Nutritional care instruction for anorexic children

12/05/2023

The period from 1 to 5 years old is the “golden age” that determines a child’s future stature, however this is also the time when children face many health and nutritional problems, especially anorexia. An appropriate nutritional content allows children to overcome the problem of anorexia and continue their growth momentum.

The importance of nutrition for children with anorexia

Nutrition and anorexia are two factors with mutual interaction. Children who have anorexia, having insufficient food and portions, lacking of some food groups may result in worse  nutritional status. Long-term anorexia can lead to energy-protein and micronutrient malnutrition. On the other hand, malnutrition in energy, protein and micronutrients also changes taste, making children lose their appetite for any type of food. The lack of micronutrients also makes the child’s immune system weaker than normal, thereby increasing the risk of respiratory and gastrointestinal infections, and causing anorexia due to the above medical problems.

Nutrition and anorexia are two factors with mutual interaction. (Photo: Freepik)

Nutrition and anorexia are two factors with mutual interaction. (Photo: Freepik)

To stop this endless “anorexia loop”, children need to be monitored and identified for nutritional deficiencies so that timely intervention can be taken before malnutrition becomes too severe and increases the risk of death in children. So how to properly supplement children’s nutrition, and which micronutrients play important role in children’s appetite? Below are these answer to the above questions

Tips for children to overcome psychological anorexia

Below are some tips compiled from domestic and foreign documents for anorexia in children:

– Only give children complementary foods when they turn 6 months old, do not give them complementary foods too early or too late.

– Give children enough food and meals according to their age’s physiological needs. Children can be fed different meals a day, however the gap should not be too close. Especially do not let children eat snacks before meals, that makes them feel full, lose their appetite, and refuse to have main dish with foods rich in nutrition.

– Feed your child when he or she feels hungry. Do not force him or create a bad impression about the meal.

– Limit your child’s eating time to 20-30 minutes. After meals, do not let children come into contact with food, so they will not lose their appetite at the next meal.

– Let children have physical activities or take a shower before eating, which helps them feel hungry.

Children having physical activities before meal to create a feeling of hunger and stimulate appetite. (Photo: Freepik)

Children having physical activities before meal to create a feeling of hunger and stimulate appetite. (Photo: Freepik)

– Let children eat with friends and family, encourage them to eat, and set an example for them in eating.

– Children should be allowed to feed themselves, hold their own food, and support them when needed.

– Introduce a variety of new foods step by step.

– Vitamins and minerals can be supplemented if meal quality is not guaranteed.

– Take your child to the doctor in case of medical symptoms such as illness, fever, cough, diarrhea, no weight gain for two consecutive months, long-term loss of appetite, less physical activity.

Types of micronutrients enables appetite of children

Zinc: According to the Hanoi Department of Health, Zinc is an important trace element, an indispensable component in the human body. Zinc participates in cell structure components, affects most biological processes in the body, activates many different enzymes, and selectively affects the synthesis and degradation of nucleic acids and proteins – these the most important ingredient of life.

Zinc is introduced into the body mainly through the digestive tract and is absorbed in the small intestine. In recent years, research on Zinc and its role in growth and development has received special attention from the medical community. More and more evidence confirms the importance of Zinc in most functional organs of the body and Zinc deficiency has become a public health risk that needs to be actively prevented.

Zinc has been proven to be a mineral that helps create appetite and desire for food. In fact, one of the symptoms of Zinc deficiency in children is anorexia and loss of appetite. Even when children are not deficient in this micronutrient, zinc supplementation also promote their appetite A clinical study by Khademian and colleagues in 2013 in Iran demonstrated the effects of supplementing 10 mg of Zinc/day for 12 weeks for children 2 – 6 years old to help increase the amount of food consumed and increase their appetite, regardless of whether the child has a Zinc deficiency or not. Zinc is an essential trace element that contributes to the activity of approximately 300 enzymes in the body involved in various physiological functions. Zinc can improve taste disorders and salivation rate thanks to its ability to stimulate neuropeptides related to feeding reflexes in the nervous system in the hypothalamus.

Zinc is a mineral that helps create appetite and desire for food in children. (Photo: Freepik)

Zinc is a mineral that helps create appetite and desire for food in children. (Photo: Freepik)

B Vitamins: B vitamins also play an important role in stimulating appetite in children. A clinical study on children from 4 to 10 years old published in the Journal of Nutrition has demonstrated the effectiveness of a diet supplemented with B vitamins, which will increase from 17 to 25% grams of food consumed by children daily, thereby increasing the amount of calories absorbed into the body, helping children gain weight. Vitamin B deficiency causes appetite loss, so caregivers need to pay attention to supplementing these vitamins to prevent anorexia.

