Weight & Eating Problems

Do you sometimes feel that your kids might eat you out of house and home? It can feel like that at times, especially during the teen years. They grab a handful of cookies here, a bag of chips there, and finish last night’s leftovers in a flash. They’re growing like weeds, of course, so you figure all that eating is OK. And most of the time, it is.

But sometimes, heavy snacking isn’t what it seems to be. A kid who eats unusually large amounts of food — and feels guilty or secretive about it — could be struggling with a common eating disorder called binge eating disorder.

About Binge Eating Disorder

Lots of people find comfort in food. After all, it’s often at the heart of our happiest celebrations. Birthdays can mean cake with friends; Thanksgiving often means turkey and stuffing with family. Most people will sometimes eat much more than they normally do (or even want to) on special occasions.

But people with binge eating disorder have a different relationship with food — they feel like they’ve lost all control over how much they’re eating, like they can’t stop. They also binge more frequently — at least twice a week for several months.

For people with binge eating disorder, at first food may provide feelings of calm or comfort or stop them from feeling upset. But if bingeing continues, it can cause anxiety, guilt and distress. A binge usually involves eating unusually large amounts of food quickly. While bingeing, a person feels completely out of control. These behaviors can become a habit, which is often alternated with dieting.

Binge eating disorder is more common in people who are overweight or obese, but it affects people of healthy weight as well. However, there’s little information on how many kids and teens have it because the condition has only recently been recognized. Some people may be too embarrassed to seek help for it.

Also, because most binge eating is done alone, even if their kids may be gaining weight, parents might not be aware that it’s due to bingeing.

While other eating disorders (like anorexia and bulimia) are much more common in females, about a third of those with binge eating disorder are male. Adults in treatment (including 2% of adult Americans — roughly 1 million to 2 million people) often say their problems started in childhood or adolescence.

Signs and Symptoms

Kids and teens who sometimes eat a lot don’t necessarily have binge eating disorder. Kids can have huge appetites, especially during growth spurts, when they need more nutrients to fuel their growing bodies. So it can be difficult to determine whether a child has binge eating disorder. But several signs distinguish someone who binge eats from someone with a “healthy appetite.”

Parents and other family members may first suspect a problem when they notice large amounts of food missing from the pantry or the refrigerator, though it’s hard to imagine one child could have eaten so much.

Other signs include:

• a child eating a lot of food quickly
• a pattern of eating in response to emotional stress, such as family conflict, peer rejection, or poor academic performance
• a child feeling ashamed or disgusted by the amount they have eaten
• finding food containers or wrappers hidden in a child’s room
• an increasingly irregular eating pattern, such as skipping meals, eating lots of junk food, and eating at unusual times (like late at night)

People who binge might experience feelings that are common to many eating disorders, such as depression, anxiety, guilt, or shame. They may avoid school, work, or socializing with friends because they’re ashamed of their binge eating problem or changes in their body shape and weight.

Causes

The causes of binge eating disorder aren’t clear, although the National Institutes of Health (NIH) report that up to half of all people who have it also have a history of depression. It’s not known, though, if binge eating brings on depression or if people with depression are prone to the disorder.

Many people who binge eat say that episodes can be triggered by feelings of stress, anger, sadness, boredom, or anxiety. However, even if someone feels better temporarily while eating, it’s usually associated with feelings of distress. Most commonly, after a binge a person will feel anxious, guilty, and upset about losing control.

How It Differs From Other Eating Disorders

Binge eating disorder is slightly different from other eating disorders.

People with bulimia nervosa (sometimes called binge-purge syndrome) binge on food and then purge (vomiting or using laxatives) to avoid gaining weight. They may also fast (stop eating for a while) or compulsively exercise after an eating binge. Like people who suffer from binge eating disorder, those with bulimia nervosa repeatedly eat very large amounts of food and feel guilty or ashamed about it. Unlike bulimia, however, those with binge eating disorder do not or are unable to purge and are, therefore, frequently overweight.

Anorexia nervosa also involves feelings of guilt about eating. Whereas people with binge eating disorder consistently overeat, people with anorexia starve themselves, causing potentially life-threatening damage to their bodies. They also may compulsively exercise to achieve weight loss, a condition known as anorexia athletica.

Diagnosis

If the doctor thinks your child might have an eating disorder, he or she will take a thorough medical history. The doctor will also discuss the family history, patterns of eating in the family, and emotional issues. In addition, a complete physical will be done and lab tests may be ordered. Blood tests can look for medical issues (like high cholesterol or thyroid problems) that may be related to having an unhealthy weight.

Doctors and mental health professionals use the criteria in the Diagnostic and Statistical Manual IV (DSM-IV) when they identify binge eating disorder. These include:

• binge eating more food than most people could consume in short periods of time
• a sense of lack of control over eating
• feelings of distress about eating behaviors
• binge eating that happens, on average, at least 1 days a week for 3 months
• the binges are not associated with regular purging with laxatives or by vomiting or excessive exercise
• binge episodes associated with:
  • eating more rapidly than usual
  • eating until uncomfortably full
  • eating when not hungry
  • eating alone or in secret
  • feelings of disgust, depression, or guilt

Treatment

As with any eating disorder, it’s also important for a child to have psychological therapy for support and to help change unhealthy behaviors.

Different types of therapy can help treat binge eating disorder. For example, family therapy and cognitive-behavioral therapy teach people techniques to monitor and change their eating habits and the way they respond to stress. Family therapy includes the whole family in the process of helping the individual.

Cognitive-behavioral therapy combines the approach of helping people change self-defeating thoughts along with changing their behavior. Counseling also helps patients look at relationships they have with others and helps them work on areas that cause them anxiety. In some cases, doctors may prescribe medication to be used with therapy.

But there’s no quick fix for any eating disorder. Treatment can take several months or longer while the person learns how to have a healthier approach to food. Although weight-control programs are helpful for some people affected by binge eating disorder, kids and teens should not begin a diet or weight-control program without the advice and supervision of a doctor.

For some parents and family members, the long road to recovery can be frustrating and expensive. Get support for yourself through parents groups or by reading about the disorder so you can help your child and your family get through this.

Risks and Complications

Many children and teens with binge eating disorder become overweight after months of overeating. Their most common health risks are the same ones that accompany obesity, including diabetes, high blood pressure, high cholesterol levels, gallbladder disease, heart disease, some kinds of cancer, and depression and anxiety.

Helping Your Child

If you suspect your child has a problem with binge eating, call your doctor for advice and referrals to qualified mental health professionals who have experience treating eating disorders in kids.

Reassure your child that you’re there to help or just to listen. Having an eating disorder can be difficult to admit, and your child may not be ready to acknowledge having a problem. You also can encourage healthier eating habits by modeling your own positive relationship with food and exercise and by not using food as a reward.

With the help of your family, friends, and supportive professionals, your child can start eating healthy amounts of food and learn to manage stress in healthier ways.

For years, doctors have used height and weight measurements to assess a child’s physical growth in relation to other kids the same age. Now they have another tool: body mass index (BMI).

