What to do when your child is too sick to eat

When your child is sick, he is usually less enthusiastic about eating. You know it is important your child continues to eat, so you offer small meals, cajole and persuade him to take a bite, and even tempt him with his favourite foods.

But what happens when your child simply will not eat, despite your best efforts? Paediatricians warn that there is a possibility that the child's persistent refusal to eat is a sign of a more serious problem, one that requires intervention and careful management.

Children with transient illnesses such as fever or cold generally show poor appetite that will improve as the child gets better. However, there are certain medical conditions that, if left unchecked without proper medical treatment, will severely affect the child's appetite.

Hand, foot and mouth disease, for instance, can cause blisters to form on the child's tongue and in his mouth. These blisters can pop and form painful ulcers, making eating an excruciating experience for the child.

Neurodevelopmental disorders and heart diseases are other examples of medical conditions that can give rise to persistent feeding difficulties.

Consultant paediatrician Dr Woon Teck Kim explains that feeding difficulties due to an organic disease can cause inadequate food intake, failure to gain weight or even weight loss. The child's recovery will be affected, and in severe cases, his health may further deteriorate.

Treating a child with this feeding difficulty requires the paediatrician to first identify the medical condition that is the cause of the problem. Usually, the child will recover his appetite once the medical condition is cured.

In situations where longer periods of treatment are needed, the paediatrician may prescribe alternative feeding methods, such as via a syringe. A balanced and complete liquid nutritional supplement may also be useful.

Tears for fears

Sometimes, the child becomes terrified of eating after recovering from a medical condition. They show signs of fear, such as crying or trembling, at the sight of certain foods or even eating utensils.

Dr Chai Pei Fan, a consultant paediatric gastroenterologist, explains that there are many possible triggers that can cause a child to link food intake to a bad experience.

"For example, a child may be unwell due to common illnesses, such as fever or some respiratory illnesses. He has reduced appetite as a result.

"Some anxious parents may attempt to force-feed the child into eating more, causing the child to feel stressed and anxious. The child, as a result, may develop a fear of feeding," he says.

Fear of feeding can also develop in children with a medical condition that requires them to be tube fed. Transitioning to solid food can be a stressful and even traumatic experience for them. For instance, many usually choke while trying to chew, and a particularly traumatic choking experience can cause a fear of feeding to develop.

Many parents have a hard time understanding the child's fears. Driven by desperation, they may force the child to eat, a move that only worsens the condition.

Treatment for fear of feeding varies depending on the complexity of the problem, but it often involves helping the parents adopt the right approach in encouraging the child to eat while desensitising the child's fears.

Paediatricians can help

In the past, diagnosing these feeding difficulties was akin to searching for a needle in a haystack.

Fortunately, the situation is changing. According to consultant paediatric gastroenterologist and hepatologist Professor Lee Way Seah, recent medical developments like the Identification and Management of Feeding Difficulties (IMFeDTM) toolkit allow paediatricians to conduct thorough investigations on the child's medical background and feeding history.

This makes the diagnosis process more accurate and less time-consuming.

Therefore, parents should not hesitate to consult a paediatrician if they have persistent problems in feeding their children.

The toolkit is created to provide a systematic diagnostic framework for paediatricians to identify and manage children with feeding difficulties.

It is the first of its kind, and developed by a multidisciplinary team of experts under an educational grant from Abbott Nutrition.