Article written by Katherine Megaw, Consultant Paediatric Dietician to Little Cooks Club
Infants or children with IA lack an appetite (“anorexia”) and do not want to be bothered with food, but would rather play. This is different from sensory food aversions (SFA), where children have a good appetite and will eat if given foods they like. IA is also different from anorexia nervosa, which causes individuals to have an intense fear of gaining weight and to purposely not eat. Children with IA don’t have a fear of eating.
They simply don’t like to eat and usually will eat only small amounts of food.
IA is the second most common feeding disorder seen by Children’s Feeding Disorders Program and it is not uncommon for patients to have a combination of IA and SFA. Those children refuse to eat certain foods and only eat small amounts of foods even when given foods they like.
SIGNS OF INFANTILE ANOREXIA
Although some babies show signs of IA, children usually begin showing signs between 9 and 18 months of age. During this time, a child’s world expands, as he or she begins walking, talking and transitioning to spoon- and self-feeding. Overall, children with IA have problems gaining weight and growing. They show a higher level of mental, physical and emotional arousal than other children their age and have problems shifting into a lower gear to do things with a lower level of arousal, such as eating, sleeping and relaxing.
FEEDING TIME
At feeding time, children with IA may:
- Show hardly any signs of hunger.
- Often refuse to eat any more after only eating a few bites. The few bites they do take seem just enough to take the edge off any hunger they may experience.
- Throw feeding utensils/food and frequently try to climb out of the high chair or leave the table to play.
- Be more interested in their surroundings and would rather play and interact with their caregivers than eat.
- Not want to go in their high chairs because it’s boring. In addition, even as babies, children with IA are easily distracted during feedings. For example, a baby with IA would not be able to eat in a shopping mall, or similar noisy environment.
BEHAVIOR
Typically, children with IA:
- Have a big appetite for life –they love talking, playing, etc.
- Are very bright, perceptive and curious.
- Have average or higher than average cognitive development.
- Have problems calming down at bed time and falling asleep.
- Are active, but focused, and engaged. Sometimes, the symptoms of IA can be confused with attention deficit hyperactivity disorder. The difference is that children with IA are focused on their activities.
Children with infantile anorexia would rather play than be bothered with food.
EFFECTS OF IA
If older children continue to eat small amounts, their height may be stunted. For example, a 9-year-old might be mistaken for a kindergartner. In some cases, this short stature may affect a child’s ability to play sports because he or she is too small to play with peers and coaches fear the child will be hurt. The good news is that if children begin eating adequately before the end of puberty, they can catch up in their height.
In general, IA does not affect a child’s cognitive development. Whatever little the child does eat seems to go straight to the brain/head and whatever nutrients are left over go to the rest of the body. This results in a child having a normal head on a small body.
When a child has IA, it often creates stress for the entire family. Parents worry about their child’s poor food intake and failure to grow and they try everything from distracting, bargaining and coaxing, to threatening to get a child to eat more. The conflict surrounding feeding can carry over to the rest of the interactions between the child and parents. This conflict can affect a child’s development and can bring down a child’s IQ.
WHEN TO ASK FOR HELP
Parents should consult their pediatrician if their child refuses to eat and grow properly. A pediatrician may refer a parent to a specialist if his or her child is not gaining weight and growing appropriately.
AVAILABLE TREATMENT
Children with IA need to experience both hunger and fullness. They need specific feeding guidelines so they can learn to eat until feeling full instead of eating a few bites and becoming distracted. The Feeding Disorders Program includes teaching parents to structure mealtime and to use self-calming time outs. Most of what the program teaches parents and children can be described as common sense; however, it is hard for parents and children to implement these techniques without guidance. Generally, treatment for IA is not time-consuming, but it does require real interaction between the parents and therapist. Typically, the program includes several sessions, for a total of six to 10 hours.
TIPS FOR PARENTS
- Don’t blame yourself. When a child does not eat, it is common to become worried, anxious and upset and to blame yourself because it goes to the core of parenthood. However, IA has not been shown to be a result of poor parenting. In fact, doctors have reasons to believe that IA has a genetic predisposition. For example, the Feeding Disorders Program has seen 10 pairs of twins. In the nine pairs of fraternal twins, only one twin had IA. In the one pair of identical twins, both had IA. If IA was caused by parenting, both fraternal twins would have the disorder.
- Don’t pressure your child or invent new ways to get your child to eat. Because parentsare often worried about theirchildren’s poor growth, they feelthey need to coax, distract,threaten, and entertain. Sometimes they force their children to eat. These methods may work initially, however, they are not long-term solutions. In fact, the more these behaviors go on during mealtime, the more the children become completely unaware ofhunger and their food intake becomes externally regulated by their parents. Kids also become bored with the distraction technique, and parents have to come up with moreand more creative ways to distract them.
- Don’t let your child have control. Toddlers are veryperceptive and realize theyhave enormous control becausetheir parents will do anythingto get them to eat. It is notuncommon for them to makeunreasonable requests, suchas asking for macaroni andcheese at 2 am, just because they want to test their parents. It is not healthy to have a 2 year-old “executive” in your home.
If you suspect your child has infantile anorexia, consult your child’s pediatrician