BMI is a calculation that uses height and weight to estimate how much body fat someone has. Doctors use it to determine how appropriate a child’s weight is for a certain height and age.

Calculating BMI

You can use the BMI calculator below to find your child’s BMI, but it’s also important to have your doctor do regular BMI measurements. That way, you’ll know the number is accurate and the doctor can discuss the results with you.

Tracking BMI

Starting when your child is 2 years old, the doctor will determine BMI at routine checkups and plot this measurement on a chart against those of other kids the same age.

Because what is normal changes with age, doctors must plot children’s BMI measurements on standard growth charts rather than using a universal normal range for BMI as is done with adults. They also use separate charts for boys and girls to account for differences in growth rates and amounts of body fat as the two genders mature.

That information is recorded in your child’s medical record. Over several visits, the pattern of measurements allows the doctor to track your child’s growth.

BMI is particularly helpful for identifying kids and adolescents who are at risk for becoming significantly overweight as they get older. In older kids and teens, there is a strong connection between BMI and the amount of body fat. So those with high BMI readings — and, probably, high levels of fat — are most likely to have weight problems when they are older.

By identifying these at-risk kids, doctors can monitor their body fat carefully and try to prevent adult obesity through changes in eating and exercise habits.

What the Figures Mean

BMI percentiles show how kids’ measurements compare with others the same gender and age. For example, if a child has a BMI in the 60th percentile, 60% of the kids of the same gender and age who were measured had a lower BMI.

BMI is not perfect. For example, it’s very common for kids to gain weight quickly — and see their BMI go up — during puberty. Your doctor can help you figure out whether this weight gain is a normal part of development or whether it’s something to be concerned about.

Kids also can have a high BMI if they have a large frame or a lot of muscle, not excess fat. And a kid with a small frame may have a normal BMI but too much body fat.

Although BMI is not a direct or perfect measure of body fat, kids at or above the 95th percentile are considered obese, a term doctors use to indicate excess body fat, which increases the risk of weight-related health problems.

Kids who measure at the 85th to 94th percentiles are considered overweight, because of excess body fat or high lean body mass. A child whose BMI is between the 5th percentile to 85th percentile is in the healthy weight range. A child with a BMI below the 5th percentile is considered underweight.

Also, it’s important to look at the BMI numbers as a trend instead of focusing on individual numbers. Any one measurement, taken out of context, can give you the wrong impression of your child’s growth.

The real value of BMI measurements lies in viewing them as a pattern over time. That allows both doctor and parents to watch a child’s growth and determine whether it’s normal compared with that of other kids the same age.

While BMI is an important indicator of healthy growth and development, if you think your child may be gaining or losing weight too fast, talk to your doctor.

Many kids — particularly adolescents — are concerned about how they look and can feel self-conscious about their bodies. This can be especially true when they are going through puberty, and undergo dramatic physical changes and face new social pressures.

Unfortunately, for a number of kids and teens, that concern can lead to an obsession that can become an eating disorder. Eating disorders such as anorexia nervosa or bulimia nervosa cause dramatic weight fluctuation, interfere with normal daily life, and can permanently affect their health.

Parents can help prevent kids from developing an eating disorder by building their self-esteem and encouraging healthy attitudes about nutrition and appearance. If you become worried that your son or daughter might be developing an eating disorder, it’s important to step in and seek proper medical care.

About Eating Disorders

Generally, eating disorders involve self-critical, negative thoughts and feelings about body weight and food, and eating habits that disrupt normal body function and daily activities.

While more common among girls, eating disorders can affect boys, too. They’re so common in the U.S. that 1 or 2 out of every 100 kids will struggle with one, most commonly anorexia or bulimia. Unfortunately, many kids and teens successfully hide eating disorders from their families for months or even years.

People with anorexia have an extreme fear of weight gain and a distorted view of their body size and shape. As a result, they strive to maintain a very low body weight. Some restrict their food intake by dieting, fasting, or excessive exercise. People with anorexia try to eat as little as possible, and take in as few calories as they can, frequently obsessing over food intake.

Bulimia is characterized by habitual binge eating and purging. Someone with bulimia may undergo weight fluctuations, but rarely experiences the low weight associated with anorexia. Both disorders can involve compulsive exercise or other forms of purging food eaten, such as by self-induced vomiting or laxative use.

Although anorexia and bulimia are very similar, people with anorexia are usually very thin and underweight but those with bulimia may be a normal weight or even overweight.

Binge eating disorders, food phobia, and body image disorders are also becoming increasingly common in adolescence.

It’s important to remember that eating disorders can easily get out of hand and are difficult habits to break. Eating disorders are serious clinical problems that require professional treatment by doctors, therapists, and nutritionists.

Causes of Eating Disorders

The causes of eating disorders aren’t entirely clear. However, a combination of psychological, genetic, social, and family factors are thought to be involved.

For kids with eating disorders, there may be a difference between the way they see themselves and how they actually look. People with anorexia or bulimia often have an intense fear of gaining weight or being overweight and think they look bigger than they actually are. Also, certain sports and activities (like cheerleading, gymnastics, ballet, ice skating, and wrestling) that emphasize certain weight classes may put some kids or teens at greater risk for eating disorders.

There is also an increased incidence of other problems among kids and teens with eating disorders, like anxiety disorders and obsessive-compulsive disorder. Sometimes, problems at home can put kids at higher risk of problem eating behaviors.

Some research suggests that media images contribute to the rise in the incidence of eating disorders. Most celebrities in advertising, movies, TV, and sports programs are very thin, and this may lead girls to think that the ideal of beauty is extreme thinness. Boys, too, may try to emulate a media ideal by drastically restricting their eating and compulsively exercising to build muscle mass.

Concerns about eating disorders are also beginning at an alarmingly young age. Research shows that 42% of first- to third-grade girls want to be thinner, and 81% of 10-year-olds are afraid of being fat. In fact, most kids with eating disorders began their disordered eating between the ages of 11 and 13.

Many kids who develop an eating disorder have low self-esteem and their focus on weight can be an attempt to gain a sense of control at a time when their lives feel more out-of-control.

The Effects of Eating Disorders

While eating disorders can result from serious mental and behavioral health conditions, as well as trauma (for example, sexual abuse), they can lead to very serious physical health problems. Anorexia or bulimia may cause dehydration and other medical complications like heart problems or kidney failure. In extreme cases, eating disorders can lead to severe malnutrition and even death.

With anorexia, the body goes into starvation mode and the lack of nutrition can affect the body in many ways:

• a drop in blood pressure, pulse, and breathing rate
• hair loss and fingernail breakage
• loss of periods
• lanugo hair, a soft hair that can grow all over the skin
• lightheadedness and inability to concentrate
• anemia
• swollen joints
• brittle bones

With bulimia, frequent vomiting and lack of nutrients can cause:

• constant stomach pain
• damage to the stomach and kidneys
• tooth decay (from exposure to stomach acids)
• “chipmunk cheeks,” when the salivary glands permanently expand from throwing up so often
• loss of periods
• loss of the mineral potassium (this can contribute to heart problems and even death)

Warning Signs

It can be a challenge for parents to tell the difference between kids’ normal self-image concerns and warning signs of an eating disorder.

