Feeding and diet
Appetite is a bodily function that is very commonly affected by illness, and one that frequently causes parents much concern and distress. The involvement of parents in, and their reaction to, feeding are associated with very fundamental and deep-rooted emotions closely linked with the giving and receiving of love and affection. It is not surprising, therefore, to find that the reason for calling a doctor is often because a child has ‘gone off his food’.

As a result of its own reserves, a normally healthy child can survive very satisfactorily without eating any solid food for a considerable period of time. When a child stops eating for a few days, he will lose weight quite rapidly especially if there is an associated fever; but this should not be a cause for worry. It does not indicate serious illness and the weight will quickly return to normal as soon as the cause has cleared up and the appetite has been regained.

The body’s principal requirement in the short term is that it gets an adequate supply of fluid, and this is particularly important if there is excessive fluid loss through sweating, diarrhoea or vomiting. Besides maintaining the general feeling of comfort, fluids are essential to maintain the blood circulation and kidney function. The signs to look for in assessing whether the child is becoming short of fluid (dehydrated) are a dry tongue and mouth, sunken eyes and the passing of less but more concentrated urine (indicated by a darker colour with a stronger odour). If the appetite is reduced, the meals should be small and frequent, nutritious and appetizing.

What type of food should be encouraged?
Surprisingly, a child frequently knows himself what is good for him. If he feels like eating egg and chips, it is reasonable to assume that his body is ready for it. The more common problem, however, is to know what to give the child when he does not feel hungry.

Fluids

The amount of fluid drunk in time of health will necessarily need to be raised when there is increased fluid loss. Clear fluids (such as orange squash or Ribena) are easiest to retain, and adding sugar or fruit flavouring to water will provide extra calories and make it more palatable. There is no need to use special glucose. Avoid ‘pop’ or other gaseous drinks as they tend to distend the stomach and reduce the appetite. Fruit juices contain Vitamin C.

Food

Milk, although a liquid, is treated by the body as a food. IT contains protein and other necessary constituents. Progress gradually from fluids to semi-solid then solid food. A suitable diet when the appetite is reduced includes boiled fish, lightly boiled or scrambled egg, vegetable or fruit puree, jellies, yoghurt, etc. Avoid fatty foods.

Should an ill child be put to bed?

Illness reduces the energy reserves of an individual by its effect on various body functions. Also, the mechanism by which the body copes with disease and infection makes considerable demands on the energy stores. Thus the requirements for rest and sleep during times of illness are considerably increased.

It was previously felt to be appropriate to keep an ill child in bed. However, as anyone who has attempted to follow this advice will know, it is far easier said than done and is not now considered to be either necessary or advisable. A child whose activities are unnecessarily restricted will rapidly become restless, especially if he is also bored. A more reasonable and effective approach is to allow the child himself to be, if not the judge, at least the indicator or how much rest he needs. If he feels like being up and about let him do just that while preventing unnecessary or excessive exercise. There are very few diseases, even among children requiring admission to hospital, that demand complete bed rest. It is important, however, to monitor the activity carefully and, as soon as you feel that the child is getting tired, encourage him to lie down.

Bed rest does not necessarily mean remaining confined to a bedroom and it will usually be much more acceptable to a child if he is allowed to stay in the living room and remain part of the family. The concept of bed rest has both a physical and psychological component, and when a child is unwell he should, whenever possible, be removed to an environment that is appropriate to his needs.