![]() Accurate measurements of weight and height and a comparison with previous measurements, and a determination of weight for height or body mass index, should be made. Some medications can also cause loss of appetite.Ī thorough physical examination is essential to look for signs of poor nutrition and to rule out an underlying condition causing the decrease in appetite. A complete functional enquiry is important to rule out the possibility of the many acute or chronic illnesses that are associated with anorexia. When a decrease in appetite is a manifestation of an organic disease, it often appears abruptly and relates to all types of food. If specific foods are eaten well on one day and refused the next, the problem is often one of unrealistic expectations ( 4). Typical portion sizes, the time taken to finish a typical meal and the mealtime atmosphere should be noted. A detailed three- to seven-day dietary history can help to estimate the child’s caloric intake. Taking a detailed history is necessary for determining whether the refusal to eat results from a physiological decrease in appetite or from an organic cause. Insistence on mealtime behaviours and table manners that are inappropriate for the child’s age may also interfere with the child’s eating ( 3). Guidance and tolerance have a positive effect, while distraction and quarrelling are negative ( 15). Mealtime atmosphere is important to the eating behaviour of a child. Family and peer group modelling are effective not only in encouraging reluctant children to eat, but are also a potent resource for increasing the range of accepted foods ( 14). If a family member or another child refuses a specific food, the toddler may imitate this behaviour ( 4). The family and a child’s peers are role models for the development of food preferences and eating habits. Verbal praise or a loving look are considered positive in developing food likes ( 4, 13). Strategies such as threats, prodding, scolding, punishment, pleading, bribing, or coercing will reduce rather than increase the intake of food ( 8, 13). Refusal to eat may also result from inappropriate feeding techniques. ![]() There is evidence of an inverse relationship between a family’s dysfunctional environment and children’s dietary intake ( 12). This behaviour may also be an indicator of difficulty in the parent-child relationship ( 7). In some children, food refusal may be an attention-seeking device ( 4). ‘Grazing’ between planned meals and snacks can also interfere with a child’s appetite. Despite the initially negative reactions to new foods, they do learn to accept them with time and repeated, neutral exposures ( 7, 9).Įxcessive intake of beverages (eg, milk, fruit juice) or sweets can reduce a child’s appetite for food, displace more calorie- and nutrient-dense foods and, in some children, may lead to failure to thrive ( 10, 11). Young children tend to be neophobic – they do not like new foods ( 8) – and are often perceived as picky eaters by their parents. If pressured or forced to eat, children’s need for autonomy may lead them to resist eating ( 7). Parents who believe that their child is abnormally small or nutritionally at risk are more likely to overreact to variations in the child’s appetite ( 7).Īs toddlers struggle to develop a sense of autonomy, they prefer self-feeding and become selective in their choice of foods ( 8). Healthy children have a remarkable capacity to maintain their energy balance over time when offered an assortment of nutritious foods ( 6). Although toddlers and preschoolers vary considerably in their intakes at meals during the day, their total daily energy intake remains fairly constant ( 6). ![]() Children’s appetites tend to be erratic during these years. Caregivers may pressure children to eat without appreciating the physiological decrease in appetite that occurs between one and five years of age ( 4). Parental efforts to make small eaters eat more may have the opposite effect. ![]() Children with smaller builds may have lower food requirements ( 4). It is not unusual to find that a child’s weight and height are within the normal range (third to 97th percentile) or even above the mean, while parental growth expectations are excessive. Some parents mistake the average weight (the 50th percentile) for normal weight. During this period, most toddlers and preschoolers experience a decrease in their appetite ( 4). Most children gain 1 kg to 2 kg and 6 cm to 8 cm per year ( 5). Between two and five years of age, weight gain slows down. During the second year of life, growth is about 2.3 kg and 12 cm, with most toddlers reaching an average weight of 12.3 kg and a height of 87 cm at two years of age ( 5). During the first year of life, an average infant gains 7 kg in weight and 21 cm in length.
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