The mechanism of action of B vitamins produces many different effects and results on the body. According to the Hanoi Department of Health, correctly understanding this factor helps avoid arbitrary supplementation of B vitamins, while optimizing nutritional health in children. Foods corresponding to each type of Vitamin B also need to be considered in order to supplement the correct and sufficient nutrients to suit the unique needs of the child’s body.

Vitamin B1

Vitamin B1 (thiamine) plays an important role in the metabolism of carbohydrates, amino acids, fats, sugars and alcohol. Without Vitamin B1, the body will have difficulty metabolizing sugar (glucose), leading to serious loss of energy. B1 deficiency can also cause edema of tissues, disturbances in nerve conduction and reduced ability of cells to use oxygen (O2).

Foods rich in Vitamin B1 present in children’s daily meals such as vegetables, beans, eggs, milk, meat, and fish.

Vitamin B2

Vitamin B2 (riboflavin) helps the body easily metabolize carbohydrates and proteins, as well as fully preserve cell membranes. Without enough Vitamin B2, children will easily experience symptoms such as stomatitis, glossitis, skin lesions, cracked lips, watery eyes, etc., while also affecting daily eating habits and operation of the liver, causing hypoglycemia, coma, even sudden death, and seizures.

Vitamin B2 can be supplemented for children through daily natural foods: eggs, mushrooms, liver, yogurt, bread, green vegetables, meat.

Vitamin B3

Vitamin B3 (Vitamin PP – niacin) participates in carbohydrate and cell metabolism, and participates in the oxidation reduction reaction process. Without niacin, children may suffer from serious illness symptoms, including digestive disorders. Common manifestations are inflammation of the oral mucosa, gastritis, and gastrointestinal mucosa accompanied by diarrhea or rectal bleeding. These factors seriously affect children’s daily diet, causing poor eating and loss of appetite.

Vitamin B3 can be supplemented from foods of animal origin (shrimp, crab, meat, fish, snails, frogs,…); vegetables (bean sprouts, spinach, squash, red amaranth,…) or other foods of plant origin (green beans, peanuts, sesame, soybeans,…)

Vitamin B6

Vitamin B6 (biotin) participates in nitrogen metabolism, nucleic acid biosynthesis, plays an essential role throughout the metabolism of lipids, proteins, and glucid, as well as the synthesis of some neurotransmitters. Vitamin B6 also assists in maintaining the health of red blood cells, the nervous system and other parts of the immune system.

Vitamin B6 can be supplemented with foods such as green vegetables, tomatoes, whole grains, liver, meat, eggs, fish, fruits (corn, grapes, apples, pineapples).

Vitamin B9

Vitamin B9 (Folic Acid) synthesizes purines and pyrimidines to mature red blood cells, and participates in the methionine development process of the fetal nervous system. Vitamin B9 deficiency can cause physical weakness, memory loss, rapid heartbeat, and affect children’s eating habits and appetite.

Caregivers should therefore be careful to let children use food sources rich in Vitamin B9 such as green vegetables, cheese, beans, mushrooms, and flowers (oranges, bananas),…

Vitamin B12

Vitamin B12 is the only vitamin of group B that participates in the process of regenerating and repairing peripheral nerves. At the same time, this is also a group of vitamins that the body cannot produce on its own, meaning it must be supplemented from the daily diet or with medication as prescribed by a doctor (in case of severe Vitamin B12 deficiency).

Vitamin B12 can be supplemented for children from animal foods such as chicken, lamb, eggs; or yogurt, milk, mushrooms.

Iron: Iron: Children with anemia due to a lack of iron in the body often have symptoms of anorexia and loss of appetite. A clinical study by Dogan and colleagues in 2013 showed a positive effect of oral iron supplementation in increasing appetite in children with anemia

According to the National Institute of Nutrition, iron plays an extremely important role in children, as they are the most susceptible to iron deficiency. Iron and hemoglobin proteins transport oxygen, so children with iron deficiency will be at risk of nutritional anemia, leading to lack of oxygen in the heart, brain, and muscles. This phenomenon causes rapid heartbeat, dizziness, vertigo, body fatigue, children cannot concentrate and often falls asleep. Especially in the long term, it causes children to suffer from anorexia, stunting, slow growth, and constipation, or vomiting.

