The Child Who Won't Eat

To cover this subject properly in a few pages is nearly impossible. It touches on so many psychological, emotional, and dietary problems at once.
Yet thinking of the thousands of children I have examined whose lack of appetite threw their mothers into crisis and poisoned the atmosphere of countless homes, I want to try to summarize the essentials of this "oppositional anorexia" — so common it is.
It often begins around six months. The child wants to leave something in the bottle, but the parents insist he finish it. The meal stretches on and on. Or a new food — vegetables, say — is introduced too abruptly. The child is startled and spits out this "foreign object." All would go well if the mother simply waited and tried again a few days later with a tiny piece of vegetable, just to let him taste it. Instead, he spits it out at every attempt. Systematic opposition begins: first to this food, then to others. At first it is calm refusal. The child does not swallow and pushes the food away with his tongue. Then the meal becomes endless — a cycle of pleas and threats, punishments and distractions. Often vomiting follows. So much effort, apparently for nothing. The mother despairs. The child is satisfied.

The child's refusal at mealtimes will soon spark tantrums of a very different kind

The child's refusal at mealtimes will soon spark tantrums of a very different kind
Between meals, the child is cheerful, full of energy, calm. He is well. Perhaps a bit thin. Should we worry about this pattern? Yes — for two reasons:

• For the child himself: even if his health seems good, the imbalance in his diet always takes a toll on his body. But the greater problem is educational. The child's refusal at mealtimes, understandable at first, will soon spark tantrums of a very different kind.


• And even if the child is well, the same cannot be said for the mother. She is anxious and exhausted. The family's equilibrium suffers. All of this over a misunderstanding.

A battle of wills?

In essence, the conflict is simple: the parents want their child to eat what they prepare — in the right quantity and quality. The child refuses because he is being forced. Are these abnormal parents? No. They are anxious about their child, so their anxiety is understandable. But they insist on an ideal portion size when different children have different needs. They envy their nephew's appetite. They cannot accept a loss of appetite caused by mild illness or emotional upset. This rigidity transforms what began as a simple, justified defensive reaction in the child into stubborn oppositional anorexia. Two other very important elements soon join in:

1. The satisfaction of capturing mother's attention — something children with a deep need for affection find irresistible. What a powerful tool for exploiting her anxiety!


2. A genuine absence of hunger. What started as refusal of excess food becomes concrete lack of appetite, caused by poor stomach function. Meals that are too long, too frequent, do not give his stomach time to rest.

Breaking the cycle

Once we understand all this, treatment becomes simple.
Stop the oppositional reaction: let the child eat according to his appetite. The need to eat will guide him surely, and he will eat more than he does when forced. In the first days, it is crucial to offer him minimal portions and not worry when he refuses an entire meal. Offer him something to drink instead. End his use of mealtimes to capture mother's attention. Remain calm and, above all, completely indifferent to his appetite. Never mention this problem — not during meals, not at any other time. Show no reaction whether his plate comes back full or empty.
But this indifference about appetite must be balanced by a loving attitude. Give him what he is really asking for with his anorexia. His appetite will return once we correct certain dietary mistakes — especially the failure to let his stomach rest:

• Meals must be brief. A bottle should last no more than fifteen minutes. With an older child, when he stops wanting to eat, remove his plate without any fuss.


• Space meals far apart — five hours or more between them. Serve four meals a day, or even three. Above all, give him nothing between meals.

It is very important to restore a balanced, varied diet. The child should eat according to his appetite, but if he eats little, he should eat a little of everything. If he refuses one dish, do not compensate by giving him a larger portion of the next course.
It sounds too simple. I know it does. But I also know how much love it takes for parents to accept some guidance in child-rearing and dietary knowledge when they came hoping for a miracle pill. Sometimes it frustrates them.

A child's lack of appetite has thrown countless mothers into crisis and poisoned the atmosphere of countless homes

A child's lack of appetite has thrown countless mothers into crisis and poisoned the atmosphere of countless homes

Some parents will decide to "try" this approach, but without real conviction. The child sees it immediately and continues to exploit their anxiety. Others will leave reassured and happy, knowing their child is normal even if he "economizes." They will find their health restored — and their child with them, gaining back the lost weight.
Using this method, I have had the satisfaction of serving many children and, above all, of bringing peace and joy back to many families. The meal, which had become a nightmare, reclaimed its proper place as a calm, restful moment — something so important in family life.

- Paul Lemoine, 1989 (O. et L. n. 85)