Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition that presents very differently in different people. Whilst inattention, hyperactivity, and impulsivity are characteristics that are commonly associated with ADHD in children and adults, we know that the reality of living with ADHD is much more complex. For example, a child with ADHD could find it more difficult to get up in the morning and pay attention at “usual” times than a child without ADHD. ADHD can also impact a child’s executive functioning skills which, put simply, are skills we use every day to learn, work, and function in daily life – these include flexible thinking, working memory and self-control. ADHD can also affect a person’s awareness of time, energy levels and fatigue, and even a person’s ability to eat and nourish themselves. These are just a few examples that scratch the surface of how ADHD can present.
Understanding the nutrition challenges experienced by kids with ADHD
Kids with ADHD face unique challenges with food and eating. We know that being well-nourished can help with managing a child’s ADHD symptoms and also many common medications for ADHD can impact a child’s eating. It’s the ultimate “Catch-22”!
Inattention can lead to children forgetting to eat even when food is presented, while hyperactivity (an atypical need for movement) can make sitting still during mealtimes difficult.
Picky eating or having a very limited range of accepted foods is also very common amongst children with ADHD, making it even harder than usual for parents to be sure their child is getting the nutrients they need to grow and develop. Many common ADHD medications can affect appetite and digestion, causing decreased appetite and an increased risk of constipation.
Helping kids to be well-nourished with ADHD
The Kids Dig Food team of Accredited Practising ADHD Dietitians Brisbane support many children and parents of children with ADHD. Some of the most common concerns that parent share with us about their children’s eating are:
- Not eating enough food
- Not eating food regularly
- Skipping meals
- Lack of appetite
- Having a very short list of accepted foods
- Refusal of entire food groups
- Difficulty tolerating even small changes to their usual foods
- Worries about their child not getting enough of particular nutrients e.g. Iron, B12, Calcium
- Concerns about growth
Whether your concerns are listed above or not, there are a few things you can do right away to support your child with ADHD with nutrition, food and eating:
STEP 1: Support your ADHD child with regular eating
Parents and Caregivers, it’s important to know that your ADHD child needs your help to eat regularly! They probably won’t remember when it is time to eat and may not experience, notice or be able to recognise their body’s appetite cues. Even teenagers need support to eat regularly. For most kids, a meal or snack every 3 hours is about right, but be guided by your child’s needs and your family’s routines in deciding what will work best.
Depending on your child’s age, stage of development and the impacts of their ADHD, to support regular eating your child may need you to:
- prepare food for them or help them to prepare it
- remind them when it’s time to eat (and possibly give some advance warning of this) or help them set reminders
- eat meals and snacks with them
- help them pack their lunchbox
- take food or help them plan for eating when outside the home
Why is regular eating important? Our bodies need a regular supply of carbohydrates, fats, protein and nutrients to work at their best. When your child skips a meal or forgets to eat all day, they may experience:
- tiredness and fatigue
- irritability/mood changes (the “hangry” kid)
- difficulty with concentration, focus and attention
- light-headedness
- poor growth or loss of weight
STEP 2: Understand your ADHD child’s appetite rhythm
Whether your ADHD child is on medication or not and whether they eat a lot or a little, it always helps to take time to understand the rhythm of your child’s appetite. Some helpful questions to ask are:
- What times of the day is my child most hungry?
- What times of the day is my child least hungry?
- When is food typically offered or available?
- Do before or after school or weekend activities alter the rhythm of my child’s appetite
- Do these activities interfere with my child’s eating in any way?
Why is understanding your child’s appetite rhythm important?
When you understand your child’s appetite rhythm, you can help create an eating routine that is responsive to their needs. You might notice that your child is particularly hungry at certain times of the day e.g. breakfast before medication or late afternoons after school or before bedtime. It always makes sense to honour your child’s appetite and offer as much food as they need to satisfy their hunger at these times, even if this seems like a LOT of food to you!
Kids who take appetite-suppressing medications for ADHD or other conditions often find it very difficult to eat when their medication is active. It is important to support but not pressure your child to eat during these times. Help your child by offering small amounts of easy-to-eat energy and protein rich foods and nourishing drinks that they find appealing when eating is difficult. They may not be able to eat much, but even small amounts will
You might notice that your child’s appetite returns (sometimes with a vengeance) when their medications have worn off or first thing in the morning before they are taken. It really helps to make the most of the natural return of your child’s appetite, whenever it strikes.
STEP 3: Understand why your ADHD child has limited range of accepted foods (they aren’t just “picky”)
If your ADHD child has a small list of foods they will eat and a longer list of foods that are “off the menu”, you are not alone! It is important to understand that food (especially unpredictable or unfamiliar food) can be very challenging for many kids with ADHD, why this is, and what you can do to help:
- Sensory Sensitivity: Some children are extremely sensitive to the texture, smell, look and taste of foods (their sensory properties). It can help to understand if your child has particular difficulty eating foods with particular sensory properties. If your child seems particularly sensitive to the sensory properties of foods or displays an unusually strong negative response to certain foods, take a note of this and discuss it with your child’s health care team e.g. Paediatrician, GP, Dietitian and/or Occupational Therapist.
- Familiar foods help your child feel safe and secure: Familiar foods feel SAFE to your ADHD child. Kids with ADHD need to work much harder than the average child to function in daily life. Familiar foods help make life feel just a little bit easier. When your child feels tired, scared, anxious or overwhelmed, familiar foods become even more important. Familiar foods help your child feel safe, and they are often extremely important foods to ensure children are receiving the nutrients they need. If you notice that your child’s list of usually accepted foods is dwindling, seek the support of a paediatric Accredited Practising Dietitian.
- A “Good enough” variety is different for everyone: Your child does not need to eat every food, or even foods from every food group to be well nourished. Food learning takes time and every person develops their own list of acceptable foods over their childhood, teen years and into adulthood. Some people end up with a much larger list of liked foods than others. If your child has a limited food range, there may not be any reason for concern about nutrients. However if you’re unsure, a paediatric Dietitian can help assess whether dietary modification or supplements are needed to support your child as they grow.
- Pressure doesn’t help kids learn to like foods: Never force, bribe, coax or bargain with your child to get them to eat any food, and especially not a food they clearly dislike. Children do best when they are supported to eat foods that
Where can parents and caregivers go for support?
Talk to your child’s GP or Paediatrician:
Discuss any concerns you have about your child’s eating and nutrition with your Doctor.
Seek the support of an APD:
Look for an Accredited Practising Dietitian who is familiar with ADHD and who can provide personalised support and practical guidance for your child and family. Also look for someone who welcomes working with other members of your child’s healthcare team such as: Occupational Therapist, Speech Therapist and/or Psychologist.
We hope this article has helped you understand a little more about how to support your ADHD child to be well nourished.