While many kids and teens — girls in particular — are self-conscious, compare themselves with others, and talk about dieting, this doesn’t necessarily mean they have eating disorders. Kids with eating disorders show serious problems with their eating and often have physical signs.

Someone with anorexia might:

• become very thin, frail, or emaciated
• be obsessed with eating, food, and weight control
• weigh herself or himself repeatedly
• count or portion food carefully
• only eat certain foods, avoid foods like dairy, meat, wheat, etc. (of course, lots of people who are allergic to a particular food or are vegetarians avoid certain foods)
• exercise excessively
• feel fat
• withdraw from social activities, especially meals and celebrations involving food
• be depressed, lethargic (lacking in energy), and feel cold a lot

Someone with bulimia might:

• fear weight gain
• be intensely unhappy with body size, shape, and weight
• make excuses to go to the bathroom immediately after meals
• only eat diet or low-fat foods (except during binges)
• regularly buy laxatives, diuretics, or enemas
• spend a lot of time working out or trying to work off calories
• withdraw from social activities, especially meals and celebrations involving food

If You Suspect an Eating Disorder

If you suspect your son or daughter has an eating disorder, it’s important to intervene and help your child get diagnosed and treated.

Kids with eating disorders often react defensively and angrily when confronted for the first time. Many have trouble admitting, even to themselves, that they have a problem. Sometimes getting a family member or friend who has been treated for an eating disorder can help encourage someone to get help. A fear of being fat or overweight is a core problem for anyone with an eating disorder. So it’s understandable that kids with eating disorders don’t want to go to a clinic and “get fat.”

Trying to help when someone doesn’t think he or she needs it can be hard. Still, getting the professional assistance needed, even if your child resists, is essential. Enlist help from friends and family that your son or daughter trusts and loves — people known to have your child’s best interests at heart.

Your child may be more receptive to a conversation if you focus on your own concerns and use “I” statements rather than “you” statements. For example, steer clear of statements like “you have an eating disorder” or “you’re too thin,” which may only prompt anger and denial. Instead, try “I’m worried that you have lost so much weight so quickly.” Cite specific things your child has said or done that have made you worry, and explain that you will be scheduling a doctor’s appointment to put your own mind at ease.

If you still encounter resistance, talk with your doctor or a mental health care professional about other approaches.

Treating Eating Disorders

Treatment focuses on helping kids cope with their disordered eating behaviors and establish new patterns of thinking about and approaching food. This can involve medical supervision, nutritional counseling, and therapy. The professionals will address a child’s perception about body size, shape, eating, and food.

Kids who are severely malnourished may require hospitalization and ongoing care after their medical condition stabilizes.

Generally, the earlier the intervention (ideally, before malnutrition or a continual binge-purge cycle starts), the shorter the treatment required.

Preventing Eating Disorders

You can play a powerful role in your child’s development of healthy attitudes about food and nutrition. Your own body image can influence your kids. If you constantly say “I’m fat,” complain about exercise, and practice “yo-yo” dieting, your kids might feel that a distorted body image is normal and acceptable.

At a time of great societal concern about obesity, it can be tricky for parents to talk with their kids about their eating habits. It’s best to emphasize health, rather than weight. Make sure your kids know you love them for who they are, not how they look.

It’s OK to appreciate attractiveness in celebrities — if your kids (and you!) feel fine about how they look, it won’t prompt them to try to change to be like someone else. Getting the message that they’re great as they are and that their bodies are healthy and strong is a wonderful gift that parents can give their kids.

Try to avoid power struggles regarding food — if your teen wants to “go vegetarian,” be supportive even if you’re an avid meat-eater. Teens frequently go through trendy eating periods, so try to set good limits, encourage healthy eating, and avoid fighting over food issues. Kids can catch on pretty quickly if their parents panic over one skipped meal. Try to gain perspective and talk to your kids about what’s going on if they don’t want to eat with the family.

Finally, take an active role in creating a healthy lifestyle for your family. Involve your kids in the preparation of healthy, nutritious meals. Let them know that it’s OK to eat when hungry and refuse food when they’re not. Also, make exercise a fun, rewarding, and regular family activity.

Developing your own healthy attitudes about food and exercise will set an excellent example for your kids.

It seems like just yesterday that you had to coax your daughter to bathe. But then she turned 11 and started spending hours in the bathroom and sizing herself up in every mirror she passes. She seems consumed by her looks. What happened? And is it healthy?

As they approach the teen years, it’s common and natural for kids to become more interested in appearances — their own and others’ — seemingly all of a sudden. Their bodies are going through some big changes as they grow and go through puberty. As preteens change physically, they become more aware of how they look.

Growing and puberty affect more than a preteen’s outward appearance — body image is affected, too. Having a healthy body image means that most of your feelings, ideas, and opinions about your body and appearance are positive. It means accepting and appreciating your body and feeling mostly satisfied with your appearance.

Developing a healthy body image happens over time. It can be influenced by experiences and shaped by the opinions and feedback of others and by cultural messages.

Body Image and Appearance

Body image can be especially vulnerable during the preteen and teen years because appearances change so much and cultural messages that fuel dissatisfaction can be very strong. Being criticized or teased about appearance can be particularly hurtful at this age.

Preteens and teens often compare their looks with others’ or with media images of the “right” way to look. In cultures in which looks seem to matter so much — and ideal images are so unrealistic — it’s all too common to be dissatisfied with some aspect of appearance.

But feeling too self-critical about appearance can interfere with body image. And poor body image can hurt a teen’s overall self-image, too.

Beyond Appearances

As teens mature mentally and emotionally, they will develop a more complex self-image — one that incorporates their interests, talents, unique qualities, values, aspirations, and relationships. But during the early teen years, the image they see in the mirror makes up a big part of their self-image.

And while it’s true that appearance isn’t everything, feeling satisfied with appearance means a lot. If you’re wondering why your child suddenly seems so focused on appearance, keep in mind that preteens are:

• Adapting to a new reflection. Spending extra time grooming, making comparisons with friends and celebrities, and experimenting with clothing, hair, and makeup can be ways of getting to know and like the new self reflected in the mirror.
• Making a fashion statement. When preteens and teens express their taste in clothes and hairstyles, they’re making statements about themselves. Experimenting with and defining their styles is one way to express their interests, personality, independence, and identity.
• Finding a way to belong. Peers, groups, and cliques — which take center stage during the teen years — can also play a role in heightening young teens’ concerns about appearances. Dressing a certain way might be a way of feeling included, fitting in, standing out, or belonging to a group of peers.

Boys and Body Image

It’s not just girls who become focused on appearance. Boys might not be as vocal about it, but they can worry just as much about their looks. They may spend the same amount of time in front of the mirror, weighing where to part their hair, what kind of product to use, assessing acne, and deciding whether or not to shave. And when your son emerges wearing pants that sag as if he hasn’t quite finished getting dressed, he may in fact have spent hours getting them to hang at that exact angle.

