The Hindu : Tamil Nadu / Chennai News : Children with feeding difficulties need help

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Friday, Mar 18, 2011
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Tamil Nadu

Tamil Nadu - Chennai

Children with feeding difficulties need help

Ramya Kannan

CHENNAI: Is your child not eating well? Are you worn out trying to feed your child every meal? Well, at least, you are in a majority. Studies show that as many as 80 per cent of parents report feeding difficulties with their children.

This is what got Glenn Berall, Chief of Paediatrics, North York General Hospital Toronto, Canada, working on actual classifications of feeding difficulties. “Worldwide, parents are worried that their kids do not eat, they are too picky, fussy or selective and may not be getting the proper nutrition to grow and develop. Until now, we have not had a systematic approach to identifying and managing children with these issues,” he said. “It is a challenge to address the issue, because it is not normally taught to the paediatrician during training. Only about 50 per cent of mothers feel that their child's paediatrician has helped them with regard feeding problems, studies have shown,” Dr. Berall explained. Broadly, his classifications are as follows: poor appetite due to an underlying disease; poor appetite as perceived by parents (leads to over-feeding and force feeding); poor appetite in a child who is fundamentally vigorous; and in a child who is apathetic and withdrawn. There are also children who eat selectively, colic in kids interferes with the feeding and children with a fear of feeding. Feeding difficulties can affect the caloric and nutrient intake, leading to possible long-term physical, psychological and cognitive development of the child.

The cumulative findings of clinical practices of Benny Kerzner, chairman, department of Gastroenterology and Nutrition, Children's National Medical Center, Washington, which were published earlier had arrived at the same classifications.

They were then used to evolve a tool for diagnosis with the support of Abbott (the company makes nutritional supplements, including for children). The Identification and Management of Feeding Difficulties (IMFeD) tool is an easy to administer questionnaire for patients which will help test if the child is getting an adequate dietary balance and see if feeding difficulties exist.

“This is only a framework that aids diagnosis. It is the paediatrician who makes the diagnosis. It helps the paediatrician save precious time, as practices tend to be crowded,” Dr. Berall said.

The effectiveness of the tool is being tested in 14 different sites (paediatricians) across the country. The study was launched on February 28, and preliminary results indicate that majority of children in India fall under the ‘lack of appetite in a vigorous child' category (61.53 per cent); followed by parent's misperception (30.70 per cent) and selective eating category (7.69 per cent).

Mukesh Sanklecha, Mumbai-based paediatrician who is spearheading the study, says intervention is most likely in the form of behavioural therapy for the parents and children, with regular follow ups at clinic. “So far, we handle it by giving drugs which are supposed to increase appetite. This may not necessarily be the right thing. For instance, in the largest category of children, the tactic would be to suggest a strict feeding regimen, cutting out any snacking/tid-bits in between meals.

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