There are many considerations to be done when you got a child with ADHD and Tourettes. The combination of methylphenidate and poor appetite are very common. Poor appetite in children is just one of many side-effects of the medication.
Methylphenidate and poor appetite
I got experience with methylphenidate and I wrote about it in my post «ADHD and Tourettes syndrome» https://wp.me/pb4jAC-1o.
The drawback with the medicine is what I already have mentioned, it gives the child poor appetite. Both ADHD and Tourettes are energy intensive conditions. So what happens when the blood sugar drops but the child still got no appetite?
These children are often very skinny.Some of them don’t have time or can’t sit still and quietly by the table. The medicine can make them sick as well as low blood sugar. I guess a natural cause of this is that the child won’t eat. But that is exactly what it has to do. The constant high stress level won’t help the child to gain any weight. This constant feeling of stress combined with medicine and poor appetite can be a huge problem, especially at school.
When the child on medicine got no or poor appetite the blood sugar drops. The anxiety exacerbated, the hyperactivity increases and more rage. The child can become more challenging and less cooperative. Well that is how we all become when we don’t eat, but up to a point you can control your feelings. But an impulsive kid got problems to control these emotions.
In my country the children bring their own lunchboxes to school. Despite this my child went four years at school without eating his lunch. No one seemed to take the responsibility looking after her. In fifth grade one teacher finally took the responsibility. And for us parents we used four years to be heard. My daughter eats her lunch every day now. The appetite is still poor but the mood is more stable, and she has become more social. Maybe teachers and other adults in the school don’t relate specific issues with the combination of medication, poor appetite in children and bad behavior?
I don’t know the practice in countries where the children get meals at school. I can see some problems with canteens and crowded areas since these kids struggle with anxiety and the influence of stress. And this won’t help on the lack of hunger.
What can we do to help?
The children with ADHD and Tourettes are just as different as you and I. With that in mind the following advices are just mine. If you get any additional ideas when it comes to medicine and poor appetite I be happy for you. If you want to shear them with me, please give me a comment or write to me.
1) If your child are using a lunchbox send something you know he likes. Some schools want the children to bring healthy diets. And that’s ok but maybe not when it comes to your child. The aim is that something is better than nothing (I am not talking about chips). A pizza slice, some bread with chocolate topping, yogurt, cereal and fruit like a banana and a carrot.
2) Make an agreement with your child. There will be an ice cream after dinner or something. You can get kids with ADHD/Tourettes to do almost everything when they know they will be awarded afterward. Remember: A promise is a promise. If they have earn it they deserve it, matter what they have done in the meantime.
3) Make an agreement with the class teacher. I guess they are also interested in a calmer and cooperative child.
4) Let the kid get butter on the bread and fatty milk to drink
5) When you give the kid pizza, add some oil and extra cheese toppings. If you got some protein powder you can mix it with the oil before you add it on the pizza. (Tryptophan is a protein which make the kid tired).
6) Variate with fine and whole wheat bread. If your kid wants just fine bread that’s fine. Mind that he or she drinks well and gets fiber from other sources. The methylphenidate have an impact on the bowel so I don’t think you need to be afraid of constipation.
7) Children with ADHD and Tourettes syndrome are creatures of habits and routines. If you change the content of the lunchbox prepare the child. If there is cereal in the lunchbox. Let them practice pouring the milk at home and that it is ok to spill some milk and how to clean it up afterwards. Many of these kids feel so clumsy and ashamed when they don’t master a task. It all comes down to their lack of self-esteem and confidence. Since these kids are creatures of habits are there any issues in the school canteen? Should there be other arrangements for your child?
8) Try some medicine free days.
9) Give them something to eat before they take the medicine. It got two purposes: To prevent sickness and to be curtain that they at least got a normal blood sugar level before they walk to school.
10) Vitamins and minerals are always important.
11) Don’t mix the potatoes, sauce, vegetables and meat balls on the plate if the child don’t wants you to do that. Just respect this. This could be OCD and not unusual when a person got tourettes.
12) Choose your fights. If you are «fighting» you will just get so tired and exhausted and you end up with no fights and no structure. The time is on your side. Just remember that children with ADHD are more immature than other kids at the same age. But even children with these diagnosis will catch up with time. It just happens later than sooner.
I am wondering why methylphenidate is the first choice. In addition to poor appetite, children with tourettes also got more tics. Are there any considerations to tourettes at all? But methylphenidate and poor appetite cause many problems like anger, and you can not be sure whether that is low blood sugar or a tic.
So if you observe a poorly regulated child with still a lot of impulsivity, he or she doesn’t have the right medicine dose. My impression is that the regulations of impulsivity are more important than the appetite. Alternatively the doctor need to change the medicines, but this is a task for a specialist not an ordinary doctor.