Feeding of rachitic and obese children

The amount of food that should be given to children is one of the most frequent concerns of parents and people in charge of their feeding. This very positive concern for the proper development of infants, can sometimes be exaggerated and cause the emergence of inappropriate habits that lead to excessive or insufficient intake of food, not in accordance with the real requirements.

Obesity and rickets can also appear due to chronic diseases that increase the risk of presenting different degrees of malnutrition or overweight throughout their development.

Due to the role that nutrition plays in the correct development of the organism and in the treatment of diseases, children should be subject to a careful daily nutritional assessment by parents, aided by the correct periodic evaluation of the pediatrician.

Feeding of children with weight deficiency

Factors that can cause weight deficit in childhood.

Environmental factors:

• Uncaring parents or caregivers, who leave during meals alone the little ones, without adequate attention.

• Frequent changes of teachers, caregivers or tutors in charge of the feeding of the little ones.

• Establishing rigid feeding schedules during the first four months of life. During this stage the little ones show hunger, with a pattern between two and a half and four hours; this can vary among different infants, and even in the same child throughout its development. Setting schedules without taking into account the child's demand could subject infants to a diet that does not meet their needs, leading to malnutrition.

• Inadequate mealtime environments such as the following:

• Lack of ventilation, lighting or hygiene.

• Distractions by television or other audiovisual media that do not allow a relaxed and quiet environment.

• The presence of other people performing other activities.

Organic factors:

• Motor impairment of swallowing. This difficulty, known as dysphagia, usually occurs secondary to another condition, such as nervous system disorders.

• Neurological disease.

• Gastrointestinal disease.

• Delay in the introduction of some foods due to some pathology.

• Intrinsic poor appetite.

Incorrect relationship of the parents or caregiver with the little ones:

• Parents or guardians who aggressively force children to eat all the food.

• Intolerant parents or caregivers who frequently scold when the child soils, touches food, has poor manners, or dawdles. Developmental delays.

What to do when a child refuses to eat?

• Do not force the child to eat by cuddling, clowning around, promising rewards or threatening punishment.

• Do not prolong meals for more than half an hour.

• Do not offer the dish again an hour later, causing a decrease in appetite at the next meal.

• Do not prepare another food or dish in place of the one he/she refuses, the one he/she refuses should be removed and wait a few days to serve it again; repeat the dish other times, always after a few days have passed, until he/she accepts it.

• In case of non-acceptance of a food, do not show concern for the temporary refusal, nor punish him/her by depriving him/her of eating another food or dessert.

• Do not mix the food with another to mask its presence.

• Do not overfill the plates.

• If necessary, space out meals more.

General recommendations to prevent poor appetite:

• Make up a varied diet, adequate to the nutritional requirements of the child, and attractive for its taste, smell, color and texture.

• Ensure a calm, cheerful and confident atmosphere during meals.

• Parents should regulate what to eat and when to eat, but children should decide how much to eat.

• Meals should not be served while watching television or other audiovisual media.

• If they are accustomed to certain incorrect practices, they should not be forbidden all at once.

• Meals should be announced at least five minutes in advance to wash hands and to collaborate in the preparation of the table.

• Do not talk about unpleasant subjects.

• Do not repeatedly point out faults in formal education or in the handling of cutlery.

• Do not insist that he/she leaves the plate completely empty; if he/she does not do so, he/she should understand that he/she has no more appetite.

• The elders should, through example, educate their children in healthy eating habits.

Feeding of overweight or obese children

Although the causes of obesity are multifactorial, at least partially mediated by genetic mechanisms, in most cases, it is the result of an energy imbalance between calories ingested and calories expended through physical activity.

Factors that can favor the appearance of obesity in children:

• Parents' valuation of childhood overweight as a symptom of good health.

• Not practicing exclusive breastfeeding until the child is six months old.

• Planning diets excessively rich in fats and simple sugars, such as fried foods, sauces, ice cream, pastries, cakes and soft drinks.

• Neglecting nutritional education and providing food only according to the preferences or whims of children.

• Excessive number of hours dedicated to television and video games.

• Reduced hours spent playing in parks and walking outdoors.

• Genetic predisposition.

Treatment of obesity: The treatment of obesity is extremely complex, especially during childhood, since in most cases adequate results are not obtained. It is estimated that only between 10% and 20% of the child population manages to lose weight and return to the appropriate percentiles. The treatment of childhood obesity focuses on three fundamental aspects, these are:

• The nutritional approach.

• Physical activity.

• Behavioral therapy.

The nutritional approach: This approach aims to achieve weight loss or weight maintenance, with adequate growth, trying to reduce fat mass and maintain lean mass. In order to achieve these objectives, the following dietary modifications are recommended:

• Gradually eliminate foods with excess energy content, rich in fats and simple carbohydrates, such as cookies, candies, sweets, sweets, processed meats and sauces.

• Increase the consumption of low-energy foods, such as vegetables and fruits.

• Maintain between four and five moderate meals throughout the day, corresponding to breakfast 20% of the total daily calories, mid-morning 10%, lun