My son is 6 and never eats. We set timers — he will take an hour to eat a slice of pizza. He lies about being done and hides food around the room. He does not get rewarded like my other two awesome eaters and it just does not phase him. What do I do? My husband thinks we should keep on top of it and not cave with punishments. I think he wants the attention and ignore it (somewhat).

For children who appear to have little appetite, but are otherwise not particularly picky eaters, it is important to set a routine for meal and snack times that includes sit down meals with the family all eating together. Meals, including snacks, should be spaced 3-4 hours apart with only water in between. This helps the child develop their hunger and fullness cues. Eating meals together with the family allows the child to experience appropriate eating by observing their parents. The parents decide the when, where and what that the child eats. The child decides how much he or she will eat.

While it can be reasonable to ask the child if they are “full full” (i.e. really full, not just a little full) when they state that they are done eating, it is not helpful to force them to eat more if they say they are full. By not allowing snacking other than at designated meal or snack times, the child will learn to eat until he or she is really full at mealtime.

Some children do have a naturally lower appetite than others. However, unless the child is falling off his/her growth curves, it is unlikely that their lowered appetite is causing physical harm. Physical concerns should be discussed with one’s physician. However, the behavior at and around mealtimes may be disruptive enough to require intervention, even when not causing physical concerns. In this case, following the above recommendations can also be effective. If a child is particularly talkative during mealtimes, talking rather than eating, it may also be appropriate to keep mealtimes for adults to talk and reserve special time after the meals to talk with the child.

ABOUT THE AUTHOR

Rebecca BegtrupRebecca Begtrup, D.O., M.P.H., is an attending psychiatrist on the outpatient psychiatry team at Children’s National and co-founded the Behavioral Health Feeding and Eating Disorders Program.

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