Eating Disorders in Children
Eating Disorders in Children
Asst. Assoc. Dr. Basak AYIK
Healthy eating ensures the establishment of a relationship between the baby and the parent, in which verbal and non-verbal signs are taken and interpreted. This process of mutual relationship forms the basis of emotional attachment between the baby and his parents.
After the 6th month, the motor and cognitive development of the baby allows him to behave more independently physically and emotionally. As the baby takes the spoon and starts to eat on his own, the 'struggle for independence-dependence' begins between the baby and the parent. In other words, at each meal, there is a conflict that arises about who will take the spoon from the baby's mouth. In these cases, meal times become 'battlefields' rather than an environment where the baby and the parent communicate.
The development of nutrition
• It is a process in which the child and parent have active participation.
• The parent determines which food "where" and "when" to recommend to the child and "how much" to eat.
• As the child grows up and matures, this task distribution becomes more complicated.
According to nutritional skills and food types, the child goes through some stages from birth;
• First 6 months: Breast milk is the main food source. No additional nutrients are recommended, including water. In some special cases, food may be preferred, but the general diet is liquid foods.
• 6-8 months: This is the period when the juices and semi-solids in the form of mash are added to the baby's meals. This transition may be in the 4th year in babies who cannot take breast milk or if they are fed more mixed (breast milk + formula milk).
• 8-10 months: Soft and lumpy food is used. During the transition to different tastes, there are fewer problems in the first 6 months compared to babies who use baby bottles.
• After 12th month: From bottle to spoon and self-feeding. The child can eat the same food and the same food as family members. Food preferences begin to appear. Therefore, it is the period when nutritional problems occur most frequently.
Why is breast milk important?
• Breastfeeding gives more control to the baby and less control to the mother in terms of duration and quantity. The opposite is the case for those who feed with a bottle. It is stated that babies, who have their own control over their feeding, do not have difficulty in transition to the spoon.
• The taste and smell of breast milk vary according to the content of the foods that the mother eats. Knowing the flavors and smells of various foods early through breast milk, the baby passes to foods of different taste and smell more easily thanks to their previous experience. In newborns who started supplementary food 6 months ago, the fear of new food and limited food consumption was 2.5 times higher than those who took breast milk; The findings determined in the studies that the transition to breastfeeding and supplementary foods after 6 months reduced the choice of food in childhood.
How often do nutritional problems occur in infants and young children?
• The frequency of feeding problems in infants and children with normal development is 25 - 35%; this rate can increase to 33-80% in those with developmental retardation.
• Serious problems such as eating rejection and vomiting occur in 1-2% of babies.
What are normal and abnormal nutritional behaviors and developmental characteristics?
In the normal feeding process, a decrease in appetite is observed after 1 year of age. Again in this period, irregularity in the number of nutrients during the day is normal. And after the 6th month, especially after the age of 1, a reduction in weighing is expected. In the presence of all this, families can be concerned about the nutrition of the child. Therefore, growth curves are used for nutritional evaluation. A child's growth curve is prepared by looking at the growth curves formed as a result of the evaluations of children who develop normally for a certain age and gender. If the child goes on the same curve during the development process, this is also considered normal.
Nutritional problems usually seen in infancy and small childhood; refusal to eat (eating less / not eating at all), choosing food (only a few kinds of food), lack of expected improvement in nutritional consistency (not switching to semi-solid / solid foods), lack of self-feeding, frequent vomiting, inappropriate behavior during meal times (irritability, crying, anger bursts) can be summarized as problems with swallowing or chewing.
In the researches, data have been obtained that girls have more frequent eating problems, children with eating problems have more siblings, they can focus less on their attention, children with eating problems have a higher proportion of working mothers, and there is a history of eating problems in these families.
What are the most common causes of nutritional disorders in infants and children?
• Reflection of problems in the mother-baby relationship; in the presence of serious psychiatric illness or eating disorder in the mother after the death of the mother
• Posttraumatic nutritional disorder: it develops after a traumatic event (such as a surgical procedure or food leak into the respiratory tract) affecting the mouth, pharynx, or esophagus. Fear is typical during feeding. In particular, fear of swallowing and choking can be observed.
• Sensory rejection due to eating: It is against foods with a certain taste, smell, appearance, or consistency. Rejecting attitudes and food selection behaviors are also common in these children.
• Nutritional disorder associated with accompanying medical condition (such as reflux, heart or lung diseases)
• Organic growth retardation: growth retardation caused by direct effects of hormones affecting growth or genetic reasons
It is the persistence of eating non-edible substances. This behavior, which occurs in 12-24 months in normal development, causes various medical problems. It can cause intestinal obstruction most frequently due to malnutrition, anemia, diarrhea, constipation, infection, iron and zinc deficiency, lead poisoning, bezoar. It was found 5 times more in individuals with mental retardation in institutional care than in general society. Male gender, young age, mental retardation, autism, and schizophrenia have been identified as possible risk factors. The severity of the disease is directly proportional to the severity of mental retardation. There are studies that found a strong relationship between PIKA in childhood and bulimia nervosa in adulthood.
It is the repetitive and voluntary introduction of stomach contents and chewing again. It is more common in boys than in girls. It is rarely seen in normal developers between the ages of 3 and 12. Those with mental retardation can be of any age. It can be seen with other eating disorders in adults without mental retardation. It may occur in the presence of inappropriate psychosocial environment or in the first years of life in cases of inadequate, limitedness, lack of stimulus and neglect in child-mother relations. It can also be done because of self-calming, pleasure, and attracting the mother's attention. It is thought that rumination stimulates the endogenous opiate system and provides relief in this way. In this respect, it is similar to stereotypical movements. There is a high association with reflux disease. It has a more chronic course in older children and adults. The main medical problems caused are; malnutrition, mouth sores, dental caries, esophagitis, aspiration, electrolyte loss, dehydration, weight loss and death. Mortality rates were reported as 25%.
(In the preparation of this article, The book was used “Biopsychosocial Approach in Child Diseases, Tuzun D., HergünerS. “.)