Self-Critical Feelings

Feeling satisfied with appearance isn’t always easy. Many kids who have positive body images become self-conscious or self-critical as they enter the teen years. It’s not uncommon for preteens and teens to express dissatisfaction about their appearance or to compare themselves with their friends, celebrities, or people they see in ads.

Our culture emphasizes the need to look just right. Ads for everything from makeup and hair products to clothing and toothpaste send messages that people need to look a certain way to be happy. It’s hard not to be influenced by that.

You might hear your son or daughter fret about anything from height and hair to the shape of their nose or the size of their ears — any aspect that doesn’t match the “ideal.”

Body shape and size can concern them, too. It’s important for preteens or teens to eat nutritious foods, limit junk foods, and get plenty of physical activity, but it’s not advisable for them to diet. Being overly concerned about weight, restricting food, or exercising excessively can be signs of an eating disorder. Talk to your doctor if you notice any of these signs in your kids.

Self-criticism that seems constant or excessive or causes daily distress that lasts might signal an extreme body image problem known as body dysmorphic disorder. This condition involves obsessions and compulsions about slight or imagined imperfections in appearance.

A Natural Transition

In most cases, the focus on appearance is a very natural and common part of becoming a teenager. Usually, these expressions of frustration clear up quickly and don’t warrant concern — just plenty of patience, empathy, support, and perspective from parents.

Still, parents can be frustrated when looks seem to matter so much to kids. It can be a delicate balance to help preteens feel confident and satisfied with their looks while encouraging them not to be overly concerned with the superficial. It’s important to encourage teens to take pride in their appearance but also to emphasize the deeper qualities that matter more.

Boosting Body Image

As preteens try on different looks, parents can help by being accepting and supportive, providing positive messages, and encouraging other qualities that keep looks in perspective. Be sure to:

• Accept and understand. Recognize that being concerned about looks is as much a part of the teen years as a changing voice and learning to shave. You know that in the grand scheme of things your daughter’s freckles don’t matter, but to her they might seem critical. As frustrating as it can be when they hog the bathroom, avoid criticizing kids for being concerned about appearances. As they grow, concern about their looks will stop dominating their lives.
• Give lots of compliments. Provide reassurance about kids’ looks and about all their other important qualities. As much as they may seem not to notice or care, simple statements like “you’ve got the most beautiful smile” or “that shirt looks great on you” really do matter. Compliment them on other physical attributes, such as strength, speed, balance, energy, or grace. Appreciating physical qualities and capabilities helps build a healthy body image.
• Compliment what’s inside too. Notice out loud all the personal qualities that you love about your kids — how generous your son is to share with his little sister, the determined way that your daughter studies for her tests, or how your son stood by his best friend. Reassure them when they express insecurity. When you hear “I hate my hair” or “I’m so little,” provide valuable counterpoint.
• Talk about what appearances mean. Guide your kids to think a little more deeply about appearances and how people express themselves. Talk about the messages that certain styles might convey. One outfit may send the message “I’m ready to party!” while others might say “I’m heading to school” or “I’m too lazy to do laundry.”
• Set reasonable boundaries. Be patient, but also set boundaries on how much time your kids can spend on grooming and dressing. Tell them it’s not OK to inconvenience others or let chores go. Limits help kids understand how to manage time, be considerate of others’ needs, share resources, exercise a little self-discipline, and keep appearances in perspective.
• Be a good role model. How you talk about your own looks sets a powerful example. Constantly complaining about or fretting over your appearance teaches your kids to cast the same critical eye on themselves. Almost everyone is dissatisfied with certain elements of their appearance, but talk instead about what your body can do, not just how it looks. Instead of griping about how big your legs are, talk about how they’re strong enough to help you hike up a mountain.

Having a healthy and positive body image means liking your body, appreciating it, and being grateful for its qualities and capabilities. When parents care for and appreciate their own bodies, they teach their kids to do the same.

Most kids steadily gain weight and grow quickly within the first few years of life. But in some cases, kids don’t meet these expected standards of growth. When this happens, it’s called “failure to thrive.”

Doctors say children “fail to thrive” when they don’t gain weight as expected. Often, these kids also have poor linear (height) growth.

Many things can cause failure to thrive, including illnesses and eating problems. Once doctors find the cause of the problem, they can work with families to help get a child back into a healthy growth pattern.

About Failure to Thrive

Although it’s been recognized for more than a century, failure to thrive lacks a clear definition, in part because it’s not a disease or disorder itself. Rather, it’s a sign that a child is undernourished. In general, kids who fail to thrive don’t receive or cannot take in, keep, or use the calories that would help them grow and gain enough weight.

Doctors usually diagnose the condition in infants and toddlers — an important time of physical and mental development. After birth, a child’s brain grows as much in the first year as it will grow for the rest of a child’s life. Poor nutrition during this period may have lasting harmful effects on brain development.

Most babies double their birth weight by 4 months and triple it by age 1, but kids who fail to thrive usually don’t meet those milestones. Sometimes, a child who starts out “plump” and seems to be growing well may gain less weight later. After a while, height growth may slow as well.

If the condition continues, undernourished kids might:

• lose interest in their surroundings
• avoid eye contact
• become fussy
• not reach developmental milestones like sitting up, walking, and talking at the usual age

Causes

A number of things can cause failure to thrive, including:

• Not enough food offered. In some cases, parents mistakenly cause the problem. Sometimes a parent measures formula incorrectly, causing an infant to get too few calories. Problems with breastfeeding or transitioning to solids also can cause failure to thrive. Parents who worry their child will get fat may restrict the amount of calories they give their infants. And sometimes parents don’t pay enough attention to their children’s hunger cues or can’t afford enough food for their children.
• The child eats too little. Some children have trouble eating enough food because of prematurity, developmental delays, or conditions like autism in which they do not like eating foods of certain textures or tastes.
• Health problems involving the digestive system. Several health conditions can prevent a child from gaining weight. These include gastroesophageal reflux (GER), chronic diarrhea, cystic fibrosis, chronic liver disease, and celiac disease.

  With reflux, the esophagus may become so irritated that a child refuses to eat because it hurts. Persistent diarrhea can make it hard for the body to hold on to the nutrients and calories from food. Cystic fibrosis, chronic liver disease, and celiac disease all cause problems with the body’s ability to absorb nutrients. The child may eat a lot, but the body doesn’t absorb and retain enough of that food. Kids with celiac disease are allergic to gluten, a protein found in wheat and other grains. The immune system’s abnormal response to this protein damages the lining of the intestine so it can’t absorb nutrients properly.

• Food intolerance. A food intolerance, which is different from a food allergy, means the body is sensitive to certain foods. For example, milk protein intolerance means the body can’t absorb foods that have milk proteins, such as yogurt and cheese, which could lead to failure to thrive.
• An ongoing illness or disorder. A child who has trouble eating — because of prematurity or a cleft lip or palate, for example — may not take in enough calories to support normal growth. Other conditions involving the heart, lungs, or endocrine system can increase the amount of calories a child needs and make it hard for the child to eat enough to keep up.
• Infections. Parasites, urinary tract infections (UTIs), tuberculosis, and other infections can force the body to use nutrients rapidly and decrease appetite. This can lead to short- or long-term failure to thrive.
• Metabolic disorders. Metabolic disorders are health conditions that make it hard for the body to break down, process, or take energy from food. They also can cause a child to eat poorly or vomit.

