Lack of Appetite

Question

My six-year-old grandson was diagnosed with CF shortly after birth. Today he coughs more than other children and expectorates mucus. Otherwise he is an adroit and intelligent boy who runs, plays football, climbs trees and skis – all this thanks to Creon, massages, inhalation and nutritional drinks. His problem lies in the fact that he never feels hungry.

When left to his own devices, he doesn´t have breakfast, snacks or lunch. He only reluctantly eats a small piece of bread for dinner. This is impossible, of course. His parents force him to eat and they punish him when he doesn´t want to – they forbid him to watch TV, play PC games or ski... When that doesn´t help, he gets shouted at and even beaten. I don´t think it possible to punish a child for its disease.

Is there anything we can do to help the boy to develop an appetite?

Answer

Hello,

Thank you for your question. It is difficult to give any advice in this case, since we don´t know your grandson. We don´t know what symptoms led to his diagnosis – if he suffered from so-called meconium ileus, underwent surgery and if his intestine is too short. We don´t have any information as to how much your grandson weighs at the moment, how much Creon he takes or if he really needs to use nutritional drinks. We don't know what other medication he takes or if he takes any probiotics, what condition his liver is in, and so on. Your grandson's doctor has all this information and you or your grandson's parents should consult him in the first place.

Children with CF almost frequently have problems with food. They don´t feel hunger, which is an important impulse to eat, since their parents consistently make sure that they eat all the time.

This problem can be easily rationalised with a six-year-old – you can explain to him why food is important and that his body can´t function properly without it (Here a comparison to a car is quite useful – you can stress that a car won´t start if it doesn´t have any fuel in the tank). You can talk to him about digestion and its phases, draw pictures of the process, use various available models of human body etc. Your grandson should also take part in grocery shopping and he should be allowed to choose the food that he likes. He should also take part in food preparation and learn to prepare a simple meal. When he goes through a non-eating phase, he should be given only meals that he likes and will always eat. This should be done even if it means for a while that his diet will not be varied. Prohibition is generally not a good way to stimulate desirable eating habits. Rewards for compliance and positive motivation have a far better impact. It is a good idea to make notes about your grandson's eating and about all success that you achieve in this respect. However, this is more effective under the supervision of a specialist – a psychologist or a psychotherapist – who, in cooperation with the family, continuously maps the situation and provides guidance.
Dr. J. Brázová

16.11.2011