In this article, DietDoc takes a look at the problems associated with feeding toddlers who lose their appetite, children who refuse to eat and kids that have to ‘catch-up’ after being ill.
Catch-up growth
Any factor that has either increased a toddler’s nutrition needs or prevented her from eating adequately, such as premature birth, illness, operations, hospitalisation, trauma (physical and emotional), malnutrition, or an inadequate diet, may retard her normal growth.
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Originally nutritionists believed that infants and toddlers who did not immediately experience catch-up growth would suffer from permanent growth retardation. More recent studies have, however, shown that even severely malnourished children in developing countries exposed to famine, and toddlers with chronic illnesses that hamper food intake, like coeliac disease or cystic fibrosis, can recover completely provided they either receive adequate nutrition or are treated appropriately so that they become capable of absorbing all the nutrients they require from their food.
Previously deprived children who have adequate diets are capable of growing at a very rapid pace. They may gain three times more weight in a specific period than children who have not been deprived. Their nutrient needs are also much greater than the needs of children who have not been malnourished.
During catch-up growth the child’s protein and energy needs are usually greatly increased, for example the requirement for energy may double and there may be a four-fold increase in protein requirements.
Milk formulas are generally used as the basic, highly nutritious food for catch-up growth, together with foods appropriate for the child’s developmental stage, e.g. porridges, and cooked, pureed meat, vegetables and fruit.
An important factor that has to be kept in mind when treating malnourished children, is that they need to have small meals frequently to enable them to absorb all the nutrients they require despite their small stomach capacity. It may also be necessary to use nutritional powder supplements to increase the amount of fats and oils the child ingests, to add glucose polymers to the diet, or to use so-called medium-chain triglycerides (a type of fat) to boost energy intake.
Feeding a child during catch-up growth can be difficult. It is essential that parents get the necessary support from a team consisting of a paediatrician and a dietician to help them calculate what food to use and what food quantities are necessary. It is also crucial that the child’s growth and progress are continually assessed - don’t try to do it alone, get professional help. In the long run, your child will benefit.
Loss of appetite
Toddlers are notorious for not wanting to eat and giving their parents endless headaches by suddenly refusing their favourite food or demanding only one type of food all the time.
Let’s first consider loss of appetite. It's important to remember that toddlers have very small stomachs and, unlike adults, they are physically unable to eat large quantities of food as main meals. Refusal to eat what adults may regard as a ‘normal portion’ may just be that the portions are too big and that the meals are spaced too far apart for a small child.
“But eating between meals is bad for you,” and “We were always told to clean our plates when we were children,” you might be saying. These diet injunctions, which we all had drummed into us in our youth, do not apply to toddlers. The important thing to remember is that toddlers need to eat many small nutritious meals a day, not sweets or cold drinks or fatty snacks (read the two articles on ‘Healthy snack and lunch box ideas') and that they should be taught at a very early age to rinse their teeth after eating (read the article on ‘Diet and healthy teeth’).
The old adage that children should clean their plates is also counterproductive. Meals should be happy, pleasant occasions, not battles. If you give a child toddler-sized portions, then the child will be able to eat all the food that is put on his plate.
Illness
Loss of appetite can also be caused by illness or emotional upsets. Don’t force a sick child to eat when he is running a temperature, is in pain or listless. Just make sure that he is well hydrated by giving him as much liquid as he will take - water, rooibos tea, diluted fruit juice and milk. You can make fresh smoothies by liquidising fresh fruit and milk or flavoured yoghurt (add enough milk to make it easy to swallow), but once again, keep the portions small.
Emotional problems
An emotionally upset toddler will generally not eat. So always explore reasons such as fear or anger when your child refuses to eat. In serious cases you might have to get help from a child psychologist to pinpoint the factors at play.
Most parents will know that there is something wrong with their child’s emotional well-being or the psychological makeup of the family, but you need to take proactive steps to solve the problem and get the child to feel safe and happy again. Don’t take the ostrich approach “If I ignore the situation, it will go away.” You need to do something, even if resolving family conflict may be unpleasant initially, the end result will be worth it. – (Dr I.V. van Heerden, DietDoc)
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