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Anorexia - Eating problems, how to handle

Eating problems, how to handle

How to Handle the picky Eater

I'm not hungry,'' four-year-old Andrew says sweetly, sitting at the dining room table, his untouched meal before him. His mother takes a deep breath, and the little vein in her neck begins to throb. Another dinner-time battle has begun.

Andrew has figured out how to drive his mother crazy: He eats only one brand of canned spaghetti for lunch, refuses dinner and whines for snacks up until bedtime.

Eating is one area where kids can begin to control their parents. Mom and Dad--worried that their slender, picky eater isn't getting enough nourishment--resort to threatening, bribing, cajoling or catering to their child to try to get him to eat.

Once an eating problem develops, it takes patience and time to deal with it. Here are some hints from the experts to help you over the hurdle.

Assess your expectations. If your child eats small portions, don't worry. Some children don't need large amounts of food, says Alvin N. Eden, M.D., associate clinical professor of pediatrics at the New York Hospital-Cornell Medical Center, chairman of the Department of pediatrics at Wyckoff Heights Medical Center, both in New York City, and author of positive parenting and Dr. Eden's Healthy Kids. Also realize that children can vary a lot in their day-to-day intake. They may be ravenous one day and pick at their food the next.

Serve small portions. ''put less food on your child's plate than you think he'll eat,'' says Quentin Van Meter, M.D., a pediatrician and associate professor of clinical pediatrics at Emory University School of Medicine in Atlanta. ''piles of food on a plate can turn off a child's appetite.''

The appropriate portion size for kids is surprisingly small--and you can always serve seconds if the child wants more, points out Dr. Eden.

Snacks are fine--but keep them small. Your child may be turning up her nose at her nutritious dinner because her tummy is full of the chips she had after school. Don't deprive her of the after-school snack--but these snacks have to be small if you expect your child to eat a full dinner, says Barton D. Schmitt, M.D., professor of pediatrics at the University of Colorado School of Medicine, director of consultative services at the Ambulatory Care Center at Children's Hospital of Denver and author of Your Child's Health.

When to See the Doctor

When a child is thin, it's often because he's quite active or just naturally slender.

But there are a few symptoms that should alert you that something may be wrong, says Barton D. Schmitt, M.D., professor of pediatrics at the University of Colorado School of Medicine, director of consultative services at the Ambulatory Care Center at Children's Hospital of Denver and author of Your Child's Health. Some illnesses, such as infestation with roundworms, can cause unnatural thinness. And preteens--girls especially--can develop a serious eating disorder called anorexia nervosa.

Call your child's physician if you notice that your child:

* Is losing weight.

* Has not gained any weight in six months.

* Has associated symptoms of illness, such as diarrhea or fever.

* Has lost weight suddenly.

* Gags on or vomits some foods.

* Has thinning hair.

* Develops fine, babylike hair on the body.

Limit the drinks, too. Many parents underestimate how filling juice and milk can be, says Dr. Van Meter. He recommends limiting juice to 6 ounces a day and milk to 16 ounces.

''The fats and sugars in these fluids can curb the appetite just enough to keep your child active and happy, but he won't be getting a balanced meal,'' he says. Soda is even worse, because it fills up the child without supplying any essential nutrients.

Consider mini-meals. Some busy, active children function better on small meals throughout the day, says Corinne Montandon, Dr.p.H., R.D., assistant professor of nutrition at Baylor College of Medicine and the Children's Nutrition Research Center, both in Houston. Toddlers, in particular, may need nutritious small meals about two to three hours apart. This doesn't mean that Mom has to prepare meals on demand, however. Keep a supply of healthy snack foods on hand. ''Give your child some cheese and fruit, or graham crackers and a small glass of milk,'' suggests Dr. Montandon. Then don't expect your child to eat a big meal at dinner.

plan ahead. ''Children who must wait too long between meals get so hungry that they get cranky,'' says Dr. Montandon, ''and cranky kids do not eat well.'' If you know that your child gets famished because you can't get dinner on the table before 7:00 p.M., furnish a nourishing mini-meal earlier, or cook dinner ahead of time so you can serve it earlier.

