Help for Eating Problems in Children with ADHD

Some ADHD children may be underweight. Here are some ideas for getting your ADHD child to eat more.

Many parents of children with ADHD worry that their child is not eating enough, and that their child is light for his/her height.

This can be for a number of reasons:

• The child won't sit still long enough to eat much.

• The child is so busy and hyperactive that he/she burns off such a lot of energy that he/she actually needs to eat more than other children of the same size just to keep going.

• The ADHD medication (e.g. Ritalin, Ritalin SR, Concerta XL, Methylphenidate, Dexedrine etc.) the child takes stops him/her feeling very hungry.

The following are ideas for you to try. They won't suit everyone, but they may give you some help to get over what can be a tricky problem!

1. Eat together at a table, and then all get down from the table together when everyone has had enough (like in a restaurant). Some children eat very little just to be able to go and play sooner, but choose to eat more when there is no option but to sit at table and get bored - while they watch everyone else eat.

2. If the child gets bored and fed up with eating, try

a. Playing a story-tape on a cassette player at meal times.

b. When he/she has eaten a little for themselves, but stops because he/she gets fed up with coping with cutlery etc, why not put a few mouthfuls on the fork for him/her? It may seem odd to be "feeding" your 8 year old - but not many of them will still be letting you feed them when they are 18! Or you could let him/her use a spoon or his/her fingers - as long as they have eaten some of the meal with "proper" cutlery first. It is important that children learn to use cutlery, even if it is hard going, or they will feel left out later. However, many children with ADHD find fiddly things like cutlery very difficult to manage - so help them to eat when they have got fed up themselves, rather than get into a battle over it.

c. Make ordinary food look fancy - sausages and mash looks more fun if you serve it with the sausages sticking out of the potato like a hedgehog. You could make a face or pattern by arranging the food differently on the plate.

d. School packed lunches can be made more appetising by trying small amounts of a wider variety of food. Why not try a small sandwich, Cheese Strings, Peperami or Baby-bel, a small piece of fruit, raisins or dried apricots, some crisps, a few biscuits and maybe some chocolate? For the drink, send a milkshake - Yazoo or similar. This may not fit with a school healthy eating policy - but being too thin isn't very healthy, either. You could tell the school that your child has a "special dietary requirement" of a "low volume, high calorie" diet.

e. Vegetables served raw can be fun - especially if your child has helped to prepare them. Carrots, cabbage, broccoli, cauliflower, and cucumber can be tried. Also frozen peas - still frozen - are often popular.

3. Whole milk, rather than semi-skimmed or skimmed milk can make quite a difference - especially if you use it everywhere (in cooking, on cereal, in milk-shakes and custard and for drinking).

4. Try to avoid low fat spread and low fat yoghurt. The yoghurts sold "for babies and toddlers" and as "luxury" are generally more full of energy than the low fat ones. The same applies for ice-cream, too. Low fat food becomes more important for your child's heart as he/she gets older - but don't forget that being too thin isn't healthy either.

5. Sometimes these children forget to drink or don't feel thirsty in the normal way. This means that when they sit down to a meal and find that they are thirsty, they fill up with drinks and don't have room for the food.

a. Offer a delicious drink (to encourage your child to drink it) about an hour before a meal, so it has gone down before he/she starts to eat.

b. Allow one drink of whatever he/she normally has at the meal, but make any further drinks only of water.

c. Avoid fizzy drinks at meal times, as the bubbles can be very filling.

6. Don't try to force your child to eat. Meals will become a battleground that only your child will win. It is much easier to modify your family's eating habits a little than to enter World War III! Have firm boundaries of what you will not tolerate in your house - and be sure that everyone knows them. However, try to be flexible within those boundaries. A lot of what we think is important is really just tradition. Does it really matter if your child has cake and Yorkshire pudding for breakfast and breakfast cereal for lunch - or if he/she will only eat vegetables if they are covered in tomato or mint sauce? As long as the diet is well balanced overall, with plenty of good food, it may not be worth worrying too much about the fine detail.

7. Fussy children are very hard to cook for! Again, it isn't worth starting a battle. Arguing over the size of a piece of meat or counting peas is no fun (for you, anyway). Some people insist on their children eating everything. Others happily cook different meals for each member of the family. The best answer is probably somewhere between. Some children are fussy about the feel or texture of a food, rather than the taste. Problems with slimy things like onions and mushrooms are particularly common. Sometimes homemade meals, like stews and casseroles taste awful without the "hated" food, in which case liquidising the onions or mushroom before you cook them makes the finished dish taste OK, but without the little bits for your child to fuss over.

8. Children, like cars, don't run well when they are empty! Regular meals can make a big difference to behaviour. You may find that a mid-morning and mid-afternoon (or after-school) snack improves your child's behaviour. Try not to skip meals yourself, as it is easy for your child to copy you - especially if he/she isn't feeling hungry. It is important to eat meals - however small - at reasonably regular intervals.

9. It is often possible to get most of the day's food eaten before the first dose of the day starts to work, or after the last dose has worn off. You could try some of the following:

a. If your child is taking the short acting (10mg) tablets of Ritalin, it is sometimes possible to time a meal for the "dip" before the next dose is due, when the child will be hungrier.

b. A big cooked breakfast, before the morning dose has taken effect, is excellent. If sausage, bacon, potato waffles, eggs, beans and fruit juice sounds too much for you to cook, why not try a bacon sandwich with a milkshake - or even a bowl of Angel Delight, or fruit pie and custard? Some supermarkets now sell Muller Sponge and Custard, Chocolate Sponge etc. in yoghurt-pot sized microwave-able portions.

c. Add a good supper before bed. Try a thick milkshake, a cheese or bacon sandwich, some yoghurt, a bowl of cereal with whole milk, rice-pudding or something similar, along with some fruit.

d. Little ones sometimes eat quite well if fed in the bath! A few bath toys, a plastic jug, and the cold tap set to a trickle will keep the child facing in one direction to give you the opportunity to spoon in all sorts of goodies - with no worry about the mess! Try baked beans, spaghetti hoops, hot dog sausages, sponge or pie and custard, boiled egg with toast soldiers, rice pudding, yoghurt, ice-cream...the possibilities are endless!

Milk Shakes:The easiest way to make a good THICK milk shake is with a packet of Angel Delight - or your supermarket's "own brand" version which will be cheaper. Instead of using the amount of milk it says on the packet, use 1 PINT of whole milk (or ½ a pint for half a packet). If you whisk it up well you will end up with a wonderfully frothy drink. You could even sprinkle chocolate or those little coloured sprinkling things (100s of 1000s, I think) on top for added effect, and serve with a straw!

You can also make gorgeous home made milk shakes in a liquidiser.

To serve 2:

8-10 Strawberries or 1-2 Bananas
½ pint of whole milk
3 scoops of vanilla ice cream
A small dollop of single cream. (Don't worry if you don't have any - add an extra scoop of ice cream instead)
Some people like to add a teaspoon of sugar, too.

About the author: Clare is the mother of 2 children with ADHD and is a doctor working in Child Psychiatry.

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