Sometimes a mix of medical problems and environmental factors leads to failure to thrive. For instance, if a baby has severe GER and is reluctant to eat, feeding times can be stressful. The baby may become upset and frustrated, and the caregiver might be unable to feed the child enough food.

Other times, doctors aren’t sure exactly what causes the problem.

Diagnosis

Many babies go through brief periods when their weight gain levels out, or they even lose a little weight. This is not unusual. However, if a baby doesn’t gain weight for 3 months in a row during the first year of life, doctors usually become concerned.

Doctors use standard growth charts to plot weight, length, and head circumference, which are measured at each well-child exam. Children may have failure to thrive if they fall below a certain weight range for their age or fail to gain weight at the expected rate.

To see if there’s a problem, doctors will ask for a child’s detailed health history, including a feeding history. This helps doctors see whether underfeeding, household stresses, or feeding problems might be to blame. A nutritionist or other health care professional also may track the calories in a child’s diet to make sure the child is getting enough.

Doctors might order tests (such as a complete blood count or urine test) to check for underlying medical problems. If a particular disease or disorder is suspected, the doctor might order other tests to check for that condition.

Treatment

Treatment for kids who fail to thrive involves making sure that the child gets the calories needed to grow and addressing any underlying feeding issues. This often requires the help of a care team that may include:

• the primary care doctor or pediatrician
• a registered dietitian to evaluate the child’s dietary needs
• occupational therapists to help caregivers and the child develop successful feeding behaviors
• speech therapists to address any sucking or swallowing problems
• a social worker if a family has trouble getting enough food for the child
• psychologists and other mental health professionals if there are any behavioral issues
• specialists (such as a cardiologist, neurologist, or gastroenterologist) to treat underlying health conditions

Usually, kids who have failure to thrive can be treated at home along with regular doctor visits. The doctor will recommend high-calorie foods and may place an infant on a high-calorie formula. Depending on the child’s feeding habits, doctors may recommend offering foods of certain textures, spacing out meals to make sure children are hungry, avoiding “empty” calories like juices and candies, and other strategies depending on the child’s condition and family situation.

In cases of severe failure to thrive, a child who is not growing with initial treatment may need tube feedings. In tube feedings, a tube is put in that runs from the nose into the stomach. Liquid nutrition is provided at a steady rate through the tube and is usually given at nighttime only. The child can continue with daily activities and eat freely during the day. Once he or she starts getting more calories, the child will feel better and will probably start to eat more on his or her own. At that point, the tube can be removed.

Children with extreme failure to thrive might need to be treated in a hospital. There, they will be fed and monitored around the clock for 10 to 14 days (or longer), until they gain some weight. After that, it still can take months until the symptoms of severe malnutrition are gone.

How long treatment lasts can vary. Weight gain takes time, so it might be several months before a child is back in the normal range. When the condition is due to a chronic illness or disorder, kids may have to be monitored regularly at their doctor’s office. In those cases, treatment may take even longer, perhaps for a lifetime.

Does My Child Have Failure to Thrive?

If you’re worried that your child is failing to thrive, remember that many things can cause slower weight gain. For instance, breastfed babies and bottle-fed babies often gain weight at different rates in the early newborn period.

Genetics also play a big role in weight gain. So if a baby’s parents are slim, the baby may not put on pounds quickly. However, infants should still gain weight steadily. As a general guideline, babies usually eat often in a 24-hour period and should gain about 1 ounce a day in the first month of life. It can be hard to judge this from home (even if you have a scale), so it’s important to see your child’s doctor regularly. Doctors can check for problems at regular well-child checkups, so it’s important to keep these appointments.

When to Call the Doctor

If you notice a drop in weight gain or your baby doesn’t seem to have a normal appetite, call your doctor. Also call about any major change in eating patterns. Toddlers and older kids may have days and sometimes weeks when they show little interest in eating, but that shouldn’t happen in infants.

If you have trouble feeding your baby, your doctor can help. When a child doesn’t readily eat, parents can become frustrated and feel they’re doing something wrong. That can make the problem worse, causing stress for you and your baby. Instead, get help for both of you by talking to your doctor.

I want to try to reform my daughter’s unhealthy eating habits. But I am worried that by not letting her eat high-calorie, high-fat junk food, I’ll be paving the way for her to develop an eating disorder. I want her to be healthy, but I don’t want to make her unhappy about herself either. How do I handle this?
– Julie

Balance is the most important thing when developing healthy eating habits. Teach your daughter to eat healthy foods the majority of the time and to save fattening or sugar-filled junk foods for occasional treats. These treats should not be completely banned or else they will be even more appealing to your daughter!

Encourage healthy habits by:

• having family meals
• being a good role model yourself
• stocking up on a variety of healthy food options
• serving three meals a day, with good-for-you snacks in between
• encouraging your kids to drink water rather than sodas and juices

Give your daughter ways to boost her self-esteem, give her lots of compliments, and encourage her to talk to you if she has any concerns about her body image.

If you’re raising a picky eater, you might worry that your child isn’t getting the nutrients necessary for proper growth and development.

But you probably don’t need to worry unless your doctor tells you that your child isn’t growing at the normal rate for that age range. Over time, most finicky eaters do get enough calories and nutrients to meet their needs.

What Are Hunger and Malnutrition?

Everyone feels hungry at times. Hunger is the body’s signal that it needs food. Once we’ve eaten enough food to satisfy our bodies’ needs, hunger goes away until our stomachs are empty again.

Malnutrition is not the same thing as hunger, although they often go together. People who are chronically malnourished lack the nutrients needed for proper health and development. Someone can be malnourished for a long or short period of time, and the condition may be mild or severe. People who are malnourished are more likely to get sick and, in severe cases, might even die.

Chronic hunger and malnutrition can cause significant health problems. People who go hungry all the time are likely to be underweight, weighing significantly less than an average person of their size. If malnourished as a child, their growth may also be stunted, making them much shorter than average.

Causes of Hunger and Malnutrition

People who don’t get enough food often experience hunger, and over the long term this can lead to malnutrition. But someone can become malnourished for reasons that have nothing to do with hunger. Even people who have plenty to eat may be malnourished if they don’t eat foods that provide the right nutrients, vitamins, and minerals.

Some diseases and conditions prevent people from digesting or absorbing their food properly. For example:

• Someone with celiac disease has intestinal problems that are triggered by a protein called gluten, which is found in wheat, rye, and barley.
• Kids with cystic fibrosis have trouble absorbing nutrients because the disease affects the pancreas, an organ that normally produces enzymes necessary for digestion.

Someone who doesn’t get enough of one specific nutrient has a nutritional deficiency, a form of malnutrition (although it doesn’t necessarily mean the person will become seriously ill). The most common nutritional deficiency in the world is iron deficiency, which can lead to anemia.