Involve your child. Decide together what you are going to serve, advises Dr. Montandon. Offer nutritious choices and then let your child pick. ''Children who are given the chance to make food decisions are more likely to eat what they choose,'' she says.

Let your child feed herself. When a child is pushing her food around the plate, it's tempting to pick up the spoon and try to tease her into eating, says Dr. Schmitt. Don't do it. ''Once your child is old enough to use a spoon by herself (usually 15 to 16 months of age), never again pick it up for her,'' he says. ''If your child is hungry, she will feed herself.''

Refrain from forcing. Just about the worst thing you can do is force your child to eat, agree experts. This will frustrate you, make your child resentful and create a power struggle that no one will win--and it won't solve the problem, says Dr. Schmitt. ''How much a child chooses to eat is governed by the appetite center in the brain,'' he explains. ''If you try to control how much your child eats, he will rebel. Trust the appetite center.''

Keep mealtimes pleasant. This is what you should concentrate on, rather than what your child does or doesn't eat, says Dr. Schmitt. ''Draw your children into the conversation, and don't make mealtimes a time for criticism or arguments,'' he advises.

Forget about forcing your child to stay at the table with his food after the rest of the family has left. ''This only develops unpleasant associations with mealtimes,'' says Dr. Schmitt.

Don't Worry--It's Normal

Suddenly it seems that your child is devouring an enormous amount of food at each meal, and you're worried that he's overeating.

But your child may simply be going through a growth spurt, explains Alvin N. Eden, M.D., associate clinical professor of pediatrics at the New York Hospital-Cornell Medical Center, chairman of the Department of pediatrics at Wyckoff Heights Medical Center, both in New York City, and author of positive parenting and Dr. Eden's Healthy Kids. While in a growth phase, children may consume large quantities of food to keep up with the calories being burned. Just be sure that your child is eating a variety of foods and isn't loading up mostly on sweets or fatty foods.

If you're concerned, check with your pediatrician. Your child's pediatrician plots your child's weight and height on a special chart. If the child's growth deviates markedly from his usual patterns, that will signal that something is wrong.

Otherwise, relax--and keep plenty of healthy foods on hand for your hungry, growing child.

Insist on politeness. Let your child know that he is expected to be at the table on time, sit with the family while they eat and refrain from making faces and rude comments about the food, suggests Dr. Eden.

Never nag--or praise. Keep eating as matter-of-fact as possible, says Dr. Schmitt. Don't fuss at your problem eater for not finishing her food or praise her when she does. You want your child to eat to satisfy her appetite, not to please you. And never discuss how much or how little your child eats when you're in her presence.

Don't cook on demand. Never get up and make special meals for a picky eater, says Dr. Eden. Serve a well-balanced meal and let your child eat what she wants from what you have served.

Eliminate ''gag'' foods. Some kids have a natural aversion to foods that they associate with being sick. If a child happened to become ill after a certain food, that food may turn his stomach. Rather than force him to eat those foods, parents should avoid serving them, advises Dr. Schmitt. ''Those foods should be put in a special category and simply eliminated from the menu,'' he says.

Avoid the dessert dilemma. This is a classic Catch22. If everyone digs into a rich gooey cake for dessert but the noneater isn't allowed any, you're reinforcing the idea that ''good'' food is a reward for eating ''bad'' food. If you do give cake to the problem eater, you're letting her fill up on empty calories, explains Dr. Van Meter.

Your best bet is to serve nutritious desserts that are considered part of the meal: fruit, gelatin with fruit or yogurt, he suggests.

Ease your mind with vitamins. If you're worried about your child's intake of certain nutrients, ask your pediatrician about giving your child a daily vitamin and mineral supplement, says Dr. Van Meter. The supplement may not be necessary, but it can put your mind at ease.

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