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How commonly do we encounter the following scenario?
A desperately anxious mother at last convinces her GP that she needs to see a paediatrician because her normally growing toddler is eating nothing. The paediatrician wonders why his time is being wasted, and “reassures” the mother that there is nothing to worry about. Needless to say the anxiety persists with, no doubt, damaging consequences. As a profession, we handle these cases poorly. With 30% of preschool children suffering from mild to moderate eating problems, we need a better way to address these issues.
The Royal College of Psychiatrists has produced this small book for parents that should prove helpful, not only to parents but also to paediatricians and other health professionals. It provides information about the epidemiology of eating problems, and gives a useful classification, categorising eating difficulties into nine types, including persistence of eating inappropriate texture of food for age, food refusal, restrictive eating and selective eating. This allows the parent or professional to come to a more specific “diagnosis”, and also a sense of the anticipated course these difficulties are likely to take. In particular, it provides clear pointers for those conditions that are indicative of significant emotional or psychiatric conditions.
Giving clear indications to the parent as to when to worry is helpful, as it is likely to encourage a sense of proportion to the anxiety accompanying the more common eating difficulties. The book goes on to provide specific and sensible advice about the practical management for each of the different types of eating difficulty.
At the end of the day, one is left with the finding that for most parents, not surprisingly, reassurance is what is required. I felt, however, that this book could help us proffer the advice in a more substantive form than we do at present, and can give us an approach that is likely to help diffuse the anxiety which contributes to the perpetuation of stressful mealtimes. I suspect the book will prove to be of most value to health visitors, but selected reading could be of use to the paediatrician too.
This book is therefore of value for a problem that presents so frequently to the general paediatrician, but I must admit to some reservations. It could have been better written, and in particular was rather unnecessarily repetitive. It certainly would have benefitted from paediatric review—I wondered who or what a community practitioner was, and gulped when I saw growth hormone mentioned in the section of treatment for restrictive eating! It was rather more concerning that children with disabilities got an occasional mention, implying that they merited the same sort of approach. It surely would have been better to emphasise that they require a different sort of understanding and input. But, despite these concerns, the book should prove useful as it provides a systematic approach to the child with eating difficulties, and some clear, sensible practical advice to guide the parent in handling the problem.