Who Is at Risk for Malnutrition?

All over the world, people who are poor or who live in poverty-stricken areas are at the greatest risk for hunger and malnutrition. In poor countries, wars and natural disasters such as droughts and earthquakes also can contribute to hunger and malnutrition by disrupting normal food production and distribution.

In the United States, food manufacturers fortify some common foods with vitamins and minerals to prevent certain nutritional deficiencies. For example, the addition of iodine to salt helps prevent some thyroid gland problems (such as goiter), folic acid added to foods can help prevent certain birth defects, and added iron can help prevent iron-deficiency anemia.

Malnutrition affects people of every age, although infants, children, and teens may suffer the most because many nutrients are critical for normal growth and development. Older people may develop malnutrition because aging, illness, and other factors can lead to a poor appetite, so they may not eat enough.

Alcohol can interfere with nutrient absorption, so alcoholics might not benefit from the vitamins and minerals they consume. People who abuse drugs or alcohol can be malnourished or underweight if they don’t eat properly.

Children and teens on special diets — such as vegetarians — need to eat balanced meals and a variety of foods to get the right nutrients. Vegetarians and vegans, for example, should make sure they get enough protein and vitamins like B12.

Symptoms and Effects of Malnutrition

Malnutrition harms both the body and the mind. The more malnourished someone is — in other words, the more nutrients that are missing — the more likely he or she is to have problems.

The signs and symptoms of malnutrition depend on which nutritional deficiencies a person has, although they can include:

• fatigue (tiredness) and low energy
• dizziness
• poor immune function (which can harm the body’s ability to fight off infections)
• dry, scaly skin
• swollen and bleeding gums
• decaying teeth
• slowed reaction times and trouble paying attention
• underweight
• poor growth
• muscle weakness
• bloated stomach
• osteoporosis, or fragile bones that break easily
• problems with organ function
• problems learning

If a pregnant woman is malnourished, her child may weigh less at birth and have a lower chance of survival.

Vitamin A deficiency from malnutrition is the chief cause of preventable blindness in the developing world, and kids with severe vitamin A deficiency have a greater chance of getting sick or dying from infections such as diarrhea or measles.

Iodine deficiency can cause mental retardation and delayed development. Iron deficiency in infancy can delay development and make older kids less active and less able to concentrate. Teens who are malnourished often have trouble keeping up in school.

Treating Malnourished Children

Fortunately, many of the harmful effects of malnutrition can be reversed, especially if a child is only mildly or briefly malnourished.

If you think your child isn’t getting enough of the right nutrients, talk to your doctor, who may perform a physical exam and ask about the types and amounts of food your child eats. The doctor may also:

• measure height, weight, and body mass index (BMI) to see if they’re within a healthy range for your child’s age
• check for underlying conditions that could cause malnutrition
• order blood tests to check for nutritional deficiencies
• order additional tests based on your child’s medical history and physical exam

Treatment for malnutrition depends on its cause. A doctor or dietitian might recommend specific changes in the types and quantities of foods your child eats, and may prescribe dietary supplements, such as vitamins and minerals.

If there’s an underlying problem causing the malnutrition, the doctor will help you find ways to ensure your child gets the necessary nutrients.

Can a Picky Eater Become Malnourished?

Parents often worry that kids who seem to live on peanut butter sandwiches or hide at the sight of vegetables might not eat enough to stay healthy. Few kids in the United States and other developed nations experience severe malnutrition like that seen in Third World countries. Even finicky eaters usually get enough calories and nutrients.

The best way for parents to make sure that kids are properly nourished is to serve a variety of healthy foods and limit unhealthy snacks. If you’re concerned that your child’s energy level is lagging or that he or she isn’t growing normally, share your concerns with your doctor.

About Lactose Intolerance

For many kids, an ice cream sundae or a cool glass of milk at lunch means an afternoon of cramps, gas, and diarrhea.

Kids who have this kind of discomfort after consuming dairy products might have lactose intolerance, which is caused by problems digesting lactose, the main sugar in milk and milk products.

Lactose intolerance happens when the body makes too little of the enzyme lactase, which is needed to break down lactose into two smaller sugars, called glucose and galactose. When there’s not enough lactase in the body, lactose doesn’t get broken down in the small intestine, and it passes into the large intestine where bacteria ferment it into gases and acids.

This process can cause cramps, abdominal pain, gas, and diarrhea about 30 minutes to 2 hours after consuming any foods or drinks that contain lactose.

For some kids, these symptoms are very severe and their systems can’t tolerate any lactose. For others, the symptoms are milder and they just have to limit the amount of dairy products they consume.

Lactose intolerance can be managed — and the stomach discomfort can be eased — with some changes to the diet. If you think that your child has a lactose intolerance, call your doctor.

Who Gets Lactose Intolerance?

Lactose intolerance is more common among people of Asian, African, Native American, and Hispanic descent.

For most people with lactose intolerance, it remains a lifelong problem. But for some kids, it’s a temporary condition that begins after they take certain antibiotics or have gastrointestinal infections, and eventually goes away.

Diagnosing Lactose Intolerance

Doctors usually diagnose lactose intolerance through a simple hydrogen breath test. A person blows into a tube to give a sample of the breath, then gives another sample after drinking a lactose solution or eating a lactose-containing food.

If someone has a lactose intolerance, the test will show that there is a higher than average level of hydrogen and methane in the breath. That’s because undigested lactose leads to higher levels of these gases in the system, which can be detected in the breath.

Certain foods, medicines, and exposure to cigarette smoking can affect the test’s accuracy, so the doctor might advise taking a few precautions before the test is done.

Besides the breath test, doctors usually do a physical exam and take a full medical history to rule out other medical conditions.

An endoscopy, which lets the doctor look at the esophagus, stomach, and part of the small intestines using a tiny camera, also can be done to check for lactose intolerance. In an endoscopy, the doctor may give the patient a medicine to help him or her relax and may spray the throat to numb it. This makes the test more comfortable. Most patients are given anesthesia and are “asleep” when this procedure is done.

The doctor then slides a thin, flexible plastic tube called an endoscope down the throat and into the esophagus and the stomach. A tiny camera in the endoscope lets the doctor look for abnormalities on the surface of the esophagus and stomach lining. During the endoscopy, the doctor also may use small tweezers (forceps) to remove a piece of tissue for biopsy. A biopsy can show damage caused by acid reflux or infection and help rule out other problems.

Problems digesting lactose can also occur in people with other diseases of the gastrointestinal tract, such as celiac disease, a condition in which the intestine becomes damaged due to the person’s abnormal sensitivity to gluten (a protein found in wheat and certain other grains).

Living With Lactose Intolerance

Severity of lactose intolerance can vary widely between kids. Because each case is different, there’s no one simple way of dealing with it. Each child needs to find what works best depending on the symptoms and how much, if any, lactase the body produces. It may help to keep a food diary as you figure out what foods and drinks your child’s system can and can’t handle.

