unusual cas

[jikeda at garnet.berkeley.edu]

>1. what do you think the etiology of such a picture might be, whether

>organic, functional, both, or neither?


I am not a psychiatrist (but I did minor in child development and am very
interested in the food habits of children); I have seen situations where a
child adheres to a restricted food regimen like this because it elicits
concern on the part of the parents.  It may be the only way the child is
able to obtain "his share" of "quality time" with his parents.  It also
helps the child "distinguish" himself from his siblings.  

One way to deal with this is to talk with the parents about positive ways in
which this child is different from his siblings - does he play soccer, get
better grades, is able to draw?  What does he do that makes him special?
The parents can then emphasize that he is special because of this positive
characteristic, not because he has a bizarre eating pattern. 

He may already have established his reputation around being "that kid who
only eats juice and crackers."  This has to stop.  Everyone in his
environment needs to cease identifying him in that way.  If they continue to
do that, it is only going to reinforce his thinking of himself as the kid
who only eats juice and crackers.  

Do refer the family to a child psychiatrist or someone with alot of
knowledge about eating disorders.  Put the child on a multi-vitamin-mineral
supplement designed for children until you can get him to widen the variety
of foods he is willing to eat.  


>2. what nutritional deficiencies might you expect to occur with such a

>diet, besides protein deficiency?


You didn't mention the kind of crackers he eats?  Soda crackers? Graham
crackers? Snack crackers?  The nutrient content of these vary.  I would
certainly do a hemoglobin/hematocrit to check for the possibility of iron
deficiency anemia.  I would also be concerned about zinc intake - zinc
deficiency often leads to a loss of appetite.  Make sure whatever supplement
is taken, has the RDA for zinc.


>3. what approach would you as a nutritionist take in further evaluating

>this child?  


Best person to talk with - Ellyn Satter, Eating Disorders Specialist,
especially in children,  you can reach her at  at 4226 Mandan Crescent, Suite 50
Madison, Wisconsin 53711
(H) 608-271-7976
(B) 608-255-9040


>

>we are not asking for "medical" explanations necessarily.  we have

>looked at what is traditional, and have come up lacking.  we would like to

>explore some fresh ideas, and will genuinely appreciate any that you

>have to offer.


She will definitely give you a fresh approach.  Good luck!  Joanne Ikeda

>

>you can respond on the bulletin board, or contact me directly at:

>

>email: csmith at umsmed.edu

>tel: 601-984-5265

>fax: 601-984-5981

>

>

>thanks in advance!

>

>clinton smith

>

>

>

>

>

Joanne P. Ikeda,MA,RD
Cooperative Extension Nutrition Education Specialist
Department of Nutritional Sciences
University of California, Berkeley
CA 94720-3104

Phone (510)642-2790
FAX (510)642-0535
E-Mail: jikeda at garnet.berkeley.edu