Clincial Tip: Is the child eating enough? Answers for anxious mothers

December 1, 2006

About six times a week, a mother of an 18-month-old, or a 2-year-old, or a 3-year-old complains to me that the child just won't eat and hasn't gained a lot of weight in several months. After quickly examining the child, while the mother explains that she is throwing away a lot of food, I ask the mother, "How is your child's activity level?" The answer is always "he (she) is tearing up the house and driving me crazy." I reply, "That's a good sign. Now if you'll excuse me for just a few minutes, I'll demonstrate to you why it's a good sign." I then leave the room and quickly graph a few points on the child's growth chart using weights from previous visits. More often than not, growth has been consistently appropriate.

About six times a week, a mother of an 18-month-old, or a 2-year-old, or a 3-year-old complains to me that the child just won't eat and hasn't gained a lot of weight in several months. After quickly examining the child, while the mother explains that she is throwing away a lot of food, I ask the mother, "How is your child's activity level?" The answer is always "he (she) is tearing up the house and driving me crazy." I reply, "That's a good sign. Now if you'll excuse me for just a few minutes, I'll demonstrate to you why it's a good sign." I then leave the room and quickly graph a few points on the child's growth chart using weights from previous visits. More often than not, growth has been consistently appropriate.

Armed with this information, I reenter the room and show the mother how well the child has grown. I also point out that the increase in weight between 12 and 18 months is smaller than the increase between 0 and 6 months; the child has gained weight but not as fast as in the first year. I explain that the child doesn't need a lot of calories to gain weight and therefore is eating relatively less. I emphasize that as long as the youngster's activity level is normal and weight gain is appropriate, he should do fine if provided with plenty of water and a well-balanced diet.

When I use this approach, only about one mother in 50 still insists that something else is wrong and asks that the child be referred to a specialist or sent for tests.