Besides, iron deficiency also affects the functioning of the circulatory system in the body:

Digestive system: children experience atrophic inflammation of the lingual papillae, malabsorption, difficulty swallowing food, reduced gastric acidity, and severe anorexia..

Nerve system: children are tired, have difficulty concentrating, easily agitated, and have nerve conduction disorders

Immune system: immune health declines, children often get sick, and thus easily lose their appetite and lose their appetite

Iron is an extremely important micronutrient, so caregivers need to pay special attention to providing enough iron for children through a properly designed nutritional diet. According to MSc Le Thi Hai, it is necessary to pay attention to a few of the following factors to properly supplement iron, improve nutritional health in children, prevent and contribute to effective treatment of anorexia.

Children from 0 – 6 months old: exclusive breastfeeding continues until 24 months

Children 6 months and older: Supplement sufficient food from 4 groups of substances (carbohydrates, fats, proteins, vitamins, mineral salts), focusing on foods rich in iron and vitamin C (which plays a role in enhancing iron absorption), especially especially green vegetables and ripe fruits such as oranges, bananas, tangerines, grapefruits, and mangoes,…

Lysine: Lysine is an essential amino acid important for child growth and helps increase hormone levels that promote appetite and regulate feelings of fullness. Not only does it help children eat well, Lysine also plays a role in increasing metabolism and maximum absorption of nutrients to optimize height.

growth and prevent osteoporosis. In addition, this nutrient also has many other optimal uses for functional activities in the body:

  • Build muscle, regenerate tissue after surgery or injury
  • Stimulates the production of digestive enzymes, effectively digesting the digestive process
  • Promotes the production of Carnitine – an essential nutrient in the process of converting fat into energy, while reducing the amount of Cholesterol in the blood

A clinical study on children from 6 months to 5 years old has proven that supplementing lysine and vitamin B12 has positive effects in the treatment of anorexia in children of this age.

According to the Ho Chi Minh City Nutrition Research Institute, Lysine deficiency is common in children with prolonged anorexia or children who do not like to eat foods rich in Lysine, leading to fatigue, dizziness, nausea, anorexia, agitation, slow growth in height, anemia, etc. At this time, it is necessary to choose foods rich in Lysine for processing, and at the same time supplement foods with added Lysine (eg milk) or take supplements. Supplement Lysine upon request from the doctor because anorexic children often eat very little.

A food is considered to have enough Lysine when it contains at least 51 mg of Lysine in 1 gram of food protein (minimum 5.1% Lysine of total protein). Therefore, caregivers need to focus on foods such as fish, red meat, lamb, poultry, egg yolks, and beans,…

Supplementing appropriate micronutrients helps children eat better (Photo: Freepik)

Supplementing appropriate micronutrients helps children eat better (Photo: Freepik)

Thus, nutrition and anorexia are extremely closely related: Children with long-term anorexia will lead to malnutrition, and malnourished children have prolonged anorexia. In order for children to overcome anorexia, caregivers need to closely monitor the child’s nutritional status and take appropriate nutritional supplements to improve his/her appetite.

REFERENCES:

  1.  Leung AK, Marchand V, Sauve RS; Canadian Paediatric Society, Nutrition and Gastroenterology Committee. The ‘picky eater’: The toddler or preschooler who does not eat. Paediatr Child Health. 2012 Oct;17(8):455-60. doi: 10.1093/pch/17.8.455. PMID: 24082809; PMCID: PMC3474391.
  2. Bộ Y tế (2015), Nuôi dưỡng trẻ nhỏ (Tài liệu dùng cho Cán bộ y tế công tác trong lĩnh vực chăm sóc sức khỏe bà mẹ – trẻ em tại các tuyến).
  3. Neil F. Shay, Heather F. Mangian, Neurobiology of Zinc-Influenced Eating Behavior, The Journal of Nutrition, Volume 130, Issue 5, May 2000, Pages 1493S–1499S, https://doi.org/10.1093/jn/130.5.1493S
  4. Khademian M, Farhangpajouh N, Shahsanaee A, Bahreynian M, Mirshamsi M, Kelishadi R. Effects of zinc supplementation on subscales of anorexia in children: A randomized controlled trial. Pak J Med Sci. 2014 Nov-Dec;30(6):1213-7.
  5. Yagi T, Asakawa A, Ueda H, Ikeda S, Miyawaki S, Inui A. The role of zinc in the treatment of taste disorders. Recent Pat Food Nutr Agric. 2013 Apr;5(1):44-51. doi: 10.2174/2212798411305010007. PMID: 23305423.
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