Is Food a “Burden” or “Enjoyment”?

By: Dr. Anjan Bhattacharya and Sangita Modak

There are so many food varieties around us. And parents always have this concern — how will I feed my child? Why does a child refuse to eat upon seeing food, avoid food placed in front, or eat selectively? It’s challenging to understand what's best for their health. How does it feel to have such concerns revolving around a child's eating habits? One of my colleagues asked me that is eating disorders fall under the Adolescent stage (11-20 years old) only. Or does this also apply to childhood? Can eating disorders exist in childhood, or is the fear of eating leading children to avoid it, disregarding the importance of nutrition? Today's report focuses on this information. Firstly, let's discuss about some faulty eating habits, scientifically known as Eating Disorder (ED).

The ways we offer or receive food vary significantly. Some eat quickly; others dislike being fed, while some avoid the final bite. These differences are categorized into six types of eating habits:

• Emotional Eaters - Those who eat in times of joy or sorrow.
• Unconscious Eaters - They eat without knowing what they're eating.
• Habitual Eaters - They eat out of habit, regardless of hunger.
• Critical Eaters - They scrutinize what and why others eat.
• Sensual Eaters - They savour food for the pleasure of taste.
• Energy Eaters - They calculate food intake based on energy or calorie content.

None of these habits are problematic unless they become disorders or deviate from normal behaviour. Apart from this, there are some other eating disorders called ED-NOS (Eating Disorder - Not Otherwise Specified) that can also exist.

Healthy eating habits for children imply teaching them to love five essential food groups from their school-going age:

• Fruits
• Vegetables
• Grains like rice or bread
• Dairy
• Proteins

Now the question arises, why do children sometimes refuse to eat? Reasons behind a child's reluctance to eat may include:

• Forced feeding
• Underlying health issues misunderstood by parents
• Fatigue
• Feeling full
• Preferences for other types of food
• Sensory issues"

Additionally, some peculiar forms of Eating Disorders (ED) are observed, such as excessive water drinking habits or Psychogenic Polydipsia. Symptoms similar to childhood diabetes might manifest, indicating a continuous habit of excessive water consumption from a young age. That is, even though it may not have biological or psychological causes or societal pressures appropriate treatment is still possible.

Another example is Pica — which has a tendency to eat non-food items like dirt or chalk. When Pica is observed, it's crucial to check if the child has an iron deficiency or anemia. If these aren’t the causes, it might indicate deeper psychological pathology.

Moreover, in cases where children are suffering from developmental issues, the prevalence of Eating Disorders - specifically ED-NOS - appears to be higher. ED-NOS are commonly seen with the following problems:

• Lack of interest in eating.
• Sitting with food in the child’s mouth.
• Preferring Junk food or outside food like pizza and fried items but refusing basic staples like rice or bread.
• Eating very small amounts.
• Consuming water excessively after every mouthful.

Accept that, Children who are affected by autism exhibit issues like:

• Eating only rice or a few specific items displays restrictive eating habits.
• Being very picky with food.
• Having difficulties with eating causes fussiness.
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Additionally, there are some hidden problems like:

1. Coughing whenever they start eating.
2. Difficulty in swallowing liquids (Liquid Dysphagia).
3. Consuming water with every bite.
4. Keeping food in the mouth without chewing.
5. Dental issues hinder eating, yet the child isn’t able to express or chew.

As Eating Disorders vary, so do their solutions. Many developmental factors can sometimes make children resistant to nourishment.

Therefore, behind a child's reluctance to eat might include various reasons that might seem trivial at first glance or might be heard from others. Some people say as the child grows these reasons might solidify (Social Validation).

But scientifically it is proven that the lack of a proper solution could lead to their exacerbation or the emergence of other problems that the child might suffer from.

For instance, let's discuss a situation where a child fears eating:

Almost every parent has one complaint - the child doesn’t want to eat. As a result, they believe there's no other option but to force-feed their child. However, forcing a child to eat in such a manner doesn't contribute to their nutrition.

Child specialists often say, “SAY NO TO FORCE-FEEDING”

From birth, a child initially drinks their mother's milk, and then from their Weaning periods, their food habits transition to Complementary feeding. However, the child's resistance to parental expectations regarding eating habits usually starts early. As a child eats an appropriate amount, parents often hope that they will continue to eat more as they grow. However, observing a child's Standard growth chart or Growth curve reveals that despite growing older, a child's belly might remain small if they eat correctly. Thus, their physical and mental development remains unimpeded.

However, when a child refuses to eat the amount of food is huge for them and their stomach but the last resort for parents is to forcefully feed them. However, by forcing a child to eat, you might not achieve the expected nutritional intake or the desired nutritional elements in their body. The problems that your child might face due to forced feeding include:

1. Developing an aversion to eating
2. Less interest in food
3. Refusing to consume food easily
4. Eating insufficient amounts
5. Gastrointestinal problems, constipation
6. Poor chewing habits
7. Picky eating behaviours

The text addresses the concerns parents may have regarding their children's eating habits and how misconceptions often lead parents to believe their child might not want to eat or might be mischievous when, in fact, there might be no underlying issue. The correct approach to feeding children ensures they eat properly when given food in the right manner, at least our 16 years of experience observe and secure that. The text also points out the potential dangers of excessive screen time when parents resort to using TVs or mobile phones to feed their children.

It emphasizes that forcing a child to eat can lead to increased stress around eating and may result in malnutrition-related issues like being Underweight or Overweight.  So if Parents really want a better healthy eating habit for their children seeking advice from experts and proper medical intervention is crucial to address these problems. However, it suggests that the first step in addressing the child's eating habits should begin with educating parents on feeding techniques. It highlights in our Child Development Centre at Apollo Multispecialty Hospital that starts with a Parent training program under the “Kolkata Development Model” to help parents understand the reasons behind a child's reluctance to eat and provide scientific methods to encourage healthy eating, as every treatment is based on Scientific Tools.

Apart from this, if your child has any physical problem, then it should be diagnosed by the right pediatrician and then proceed. To tell us how useful this parent training program is, we remember an incident of a sixteen-year-old girl with Down syndrome who had stopped eating for the last four to five days. The girl is the only child of her parents, and her father himself is a pediatrician! When she arrived at our center in his child’s dehydrated state, we had to be first admitted and given saline. Then slowly, on the fourth day of our Kolkata development model, the child took herself a biscuit and took a bite.

The significance of the Kolkata Development Model is that it is a Parent Training Based Model, where work is started with the training of parents at the beginning. As a result, the parents then underwent graded re-introduction training, and the girl completed the full dish by the end of the sixth day. She was released the next morning and her parents were asked to follow the Kolkata Development Model. After seven days, when they came to the regular follow-up, they were excited to share that not only was the girl eating well, but that the girl had started saying "water," "take," etc. from her mouth.

All the children who come to our Child Development Centre, no matter how much they had trouble eating before they arrived! The improvement is happening so fast. For example, a growth retarded child from a different province, who had Cornelia de Lange syndrome, began to eat rice, bread, and fruit within two weeks. Yet, the boy came with an eating disorder that lasted for eight years! Within the first two weeks, he learned to eat, and he never had a problem eating.

So ending with a take-home message that “Eating is not a burden, it is a pleasure that children should enjoy themselves. By burdening the child with his own needs, do not make the child afraid of eating”

The article is contributed by Dr. Anjan Bhattacharya (Developmental Paediatrician) Apollo Multispecialty Hospitals, Director, Nabajatak Child Development Centre and Sangita Modak (Developmental Child Nutritionist)