Appetite is defined as the desire for food, while appetite loss can be defined as a lack of interest in food. Loss of appetite can occur in all age groups, but is particularly common in preschool children (aged 1 to 6 years). There is not a single cause for loss of appetite. Many organic (physical) and non-organic (psychological) conditions can lead to loss of appetite. Therefore, children suspected of having loss of appetite should be evaluated by a specialist, underlying reasons for the loss of appetite should be investigated, and the treatment should be planned accordingly.
Organic Causes
Organic causes underlying loss of appetite arise from various physical and metabolic problems in the body. Conditions like congenital heart diseases, neurological problems, acute and chronic infections, gastroesophageal reflux, digestive disorders, cystic fibrosis, chronic liver, and kidney diseases can all cause loss of appetite.
It should be noted that less than half of the cases of appetite loss are due to organic reasons. Various diagnostic and laboratory tests should be carried out to investigate whether there is an organic cause underlying loss of appetite and if there is, the primary goal should be to treat that disease. Organic causes are examined under different headings below.
Parasites and Other Gastrointestinal Infections:
Intestinal parasites are one of the prominent reasons for loss of appetite in children. Parasites can cause loss of appetite either directly or by leading to metabolic problems such as iron deficiency and vitamin B12 deficiency. If your child is experiencing abdominal pain, drooling at night, and itching in the anal area in addition to loss of appetite, the likely reason may be parasites.
Furthermore, gastric and intestinal infections are also significant reasons for loss of appetite in children. In such children, symptoms may include vomiting, abdominal pain, diarrhea, and fever alongside loss of appetite.
Constipation:
Constipation is particularly a significant reason for loss of appetite in pediatric patients. If a child is experiencing both constipation and loss of appetite, constipation should be treated as a priority.
Swallowing Difficulties:
Swallowing difficulties are a major reason for loss of appetite and food refusal in infants and non-speaking children. The reason for swallowing difficulties may be food allergies, acid reflux, or structural anomalies in the esophagus and stomach. In such cases, the child may not want to eat because they feel discomfort when eating.
Developmental Delay/Neurological Diseases:
In children with a structural disorder due to neurological damage, loss of appetite and food selectivity can be observed. The extreme selectivity and reluctance towards foods in these children can be due to delays in motor function development. Children with developmental disabilities generally tend to reject solid foods.
Iron Deficiency:
Reduced appetite can be seen as a consequence of iron deficiency in children. In a study conducted in our country, one-third of children who presented to the pediatric clinic due to loss of appetite were found to have iron deficiency. Evaluation results have shown that reduced appetite due to iron deficiency could be attributed to an increase in appetite-suppressing hormones. In children with iron deficiency and loss of appetite, returning to normal appetite has been observed with iron therapy.
Vitamin B12 Deficiency:
Loss of appetite is also a symptom of vitamin B12 deficiency, which is characterized by forgetfulness, palpitations, weakness, mood disorders (depression and excessive irritability), attention deficits and focus issues, numbness, weakness, fatigue, among other complaints.
Zinc Deficiency:
It is known that zinc deficiency, which plays an important role in cell growth, differentiation, and the immune system, can lead to loss of appetite in babies and children. Loss of appetite ranks at the top among the symptoms of zinc deficiency. Since zinc deficiency can be a significant cause of loss of appetite, zinc-containing supplements are frequently recommended in pediatric clinics.
Infections:
Loss of appetite that occurs in all infectious diseases (upper and lower respiratory tract infections, gastrointestinal infections, urinary tract infections, etc.) usually returns once the illness is resolved. Loss of appetite due to acute infections is temporary. In chronic infections, loss of appetite can become persistent.
Non-Organic/Psychological Causes
Non-organic causes are primarily behavioral and have no relation to any physical illness. Psychosocial factors such as inadequate nutrition knowledge of the parents, lack of care, or communication problems between the caregiver and the child can be given as examples.
The reasons underlying loss of appetite can stem from the child's emotional need for maternal care, seeking attention by showing anger toward the mother, or a need to demonstrate increased autonomy with age. Psychological satisfaction should be achieved before attempting to establish appropriate feeding behaviors in these children.
Additionally, loss of appetite and eating disorders that develop due to psychological reasons are often indicated to have originated from abnormal feeding practices performed by parents or caregivers. Continuous continuation of such practices can further increase the child's loss of appetite, leading to a vicious cycle.
Common erroneous feeding behaviors that can lead to loss of appetite include:
The development of taste preferences and taste perception (palate) in babies and children can hinder the acceptance of certain foods. Therefore, pressuring children to consume new foods they reject may backfire. Rejection of new foods should not always be interpreted as loss of appetite.
A stressful eating environment prevents children from responding positively to new foods. Loss of appetite can be confused with various conditions such as food phobia; refusal of certain foods due to taste preferences is defined as food refusal. Food selectivity; refusal of both familiar and newly tried foods is described as food aversion. It is generally stated to be a consequence of diets lacking food variety. Both conditions can be corrected with a proper approach.
It is pointed out that presenting a food to a child as many as 8-15 times without pressure has been effective in resolving selective eating behavior. Preparing foods that attract the child's attention by providing shapes they love can be beneficial, and involving the child in the preparation process often yields positive results. Increasing food variety should be the primary focus. In this respect, trial and error with mutually exclusive foods can be done.
In children with other feeding difficulties such as food fear, the primary goal in solving the problem should be to reduce the anxiety related to eating. Especially in babies and small non-speaking children, attention should be paid to whether crying is caused by nutrition. Finding the reason for severe and extreme food fear should be the main focus. In some children, an early transition to solid foods may be helpful.
Conclusion:
Loss of appetite, selective eating, and food phobias are quite common health problems during childhood and early periods. Although many of the underlying factors for each feeding challenge may stem from non-organic reasons, especially in growing young children, a detailed dietary history should first be taken, symptoms and signs should be evaluated, and in-depth examination and physical examination should be carried out to rule out any underlying organic causes. In the presence of identified organic causes, the primary focus should be on treating these conditions. On the other hand, for developing feeding problems, a nutritional program containing energy and essential nutrients suitable for the child's age may aid in effectively treating the feeding issue.
Recommendations for Loss of Appetite:
In conclusion, loss of appetite seen in childhood and left unattended in the early period affects both the child's eating style and eating-related behaviors in later years. Therefore, factors that may cause loss of appetite should be identified early, and the child's growth and development should be closely monitored. To solve the problem of loss of appetite, doctors, dieticians, psychiatrists, psychologists, social workers should collaborate with the family in a multidisciplinary approach.
