Dear Doctor,

My daughter is two years old and she has always had a healthy appetite. However, I sometimes worry that she over-eats, if there is such a thing. Nothing seems to fill her. She has three meals a day and some fruit or yoghurt in between meals. Even when she’s just had a meal, she’s more than willing to eat some more should it be available. Her father insists on giving her a bite every time she asks for it but I’m worried this might be some sort of condition. Is she normal?

Pauline

Dear Pauline,

Usually a two-year-old does not understand the difference between hunger and satiety. Therefore, sometimes children tend to eat more, particularly if they find that food/snack delicious. There are certain eating associations, usually initiated by parents, which makes a child overeat. This is like giving a child something to munch while watching TV or playing, rewarding the child for doing something good by giving a favourite snack. It may be a way to pacify a child, like immediately giving the child something to eat if he seems sad or cries. Many parents simply give a packet of chips, cookies, or any kind of snack to keep the toddler occupied while they finish some work. All these activities make a child eat more than necessary. It may upset the tummy as well sometimes, but the real risk is obesity now or later in life with its related health problems. At times a child may not be able to differentiate between thirst and hunger and may tend to eat, if feeling thirsty. Moreover overeating is not necessarily eating the kind of food which is healthy and right.  It is more commonly eating fast food. This food is commonly high in fat, sugar and calories, which lacks in nutrients and is high in calories. This also carries the risk of causing obesity and associated health problems.

Among common medical disorders, a child may have increased appetite due to uncontrolled diabetes or hyperthyroidism.

Do not give snacks unnecessarily to your child as a reward or pacifier. Do not let him form the habit of munching popcorn or peanuts to pass time. Two times snacking is good enough like once between breakfast and lunch and another in the evening. Another time something very small may pass off before sleeping, if he sleeps late but other times, avoid giving snacks. Try to see that snacks are homemade and nutritious, because the junk food available as snacks has no nutrition, whatever claims are made.  Make sure that the child takes enough water throughout the day and is well hydrated. Encourage him to relish and take three square meals each day. His meals should include whole grains, fresh fruits and vegetables, fresh milk products and healthy meat, like fish. Also encourage the child to be physically active and play outdoor games.

Once a child falls in the habit of eating the necessary amount and eating healthy, he will always maintain this habit.

Dr. Rachna Pande is a specialist in internal medicine.

rachna212002@yahoo.co.uk