Eating Disorders

WHAT IS THE IMPORTANCE OF NUTRITION IN CHILDHOOD?

The most important factors influencing growth during childhood are nutrition, genetic background, and hormones. However, nutrition, especially in the first 2 years, has the greatest impact on growth. Dietary habits acquired in the early years not only influence the child’s growth but also reduce the risk of chronic diseases such as cardiovascular diseases, diabetes, and hypertension in adulthood. For us healthcare professionals, growth is a fundamental indicator of a baby’s health. Therefore, when babies with complaints of poor appetite are presented, it is essential to examine whether there is a growth pause or regression, and if so, investigate it. However, one of the most common mistakes is telling parents of a normally growing baby, “Your baby is normal, weight gain is perfectly fine, there is nothing to worry about regarding the poor appetite.” Even if there is no growth pause in the child, it should be kept in mind that micronutrient deficiencies or inappropriate feeding methods may be present, and the mother’s concerns should be taken into account by obtaining a detailed history.

HOW COMMON ARE NUTRITION PROBLEMS IN CHILDHOOD?

Nutrition problems in childhood occur with a frequency of 25-35%, and in 1-2%, they can be very severe. In other words, about one in every 3-4 mothers complains about her child’s poor appetite or eating problems.

WHEN DOES THIS PROBLEM ARISE? IS IT PRESENT FROM BIRTH, OR DOES IT DEVELOP LATER?

Genetic factors, hormones, the mother-child relationship, and the mother’s feeding attitude play a role in the development of eating behavior. Some children are selective from birth, while others become problematic eaters due to the wrong feeding model of the mother or caregiver.

Parental feeding models are divided into 4 groups:

1. Controlling: Insisting that the child eat more or consume a particular food, promising rewards like sweets, candy, or an iPad if they eat well.
2. Permissive: Preparing and offering the child’s favorite foods, preparing what the child wants when they want it, and letting them eat in the manner they prefer.
3. Neglectful: Allowing the child to eat whenever they want, eat whatever they want, not always keeping track of what they eat, and sometimes forgetting to provide meals.
4. Sensitive-responsible: Sitting with the child during meals, including the child in family meals, not allowing the child to consume junk food or snacks between meals, offering healthy foods and allowing the child to choose from them. No coercive or forceful attitudes during meals.

Among these feeding models, the sensitive-responsible model is the most suitable and preferred. The wrong feeding model can lead to eating problems in children.

ARE EATING DISORDERS SUBDIVIDED INTO SUBGROUPS?

Yes, I would like to talk about the 4 groups we frequently encounter:

1. Child evaluated as having a poor appetite: The parent believes that the child has a low appetite and does not eat enough, but in reality, the child’s growth rate and the amount and variety of food consumed are normal. The parents’ excessive concern can lead to forcing the child to eat more, insistence, and sometimes even the development of a fear of eating in the child. Unfortunately, in our society, especially among grandparents, there is a habit of overfeeding children, leading to a high prevalence of this patient group. Sometimes, due to coercion, these children also develop a fear of eating. It is essential to explain to the mother that the child’s growth is within expected values and transition to a “sensitive-responsible feeding model” should be made. Otherwise, the relationship between the mother and the child is disrupted, and bigger problems may arise in later years.

2. Child with poor appetite and active: A lively, active child who is more interested in playing, talking, and exploring the surroundings than eating. Their interest in food dissipates quickly, and they may not want to sit at the table. Weight gain may stop after 9-10 months. In this case, information is provided to the family about the child. A meal plan is designed to increase the child’s appetite. Meals are planned together with the family, without distracting elements, limited to 20-30 minutes. Absolutely no coercion or pressure should be applied to eat. Weight and height are monitored, and if necessary, nutritional support is provided.

3. Extremely selective eater: The child reacts to the smell, taste, appearance, or texture of certain foods, showing aversion. They do not want to try new foods. These children may also have sensory difficulties in areas other than eating: they may be bothered by loud noises or bright lights, unable to step on sand or grass barefoot, dislike dirty hands, and be uncomfortable with clothing tags. Forcing these children to eat the disliked food has the opposite effect. It is essential not to give the food that causes them to gag or vomit again. Hated foods should be presented in different ways and tried 10-15 times. In extremely selective eaters with micronutrient deficiencies, nutritional support and sometimes medication may be necessary.

4. Child afraid of eating: When they see a bottle, a bib, or a high chair, they start crying, throw themselves backward, lock their mouths, and may induce vomiting to avoid eating. This is observed after medical interventions such as the placement of a feeding tube or breathing tube or in situations where feeding is forced. In our society, it is frequently seen in children whose parents apply forceful feeding, forcibly open their mouths, or feed them lying down. This condition is more common in families applying a “controlling feeding model.” Transitioning to the appropriate sensitive-responsible feeding model is recommended. The child should be encouraged to eat independently, sitting, without coercion, and their own pace. This process requires some time and patience, but it is crucial for the mother-child relationship and future eating habits.

IS THERE TREATMENT FOR EATING DISORDERS? WHAT APPROACH DO YOU TAKE?

The treatment of eating disorders is possible. First and foremost, I take a very detailed history in these patients. I inquire about the mother’s nutrition, including before birth, the baby’s breastfeeding process, all aspects of nutrition, the transition to complementary foods, likes and dislikes, the amount consumed, the method of administration, allergy history, etc.

I administer a survey to determine which subgroup of eating disorders the child belongs to. I record each food the child eats individually and prepare a nutrition plan to supplement the missing food group. After performing a detailed physical examination and measuring the child’s previous and current height-weight values, I check for growth pauses or regressions. If there is a growth problem or if I suspect another underlying disease, I request the necessary tests. Based on all these results, I create a personalized treatment plan for the child. Everyone contributing to the child’s feeding action, including the mother, father, grandparents, caregivers, etc., must participate and comply with this plan. We schedule regular meetings to plan the next steps. In some cases, nutritional support, vitamin supplements, or medication may be necessary. In conclusion, there is always a solution for each patient group; we just need to work in collaboration with the family and give it some time.

FINALLY, DO YOU HAVE ANYTHING TO SAY TO FAMILIES?

I would like to talk about the “Basic Nutrition Principles”:

1. Avoid distractions (TV, computer, phone, etc.) during mealtime.

2. Feed in a way that increases appetite (every 3-4 hours, in a way that promotes hunger).
3. Limit mealtime to 20-30 minutes.
4. Provide age-appropriate food.
5. Tolerate age-appropriate messiness and dirtiness.
6. Encourage self-feeding from the beginning.
7. Adopt a natural attitude during mealtime, avoid pressure, and use a sensitive-responsible feeding model.
8. Systematically introduce new foods.

These principles are a must! My advice to all mothers is to adhere to these rules from the moment they start introducing complementary foods, but if they notice a problem with the baby, seek medical attention without delay. The concerns of mothers about their baby’s appetite and nutrition should always be taken seriously, and appropriate guidance and treatment should be provided. These problems do not diminish as time goes on; they grow, and their treatment becomes more challenging. I have a recommendation for “sleep disorders” and “eating disorders”: “The earlier, the easier.” Of course, the best is to avoid these problems altogether by transitioning to appropriate complementary foods and using appropriate feeding methods from the beginning. (Taken from an interview with a magazine.)