He wails at the sight of a bottle, screams when a spoon comes in his direction and spits everything out when you attempt to force-feed him. You have pleaded, cajoled, reasoned, yelled and made threats you know you will never carry out, but your child still refuses to eat. Every mealtime is a battle between you and your child, and you feel like you are often on the losing end. Your child is not eating. What do you do?
The obvious option for many parents is to seek advice from a paediatrician. But despite specialising in the care of children, many paediatricians are not sufficiently equipped to deal with feeding difficulties, according to a US-based paediatric gastroenterologist.
“One of the reasons is the kind of training we receive. Paediatricians learn about the most difficult, sophisticated or aberrant cases, but these constitute a very small proportion of the children that have to be fed. There are no lectures in medical school on how to feed a child, so there’s a window to fill; a gap in our education that we need to address,” says Dr Benny Kerzner, professor of paediatrics at George Washington University and chair emeritus at the department of gastroenterology and nutrition at the Children’s National Medical Centre in Washington DC. He has chaired the Greater Washington Feeding Disorders Programme for 25 years.
Although there are studies that suggest that up to 80% of parents report having feeding difficulties with their children, it remains an issue that is often overlooked, ill-understood and consequently under-diagnosed, neglected or poorly managed by parents as well as doctors.
There is a wide variety of feeding difficulties and causes to consider in figuring out why the child is not eating as the parent thinks he should. Is it simply a phase that the child will outgrow in due time? Is he averse to specific tastes and textures? Is there an underlying condition that makes eating an unpleasant activity for him? Or is he just being grumpy? How far should the parent go in making the child eat?
There is no systematic approach to tackling the problem, and an absence of a framework to identify and manage feeding difficulties in children does not tip the scales in favour of any sort of resolution. The knowledge that prolonged feeding difficulties can lead to serious consequences – be it physical, emotional, psychological – adds to the urgency of early diagnosis and intervention.
“These difficulties can affect our children’s dietary intake, growth, cognitive development and the parent-child feeding relationship. Any of these can pose serious risks. Therefore, feeding difficulties need to be diagnosed and managed early and effectively,” says Prof Dr Lee Way Seah, head of the department of paediatrics, faculty of medicine at Universiti Malaya and representative of the Malaysian Paediatric Association (MPA).
With this in mind, MPA and nutritional products manufacturer Abbott Nutrition International have joined forces to promote and implement IMFeD, which stands for Identification and Management of Feeding Difficulties, an innovative system that classifies feeding difficulties according to key factors such as genetics, appetite, psychological issues and medical conditions. Based on a classification system introduced by child psychiatrist Dr Irene Chatoor, professor of psychiatry and paediatrics at George Washington University and director of the Infant and Toddler Mental Health Programme at the Children’s National Medical Centre in Washington DC, IMFeD is designed to help paediatricians identify and assess feeding difficulties and suggest the best course of action.
Prof Dr Kerzner teamed up with Prof Dr Chatoor to pursue the idea of developing a diagnostic toolkit. Now six years later, the result is a toolkit that features a questionnaire to gather data on the child’s feeding patterns, an interactive diagnostic tool that enables paediatricians to match conditions with the types of feeding difficulties, and guidelines on managing each type of feeding difficulty.
It also comes with educational materials for parents who are helping to manage their children’s feeding difficulties at home.
“The paediatrician needs to be able to distinguish between the variety of conditions that is brought to him or her, and tailor treatment to fit the severity of the condition,” says Prof Dr Kerzner at the launch of IMFeD in Kuala Lumpur late last month.
He adds that feeding difficulties range from those that can be fixed simply with some emotional support to those where dramatic intervention is required.
Limited time offer:
Just RM5 per month.
