Anorexia and bulimia in teens, especially girls, have received much publicity in
recent years, however, few people know feeding problems can affect young
children and even infants. While the media can induce overeating and the
consumption of junk food in youngsters, the main eating problems in this age
group are due to genetics, congenital disorders and psychological and other
A recent all-day seminar on feeding challenges and eating
behaviors of babies and children, organized by the eating disorders center of
Hadassah University Medical Center on Jerusalem’s Mount Scopus, discussed the
Although it was very professional, the selection of refreshments
for the mid-morning break and the stand-up lunch in the Schacht Auditorium lobby
Packets of Materna baby formula were handed out, and the
Osem food company, which sponsored the meeting, supplied sweet cakes, yogurts
and soft drinks, gum drops, white pita bread, and powdered instant soup mixes
(albeit with fresh baby carrots and bottles of water). They were hardly examples
of healthy foods.
The 150-or-so participants were greeted by the medical
center’s director-general Dr. Osnat Levtzion- Korach and Prof. Eitan Kerem,
director of the pediatrics division both on Mount Scopus and at the Hadassah’s
Ein Kerem campuses.
Dr. Pnina Hertz, a developmental psychologist who
heads the eating disorders center it is part of center for pediatric chronic
diseases, said it was established because it was so hard for parents to run from
one place to another to consult with different specialists.
young children who have eating problems is difficult enough. It’s better to have
one holistic, coordinated, multidisciplinary place where all the experts are. We
thought of it when the parent of one premature baby suggested it because he had
to go from one place to another to get help.”
But even so, said Hertz,
the center still has a two- or three-month waiting list.
percent and 29% of children will at least once in their lives suffer from
The Mount Scopus Center has patients who are brought in
from all over the country. There is a constant growth in such difficulties
because very premature babies who until recent years would not have lived do
survive and suffer from feeding difficulties that have to be treated for them to
Prof. Wexler Isaiah, who specializes at Hadassah in pediatric
metabolism and feeding disorders and heads the day hospital, noted that there
are numerous hospital centers dealing with feeding problems.
has a different philosophy and approach. It’s important to listen to all views.
All of us agreed that the families need our help in the best possible
SOROKA UNIVERSITY Medical Center in Beersheva performs 16,000
deliveries a year, the second most in Israel after Shaare Zedek Medical Center
(around 21,000 annually, including those at its Bikur Cholim Hospital branch) in
Jerusalem. Dr. Gal Meiri, head of pediatric psychiatry there, told the
participants that Soroka receives many requests for help that involve babies’
and young children’s eating disorders – perhaps one-third of all referrals. “We
too have a holistic approach combining medical, psychiatric and developmental
matters,” he said.
The “bible” of psychiatric problems, known as the
Diagnostic and Statistical Manual of Mental Disorders (now in its Fifth
Edition), classifies problems of feeding and eating disorders. There is a large
variety of problems, from pica (characterized by an appetite for non-nutritive
substances such as dirt, ice, clay, chalk or sand) to rumination disorder (an
under-diagnosed chronic condition of effortless regurgitation of most meals).
The parent only and not the child may be involved, as in the psychiatric
Munchausen-by-proxy syndrome, in which a parent (usually the mother) or
caregiver deliberately exaggerates or fabricates a child’s “refusal” to eat and
wants the child to appear to be sick.
Feeding babies and young children
often becomes a struggle for parents. They complain they eat too little, refuse
solids or to eat other things beyond breast milk, have bad or strange eating
habits or are selective eaters. Even in a premature baby unit, some newborns
seem to refuse to eat. Sometimes eating is accompanied by
Babies may have slow weight increases and failure to thrive.
All of these issues affect about 1% of children before their first birthdays;
among all babies and toddlers, about a quarter have eating
Meiri noted that there is a diagnostic classification from zero
to three according to severity. The problems may involve neurological,
behavioral, cardiorespiratory, metabolic and other problems. Eating behavioral
disorder, for example, is the difficulty of following a regular eating pattern.
There are children who will eat at home but refuse to eat
“There is even infantile anorexia, in which a child under the
age of three refuses to eat enough for at least a month,” he said. “This
even though the baby has been found to have no medical disease or
trauma. It usually begins at six months of age and can continue for up to three
years. Such a child shows no signs of hunger and seems to have little interest
in food, but he may be curious and show good interaction with parents. The
problem can cause a significant delay in development.”
said, “a baby may not make eye connection with a parent, smile or make gurgling
noises. The mother might not be aware that there’s a problem; she may have her
own problems of postpartum depression. A child may have difficulty remaining
alert enough to be left quietly for eating or he may be too sleepy. This can
result in a failure to gain enough or even weight loss. A feeding tube may be
the last resort.”
