When Meds Affect Appetite
How to keep your child well nourished when ADHD treatment and medications affect appetite and eating patterns.
Ten-year-old Ben Richardson is tall, sturdy and muscular – for an eight-year-old. The lively fifth-grader tips the scales at just 65 pounds. On ADHD medication since age five, he’s seen improvement in every area of functioning, except for appetite. That’s because stimulant medications also work on the part of the brain that controls hunger. “I’m just not hungry at mealtime,” Ben explains.
“It’s like taking a diet pill and then sitting down at the table to eat,” says Dr. Larry Silver, Professor of Psychiatry at Georgetown University Medical School. Dr. Silver, and many other experts, counsel parents to time meals between doses of medication-but for many ADHD children like Ben, that strategy can be challenging.
“It’s a double edged sword,” says his mother Michelle. “On medication I can get him to the table, but I can’t get him to eat. Without it, I can get him to eat, but I can’t get him to sit still at the table.”
Michelle’s concern is shared by thousands of other parents who are frustrated by the sight of full dinner plates untouched, and school lunches unopened. “The instinct as a mother is to provide food and nutrition for your children,” says Michelle. “I can’t force feed him, and meals often end up with me begging or the two of us arguing.”
But nutritionists who study the issue say it’s time stop arguing and stop making food an issue of contention. Keith Ayoob, Ph.D., Assistant Professor of Pediatrics at Albert Einstein Medical College in New York, and Director of the Nutrition Clinic at its Children’s Evaluation and Rehabilitation Center says, “Our job as parents is to make available high-calorie, nutrient dense foods for the times they are hungry, which may not be at the same time as the rest of the family.”
That means keeping the kitchen stocked with plenty of high protein, high calorie foods like cheese, pudding, custard, meats, and dried fruits. “Nuts and raisins are excellent snacks,” says Dr. Ayoob. And stay away from nutrient poor foods such as soft drinks and gelatin. “They deliver needed calories, but no nutrients at all,” Ayoob adds.
Dr. Ayoob lists 10 easy-to-manage strategies to help your hyperactive child on stimulant medication grow up healthy and strong.
1. Make breakfast the most important meal of the day, and serve it before the first stimulant dose takes effect. “That may mean getting up half an hour earlier, and preparing a non-traditional breakfast,” Ayoob says. If you include your child’s favorite dishes, even hyperactive youngsters often will consume everything on their plates.
By non-traditional, Dr. Ayoob means fried chicken, pasta with cheese and meat, even hamburgers-foods often left over from the night before. “If your child loves omelets, you can try that too,” he says. “But skip the bacon and sausage, which provide calories with little nutrition. Use cheese instead.”
Parents also can offer sandwiches for breakfast, using whole wheat instead of white bread to pack in more nutrients. “Cheese, peanut butter, chicken-all of these nutrient dense foods are great in sandwiches.” Ayoob even suggests pizza for breakfast-topped with your child’s favorite cheese and sauce. To pack extra nutritional punch, load on extra cheese, sliced chicken, and crumbled hamburger or meatloaf.
2. At mealtime, serve the most nutrient dense, high calorie foods first. Then move on to the vegetables if your child is still hungry. If dinner includes chicken, potatoes, green beans, and salad, serve your child a plate with only the chicken and potatoes, then offer green beans and salad when they’re finished. “Remember, these children may be able to eat only six bites and that’s it. So make sure those six bites contain the most calories and nutrients.”
Won’t the child suffer from not eating vegetables? “Forget about it,” says Ayoob. “Don’t try and apply the same rules to these kids as to others. The priority here is to give them the most calories from any nutrient dense food.” Supplement with vitamins if necessary. Don’t overwhelm your child with food.
3. Serve small portions. Children with scant appetites get discouraged by the sight of a full plate, which makes them less likely to try and eat. Your child won’t feel the task of finishing a small plate is insurmountable. If your child is still hungry, he or she will ask for more.
Other ways to make portions look less daunting: Cut sandwiches into diagonal halves or quarters. And instead of serving one huge burger cut in half, divide it into two thinner patties.
4. Don’t worry about sweets. Let the kid indulge a bit, particularly if sweets are delivered with nutrients. “The belief that sugar makes kids more hyper is a myth,” says Ayoob. “If anything, it calms them down because it releases serotonin in the brain. Hyperactive kids are hyperactive because they have a neurological disorder, not because of what they eat. “Make sweets count by packing them with nutrients.
Carrot cake, or cookies with peanut butter, nuts and raisins are excellent choices. “Ice cream also provides calories with nutrients,” says Ayoob. “In this situation, don’t worry about the fats. Sometimes more fat is necessary to provide sufficient calories if the child is unable to eat larger portions.” Modify your recipes to increase calories and nutrients.
5. If you bake, substitute evaporated milk for whole milk. It serves the same purpose with double the nutrients. Add nuts and raisins to muffins and other baked goods. Use whole grain flour instead of white. Include a dollop of evaporated milk in milk shakes. Sprinkle in some powdered milk when making custards. If your child insists on jello, use milk instead of water.
6. Don’t worry about school lunch. “It’s something over which you have no control,” says Ayoob. “And if your child has had a packed breakfast, what they eat or don’t eat at school matters a lot less.”
7. Make vegetables count by increasing their calorie content. Smother a baked potato or broccoli with melted cheese.
8. If the rest of your family uses low-fat salad dressing, set aside a portion for your child that has dressing with a higher fat and calorie count.
9. Keep nutritious snacks ready for middle-of-the night refrigerator raids. Children who take ritalin get hungry at unexpected times. Keep bowls of nuts and raisins around the house-even in your child’s room.
And since parents often report finding their youngsters raiding the fridge after midnight, make sure it is filled with the right temptations, such as custard, yogurt, carrot cake, and raisin bread. “You can even prepare a plate for your child filled with the foods he likes,” Dr. Ayoob suggests. “Include meats, cheeses, pasta, whole grain bread, and dessert.” If you put it in the refrigerator before bedtime, often you’ll find it’s gone the next morning.
10. Don’t argue about food, and provide positive reinforcement when children do eat. Your child may develop a negative association with food, which only adds to the problem.
Instead, encourage him to eat right by purchasing and serving nutrient-rich foods, adjust to their idiosyncratic eating schedule, be flexible, and relax. Your child isn’t refusing food just to drive you crazy!