothers are fearful and the resulting meal conflict has negative consequences."

It is common for mothers to be concerned about their child’s eating habits: a study by Abbott Nutrition shows that two in five consider their child to be a fussy eater, with 55 percent coaxing or enticing them to eat certain foods.

This anxiety is typically borne out of a fear that if the child is undernourished their development will be stunted, Kerzner said. Research shows, however, that psychosocial factors such as mother-child interactions actually have a greater impact than nutritional status on the cognitive development of toddlers with eating disorders. [Pediatrics 2004 May;113(5):e440-7]

Concerned mothers will often consult their GP or pediatrician, which provides the ideal opportunity to allay their fears, Kerzner said.

"The doctor needs to be empathetic, and needs to be certain that he’s not slighting the issue. You don’t want to make too much of a big deal out of it but you want to be knowledgeable enough to tell her why she can relax."

The doctor should begin by taking a thorough history in order to rule out genuine medical explanations such as allergies, pain with swallowing, or gastroesophageal reflux, Kerzner said.

"You’ll then be left with a large number of children where the mother is still concerned. Those I divide into two: the children who primarily have an appetite issue and, at the other end of the spectrum, the kids with sensory issues."

For children in the first group the doctor can teach some basic appetite-enhancing techniques or "food rules," such as stopping snacking between meals, limiting the size of meals, avoiding distractions at mealtimes and adopting a neutral attitude so that the child does not feel pressured to eat.

Sensory issues such as neophobia – the fear of new things – can be overcome by introducing new foods slowly and gradually, Kerzner said, adding that parents need to show genuine persistence and not lose heart if the child rejects a new food two or three times.

Doctors can also use growth charts to demonstrate to parents that their child is developing normally. In some cases they may also wish to recommend a dietary supplement or, if the problem persists, refer the child to a dietician, he said.

"In order to put them at ease you can’t fool them. What we need to have is a genuine discussion explaining the attitude that we have and why we’re not worried," Kerzner concluded. He was speaking at a press conference organized by Abbott Nutrition.