Eating Behavior in Children

Variations in eating behavior in children range from age-appropriate variability in appetite to serious or even life-threatening eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating. Disordered eating can also result in overeating and obesity (see also Obesity in Adolescents) (1).

Parents of young children are often concerned that a child is not eating enough or eating too much, eating the wrong foods, refusing to eat certain foods (see also Avoidant/Restrictive Food Intake Disorder [ARFID]), or engaging in inappropriate mealtime behavior (eg, sneaking food to a pet, throwing or intentionally dropping food) (2).

Assessment should include a detailed history of problem frequency, duration, and intensity. Growth should evaluated based on height or length and weight, which are measured and plotted on appropriate charts (see growth charts from the World Health Organization [birth until age 2 years] and growth charts from the Centers for Disease Control and Prevention [after age 2 years]). Often, when parents are shown charts that show the child is growing at a normal rate, their concerns about eating diminish.

Children should be evaluated for eating disorders if:

• They voice persistent concerns about their appearance or weight.

• Their weight decreases or plateaus at an age when growth and weight gain are expected.

• Their weight begins to increase at a noticeably faster rate than their previous growth rate.

Persistent concerns about appearance should raise suspicion of body dysmorphic disorder.

Most eating behavior problems do not persist long enough to interfere with growth and development. If children appear well and growth is progressing consistently within an acceptable range, parents should be reassured and encouraged to minimize conflict and coercion related to eating. Prolonged and excessive parental concern may in fact contribute to subsequent eating disorders.

If parents are concerned that children are not eating particular foods or are not eating enough, attempts to force-feed are unlikely to increase intake; children may develop negative emotional reactions to foods or may hold food in their mouth or spit it out or may even vomit. Parents should offer meals while sitting at a table with the family without distractions, such as television, digital devices, or pets, and avoid associating food with excessive positive or negative emotions. Food should be removed in 20 to 30 minutes without comment about what is or is not eaten. Children should participate in cleaning up any food that is thrown or intentionally dropped on the floor. These techniques, along with restricting between-meal eating to one morning and one afternoon snack, usually restore the relationship between appetite, the amount eaten, and children’s nutritional needs.

(See also Overview of Behavioral Problems in Children.)