Background Education for Providers
Medications have been used to induce hunger (e.g., cyproheptadine) or to reduce anxiety that may cause a child to ignore hunger cues (e.g., clonidine), but unfortunately little data are available on the efficacy of these interventions. The children who are the most likely to benefit from these appetite stimulants are those with suboptimal nutrition who have intact oral skills but who are not responsive to internal hunger cues. Close consultation with a physician is strongly recommended if these medications are to be considered due to potential complications from these therapies.
Instructions for Provider
Careful consideration should be given to the underlying etiology of the feeding problem before appetite manipulation is used as a treatment strategy. For instance, there are a variety of medical conditions (e.g., feeding tube dependence, food allergies, cancer) and medical treatments (e.g., anti-seizure and stimulant medications) that predispose children to poor appetite. Appetite manipulation is also often difficult for caregivers to tolerate as they can become concerned about their child’s nutritional or hydration status. Therefore, careful selection criteria should be considered prior to implementing an appetite manipulation as a treatment strategy. Prior to attempting to manipulate the child’s appetite, the clinician should assess (1) medical conditions that prohibit periods of fasting; (2) the child’s hunger drive; (3) the child’s developmental and oral motor skills to ensure that foods presented are commensurate with the child’s feeding abilities; and (4) the caregiver acceptance of appetite manipulation so as not to cause undue stress on the family. Given the medical and nutritional concerns that frequently accompany this treatment strategy, appetite manipulation should only be conducted under close medical supervision. Often this intervention is best suited to inpatient care settings where medical supervision is consistently available.