Many foods, drinks, and digestive aids are available for those with a lactose intolerance (like milk specifically made for people with this condition, which most supermarkets carry). Ask your doctor if your child should supplement certain dairy products with drops or tablets that contain the lactase enzyme.

While kids with the most severe cases may have to avoid all dairy products, doctors now recommend that most have some dairy in order to get enough calcium, vitamin D, and protein. Many kids can have small amounts of dairy products — which should be consumed in combination with other foods that don’t contain lactose — and some can have one to two glasses of milk each day without any problems, especially if consumed with non-dairy foods.

Also, kids with lactose intolerance may find that other dairy products, such as yogurt and cheeses, are easier to digest than milk. Lactose-free milk is also a great way to get calcium in your child’s diet without the problems. A lactase enzyme supplement can be used, too. Taking this before eating foods that contain dairy will help the body digest the lactose sugar in dairy and prevent the symptoms of lactose intolerance, like pain, cramping, bloating, gas, and diarrhea.

Encourage your child to eat other calcium-rich foods that don’t have lactose, like broccoli, collard greens, kale, turnip greens, salmon, almonds, soybeans, dried fruit, fortified orange juice, and tofu.

Also, consider talking with a registered dietitian to come up with dairy alternatives and a well-balanced diet that provides vital nutrients for your child.

The number of overweight children in the United States has grown at an alarming rate, with 1 out of 3 kids considered overweight or obese.

Many kids are spending less time exercising and more time in front of the TV, computer, phone, tablet, or video-game console. And today’s busy families have fewer free moments to prepare nutritious, home-cooked meals. From fast food to electronics, quick and easy is the reality for many of us.

Preventing kids from becoming overweight means making choices in the way your family eats and exercises, and how you spend time together. Helping kids lead healthy lifestyles begins with parents who lead by example.

The Effects of Obesity

Obesity increases kids’ chances of developing medical problems that can affect their present and future health. These include serious conditions like type 2 diabetes, high blood pressure, and high cholesterol — all once considered adult diseases.

Overweight and obese kids are also at risk for:

• bone and joint problems
• shortness of breath that makes exercise, sports, or any physical activity more difficult and may make asthma symptoms worse or lead kids to develop the condition
• restless sleep or breathing problems at night, such as obstructive sleep apnea
• a tendency to mature earlier (overweight kids may be taller and more sexually mature than their peers, raising expectations that they should act as old as they look, not as old as they are; overweight girls may have irregular menstrual cycles and fertility problems in adulthood)
• liver and gall bladder disease

Cardiovascular risk factors (including high blood pressure, high cholesterol, and diabetes) that develop in childhood can lead to heart disease, heart failure, and stroke in adulthood. Preventing or treating overweight and obesity in kids may lower their risk of cardiovascular disease as they get older.

Obese kids also might have emotional issues to deal with (such as low self-esteem), and may be teased, bullied, or rejected by peers. Kids who are unhappy with their weight can be more likely than average-weight kids to:

• develop unhealthy dieting habits and eating disorders, such as anorexia nervosa and bulimia
• be prone to depression
• be at risk for substance abuse

Is My Child Overweight?

Body mass index (BMI) uses height and weight measurements to estimate a person’s body fat. But calculating BMI on your own can be complicated. An easier way is to use a BMI calculator.

Once your child’s BMI is known, it can be plotted on a standard BMI chart. Kids ages 2 to 19 fall into one of four categories:

1. underweight: BMI below the 5th percentile
2. normal weight: BMI at the 5th and less than the 85th percentile
3. overweight: BMI at the 85th and below 95th percentiles
4. obese: BMI at or above 95th percentile

BMI calculations aren’t used to estimate body fat in babies and young toddlers. For kids younger than 2, doctors use weight-for-length charts to determine how a baby’s weight compares with his or her length. Any child who falls at or above the 85th percentile may be considered overweight.

BMI is not a perfect measure of body fat and can be misleading in some situations. For example, a muscular person may have a high BMI without being overweight (extra muscle adds to body weight — but not fatness). Also, BMI might be hard to interpret during puberty when kids have periods of rapid growth. It’s important to remember that BMI is usually a good indicator — but is not a direct measurement — of body fat.

If you’re worried that your child or teen may be overweight, make an appointment with your doctor, who will ask about eating and activity habits and make suggestions on how to make positive changes. The doctor also may order blood tests to look for some of the medical problems associated with obesity.

Depending on your child’s BMI (or weight-for-length measurement), age, and health, the doctor may refer you to a registered dietitian for additional advice and, possibly, might recommend a comprehensive weight management program.

Causes of Overweight

A number of things contribute to becoming overweight. Dietary and lifestyle habits, lack of exercise, genetics, or a combination of these can be involved. In some instances, endocrine problems, genetic syndromes, and medicines can be linked to excessive weight gain.

Diet and Lifestyle

Much of what we eat is quick and easy — from fat-laden fast food to microwave and prepackaged meals. Daily schedules are so jam-packed that there’s little time to prepare healthier meals or to squeeze in some exercise. Portion sizes, in the home and out, have grown greatly.

Plus, now more than ever life is sedentary. Kids spend more time playing with electronic devices — from phones and tablets to computers and video game systems — than actively playing outside. Television is a major culprit.

Kids younger than 6 spend an average of 2 hours a day in front of a screen, mostly watching TV, DVDs, or videos. Older kids and teens average 4½ hours a day watching TV, DVDs, or videos. When computer use and video games are included, time spent in front of a screen increases to more than 7 hours a day! In other words, many kids spend almost all of their after-school free time in front of one screen or another.

Kids who watch TV more than 4 hours a day are more likely to be overweight compared with kids who watch 2 hours or less. Not surprisingly, TV in the bedroom is also linked to increased likelihood of being overweight.

The American Academy of Pediatrics (AAP) recommends that children and teens spend no more than 1-2 hours a day using entertainment media and discourages any screen time for children younger than 2 years old. The AAP recommends that no TVs, computers, or video games be in children’s bedrooms and that screens be turned off during mealtimes.

Exercise and Physical Activity

Many kids don’t get enough physical activity. Although physical education (PE) in schools can help kids get up and moving, more and more schools are cutting PE programs.

Kids should be active every day. Older kids and teens should get 60 minutes of moderate to vigorous exercise or physical activity, including aerobic and muscle- and bone-strengthening activities. Children ages 2 to 5 years should play actively several times each day.

Genetics

Genetics also can play a role in what kids weigh. Our genes help determine body type and how the body stores and burns fat just as they influence other traits. Genes alone, however, cannot explain the current obesity crisis. Because both genes and habits can be passed down from one generation to the next, multiple members of a family may struggle with weight.

People in the same family tend to have similar eating patterns, maintain the same levels of physical activity, and adopt the same attitudes toward being overweight. A child’s risk of obesity greatly increases if one or more parent is overweight or obese.

Preventing Overweight and Obesity

The key to keeping kids of all ages at a healthy weight is taking a whole-family “practice what you preach” approach. Make healthy eating and exercise a family affair. Get your kids involved by letting them help you plan and prepare healthy meals, and take them along when you go grocery shopping so they can learn how to make good food choices.