It is usually normal for babies frequently to spit up
milk, so a parent feels unsure how much more he needs. In the majority of cases,
the problem does not result in the stomach being emptied. Try feeding the infant
again; if he fights it, the parent feels more pressured and may feed him by
force. The baby then feels stress and doesn’t want to be fed. Never force-feed a
baby, Meiri urged. Instead, go for medical help.
Babies and toddlers may
in rare cases develop sensory food aversions – turning down specific tastes,
textures, odors or forms of food. He will eat better if he gets the food he
really likes. Other reasons for refusal to eat may involve post-traumatic
feeding disorder – the refusal to eat after experiencing a traumatic event. The
baby may refuse to drink from a bottle or eat from a spoon. Desensitization can
be used to treat it. Sometimes this is the first symptom of autism, which
affects nearly one in 90 children.
HADASSAH MOUNT Scopus clinical
dietitian Hila Elyashar-Iron discussed overweight and obesity in young children.
While in previous generations, families spent most of their time together,
enjoyed meals around the dinner table together and children played outside,
today most mothers work outside the home and fathers spend even more time at
work. Children are left alone in the home and eat alone, usually fast food they
heat up in the microwave. Instead of getting exercise outdoors, they tend to
spend a majority of their free time at the computer, with their smartphone and
in front of the TV – all of which promote overweight.
advertising in the media, children are encouraged to eat junk
Somehow, most people admire fat babies and regard them as the
height of good health, but they are wrong. “Israel ranks among the top 10
countries with overweight children, according to the Health Ministry’s Mabat
study of 2003- 2004, and it probably is worse today,” Elyashar-Iron
The body-mass index (BMI), a formula based on height and weight, is
accurate in determining underweight, normal weight, overweight and obesity in
adults, but it is not reliable in children. Instead, special growth charts
according to age of boys and girls (separately) should be used.
10% and 20% of fat babies will be fat children, 40% will be fat teens, and 75%
to 89% will be fat adults. All of this excess weight can lead to diabetes;
learning problems; depression; hypertension; cardiac, orthopedic and respiratory
disease; liver disorders; and even cancer in adulthood, said the dietitian. “The
ministry says there is no greater public health challenge than to prevent
overweight and obesity throughout life – at home, in school, at work and during
Digestive problems in children were discussed by Dr. Perri
Millman, a Hadassah pediatric gastroenterologist.
“There are parents who
feed babies while they’re asleep because they claim they can’t do it when the
infant is awake, as well as those who claim their children ‘don’t eat anything’
although they look fine. Many parents with healthy babies whose ribs “show”
refuse to recognize that this can be completely normal.
“If the baby is
fat, that is not normal.
Force-feeding is absolutely wrong and can cause
psychological trauma; often it is done by parents who have high hopes about
their children’s growth, and they think they are not getting enough.”
women who breastfeed cannot know how much their infants are getting, they should
go to Tipat Halav [well-baby clinics] and have the child’s weight and
development compared to the norm in growth charts.
Spitting up (reflux)
is also normal, as the sphincter muscle at the top of the esophagus may not be
developed enough at that age. But there are medical problems – heartburn, colic,
pneumonia, asthma, failure to thrive and refusal to eat, that have to be
treated. “We can perform tests, but usually we can take the young patient’s
medical history and figure it out.” Surgery is sometimes necessary, said
Millman, who recalled the case of a seven-year-old girl who “hated to eat” and
didn’t grow properly and developed asthma, with pneumonia every year, reflux
esophagitis and heartburn. She underwent an operation and was free of asthma and
Dr. Shlomit Semish, a retired expert in biochemistry, food
science and nutrition at the Hebrew University’s faculty of agriculture, food
and environment showed a shocking segment from a foreign film showing a mother
with difficulties feeding her toddler; she held the child’s nose closed with her
fingers to force her to open her mouth. This can cause psychological problems in
the child. “Early experiences such as these are preserved and can affect
Force feeding is always wrong. There are other ways of
feeding a child with such problems,” she insisted.