This is a guest post by Jill Castle, a registered dietitian, childhood nutrition expert, blogger and podcaster over at The Nourished Child. You can learn more about nutrition for kids with ADHD by checking out her class The ADHD Diet for Kids.
Sammy isn’t eating enough. How does his mom know? He comes home from school with a full lunch box. He’s eaten hardly a morsel.
Julia seems to go all day without eating. She’s not hungry when she gets up and really doesn’t have an appetite until after school. When she gets home, she’s hangry.
Both Sammy and Julia have ADHD. And they both take medications to help them manage their focus and behavior while at school. Unfortunately, they also both experienced one of the most common side effects of ADHD medication: Poor appetite.
The Medication – Poor Appetite Cycle
Anywhere from 30 to 60% of kids with ADHD who take medications to help manage it experience side effects that affect their appetite. For many, this ultimately affects their nutritional intake, according to a 2018 review study in Translational Pediatrics. Kids may have a variety of other side effects while on medications, including abdominal pain (up to 40% of children), and up to 20% report headaches. Although these side effects are considered transitional, some children will struggle with appetite and eating while on medications.
When a child’s appetite is affected by medication, it generally looks like this:
The irony of the medication – poor appetite cycle is that while medications are working, calories and nutrients take a hit. In other words, the essential nutrients that may help the brain and body focus, pay attention and function well happen to be in low supply. Obviously, the ideal is to have effective medications on board with optimal nutrient intake to get the most out of both strategies.
Trapped in the Medication – Poor Appetite Cycle
In my experience, kids with ADHD get into the medication-appetite cycle and can’t get out. Day after day, they “aren’t hungry” and skip meals, or barely eat. Over time, parents may make small adjustments to the feeding routine.
- Kids who aren’t hungry in the morning go off to school without breakfast.
- Parents may give up on making a balanced lunch, trying to avoid food waste or the discouragement they feel when their child returns with a lunchbox that’s been barely touched.
- Parents offer what their child will eat, rather than what they know the child needs or is good for them.
The Nutrition Maneuver that May Help
Whether your child has a robust appetite or no appetite at all, there’s one maneuver you can make to help build your child’s appetite, help him regulate it, and improve his overall nutrition: Maintain a regular feeding schedule.
How a Regular Feeding Schedule Helps
One of the first things I like to see all families implement when trying to break free from the medication – low appetite cycle is to start using a predictable feeding schedule. I suggest this to help a child rebuild his appetite cues of hunger and fullness, especially if he’s lost a sense of hunger due to medications and long periods of not eating. It also helps set the foundation for the habit of eating at intervals, which may regulate appetite.
To build or support appetite cues, particularly for hunger, eating is key. When the tummy is filled with food it empties through the process of digestion. This then triggers hormones in the gut that signal the brain to recognize hunger and the desire to eat again.
Secondly, eating on a routine schedule builds a habit of pausing during the day to sit down and eat. These are opportunities to eat, not mandatory eating sessions. Once a child is at the table, he is more likely to nibble on something.
When parents believe meals and snacks are mandatory, they may err in their feeding approach, pressuring, bribing or forcing their child to eat. This will almost always be counter-productive for your child.
Strategize Your Food Offerings
Although most parents want to know the best foods to give children with ADHD, a child may not be willing to eat them. I advise using a bit of strategy when selecting meal and snack items. For example, if your child says he isn’t hungry in the morning, offer something light and quickly digested such as a fruit smoothie, a baggie of crunchy granola, or a mix of dry cereal, raisins, pretzels, and nuts (if allowed). These items are easy to eat on the go and don’t take much time.
At school, send a nutritious snack for lunch instead of a traditional lunch box. Always ask your child what sounds good, but a simple snack combination such as cheese and crackers, a higher protein-based granola bar and a 100% juice box, or a beef jerky and pita chips can work well. The idea is to offer something light to the child who is not eating at all, understanding that something nutritious is better than nothing at all.
Instead of giving a snack after school, re-engineer snack time and offer a full lunch. This is the time when medications tend to wear off, and your child’s appetite resurges.
There are affiliate links in this post so if you end up purchasing a program, I will receive a percentage. I only participate in these when I believe 100% in a product or program. I’ve worked closely with Jill (wrote a book with her) and she knows her stuff.
photo credit: Photo by Kyle Nieber on Unsplash
My kid doesn’t have ADHD, but still comes home with a half-eaten (at best) lunch because their lunch period is just 15 minutes from the time they enter the cafeteria. We usually pack a lunch so she doesn’t have to spend some of that lunch period waiting in line and we try to provide food that can be eaten quickly, but she’s a slow eater by nature so she usually runs out of time to eat most of what she would like to eat. Technically, she could eat more in the playground because they have 15 minutes of recess after lunch, but she needs the play and physical activity too, so it’s really a difficult trade-off.
I often wonder how much more of the less desirable foods (ie veggies) in school-provided lunches would be eaten if the kids simply had more time to eat. It’s not surprising they eat the more desirable foods first, especially under time pressure, and then leave the other stuff because they are literallly being booted from the tables.
I’m not sure what can be done to address is -I know many schools already have trouble providing enough time for recess. Last year, our school experimented with having a 20 minute lunch period, but they took those 5 minutes from the recess period, so then the kids loose out on play time. It’s very frustrating for me as a parent, and I can only imagine that being under this time pressure makes it even worse for kids with ADHD.
Maryann Tomovich Jacobsen, MS, RD says
Yes, this is a problem. We switched to a school that has recess before lunch and it works well. Kids are really hungry and don’t rush through lunch to play. But I agree that more time to eat is important.