Try to avoid these common food/eating behavior traps:

• Don’t reward kids for good behavior or try to stop bad behavior with sweets or treats. Come up with other ways to change behavior.
• Don’t maintain a clean-plate policy. Be aware of kids’ hunger cues. Even babies who turn away from the bottle or breast send signals that they’re full. If kids are satisfied, don’t force them to continue eating. Reinforce the idea that they should only eat when they’re hungry.
• Don’t talk about “bad foods” or completely eliminate all sweets and favorite snacks from kids’ diets. Kids may rebel and overeat these forbidden foods outside the home or sneak them in on their own.

Recommendations by Age

Additional recommendations for kids of all ages:

• Birth to age 1: In addition to its many health benefits, breastfeeding may help prevent excessive weight gain. Breastfed babies may be more able to control how much they eat and follow their own internal hunger cues.
• Ages 1 to 5: Start good habits early. Help shape food preferences by offering a variety of healthy foods. Encourage kids’ natural tendency to be active and help them build on developing skills.
• Ages 6 to 12: Encourage kids to be physically active every day, whether through an organized sports team or a pick-up game of soccer during recess. Keep your kids active at home, too, through everyday activities like walking and playing in the yard. Let them be more involved in making good food choices, such as packing lunch.
• Ages 13 to 18: Teens like fast food, but try to steer them toward healthier choices like grilled chicken sandwiches, salads, and smaller portion sizes. Teach them how to prepare healthy meals and snacks at home. Encourage teens to be active every day.
• All ages: Cut down on TV, computer, and video game time and discourage eating in front of a screen (TV or otherwise). Serve a variety of healthy foods and eat family meals together as often as possible. Encourage kids to eat breakfast every day, have at least five servings of fruits and vegetables daily, and limit sugar-sweetened beverages.

If you eat well, exercise regularly, and build healthy habits into your daily life, you’re modeling a healthy lifestyle for your kids. Talk to them about the importance of eating well and being active, but make it a family affair that will become second nature for everyone.

Most of all, let your kids know you love them — no matter what their weight — and that you want to help the whole family be happy and healthy.

Many young kids put nonfood items in their mouths at one time or another. They’re naturally curious about their environment and might, for instance, eat some dirt out of the sandbox. Kids with pica, however, go beyond this innocent exploration of their surroundings.

About Pica

The word pica comes from the Latin word for magpie, a bird known for its large and indiscriminate appetite.

Pica is most common in people with developmental disabilities, like autism and intellectual disabilities, and in children between the ages of 2 and 3. Pica also may surface in children who’ve had a brain injury affecting their development. It can also be a problem for some pregnant women, as well as people with epilepsy.

People with pica frequently crave and eat nonfood items such as:

• dirt
• clay
• paint chips
• plaster
• chalk
• cornstarch
• laundry starch
• baking soda
• coffee grounds
• cigarette ashes
• burnt match heads
• cigarette butts
• feces
• ice
• glue
• hair
• buttons
• paper
• sand
• toothpaste
• soap

Pica is an eating disorder that can result in serious health problems, such as lead poisoning and iron-deficiency anemia.

Signs of Pica

Warning signs that a child may have pica include:

• eating of nonfood items, despite efforts to restrict it, for a period of at least 1 month or longer
• the behavior is considered inappropriate for your child’s age or developmental stage
• the behavior is not part of a cultural, ethnic, or religious practice

Why Do Some People Eat Nonfood Items?

The specific causes of pica are unknown, but certain conditions and situations can increase a person’s risk:

• nutritional deficiencies, such as iron or zinc, that may trigger specific cravings (however, the nonfood items craved usually don’t supply the minerals lacking in the person’s body)
• dieting — people who diet may attempt to ease hunger by eating nonfood substances to get a feeling of fullness
• malnutrition, especially in developing countries, where people with pica most commonly eat soil or clay
• cultural factors — in families, religions, or groups in which eating nonfood substances is a learned practice
• parental neglect, lack of supervision, or food deprivation — often seen in children living in poverty
• developmental problems, such as mental retardation, autism, other developmental disabilities, or brain abnormalities
• mental health conditions, such as obsessive-compulsive disorder (OCD) and schizophrenia
• pregnancy, but it’s been suggested that pica during pregnancy occurs more frequently in women who exhibited similar practices during their childhood or before pregnancy or who have a history of pica in their family

Eating earth substances such as clay or dirt is a form of pica known as geophagia, which can cause iron deficiency. One theory to explain geophagia is that in some cultures, eating clay or dirt is believed to help relieve nausea (and therefore, morning sickness), control diarrhea, increase salivation, remove toxins, and alter odor or taste perception.

Some people claim to enjoy the taste and texture of dirt or clay or other non-food item, and eat it as part of a daily habit (much like smoking is a daily routine for others). Pica may also be a behavioral response to stress.

Another explanation is that pica is a cultural feature of certain religious rituals, folk medicine, and magical beliefs. For example, some people in various cultures believe that eating dirt will help them incorporate magical spirits into their bodies.

None of these theories, though, explains every form of pica. A doctor must treat each case individually to try to understand what’s causing the condition.

When to Call the Doctor

If your child is at risk for pica, talk to your doctor. If your child has consumed a harmful substance, seek medical care immediately. If you think your child has ingested something poisonous, call Poison Control at (800) 222-1222.

A child who continues to consume nonfood items may be at risk for serious health problems, including:

• lead poisoning (from eating lead-based paint chips or dirt contaminated with lead)
• constipation or diarrhea (from consuming indigestible substances like hair, cloth, etc.)
• intestinal obstruction or perforation (from eating objects that could block or injure the intestines)
• tooth or mouth injuries (from eating hard substances that could harm the teeth)
• parasitic and other infections (from eating dirt, feces, or other infected substances)

Medical emergencies and death can occur if the craved substance is toxic or contaminated with lead or mercury, or if the item forms an indigestible mass blocking the intestines. Pica involving lead-containing substances during pregnancy may be associated with an increase in both maternal and fetal lead levels.

What Will the Doctor Do?

Your doctor will play an important role in helping you manage and prevent pica-related behaviors, educating you on teaching your child about acceptable and unacceptable food substances. The doctor will also work with you on ways to to restrict the nonfood items your child craves (i.e., using child-safety locks and high shelving, and keeping household chemicals and medications out of reach).

Some kids require behavioral intervention and families may need to work with a psychologist or other mental health professional.

Medication may also be prescribed if pica is associated with significant behavioral problems not responding to behavioral treatments.

Your doctor may check for anemia or other nutritional deficiencies. A child who has ingested a potentially harmful substance, such as lead, will be screened for lead and other toxic substances and might undergo stool testing for parasites. In some cases, X-rays or other imaging may be helpful to identify what was eaten or to look for bowel problems, such as an obstruction.

Fortunately, pica usually improves as kids get older. But for individuals with developmental or mental health concerns, pica may continue to be problem. Ongoing treatment and maintaining a safe environment and are key to managing this condition.