ADHD: Making every eating opportunity count
Professor David Coghill, Professor of Child and Adolescent Psychiatry at the University of Melbourne.
Appetite suppression is a common effect of stimulant medication for ADHD, but the consequences can extend beyond skipped lunches. When children have fewer opportunities to eat, making those moments count becomes an important part of supporting nutrition, growth and development. Could practical, nutrient-dense foods such as eggs help?
Managing appetite suppression in children with ADHD
Appetite suppression is one of the most commonly reported side effects of stimulant medication for attention deficit hyperactivity disorder (ADHD). While it can be concerning for families, it is also a predictable consequence of treatment that can usually be managed with practical strategies.
Understanding how appetite changes across the day is often the first step. By helping families work with a child's appetite pattern rather than against it, GPs are perfectly placed to reinforce practical strategies to support adequate nutrition allowing children to continue to benefit from effective ADHD treatment.
Importantly, appetite itself is not necessarily the issue. The more important question is whether reduced food intake is affecting weight gain, growth or overall wellbeing, and whether additional support or review by the treating ADHD clinician is needed.
Understanding the appetite pattern
Most children taking stimulant medication will experience some degree of appetite suppression. Importantly, this does not mean they lose their appetite altogether.
One of the most helpful things GPs can do during routine review appointments is to explain that appetite suppression is rarely a 24-hour phenomenon. Most children will wake up with a normal appetite before medication takes effect. Appetite then tends to reduce throughout the middle of the day before returning later in the afternoon or evening as medication wears off.
Understanding this pattern can help families anticipate changes and avoid unnecessary concern when appetite suddenly becomes a struggle.
It also creates opportunities to support nutritional intake by working with the child's appetite rather than against it.
Work with the pattern, not against it
Parents often get stuck focussing on trying to get children to eat more at times when appetite is naturally at its lowest. GPs can help reframe the conversation by encouraging families to identify the times when a child is more willing to eat and make the most of those opportunities.
Breakfast is often the best place to start when supporting families to work with a child's appetite pattern. Because medication has not yet taken effect, appetite is usually strongest first thing in the morning. Encouraging children to eat a healthy, substantial breakfast before taking medication, including foods such as eggs, fruit, dairy, and wholegrain breads or cereals, can help establish a strong nutritional foundation for the rest of the day.
Similarly, many families can benefit from working in more flexibility with evening meals. If appetite does not return until later in the day after their traditional ‘dinner time’, adjusting the timing of meals to align with a child's hunger may be more effective than expecting them to eat according to a schedule that no longer reflects their appetite.
The goal is not to force children to eat when they are not hungry. It is to maximise nutrition when appetite is present.
Making every eating opportunity count
When eating opportunities become more limited, food choices become increasingly important. Rather than focusing on volume alone, families can prioritise including foods that provide high amounts of key nutrients in relatively small portions.
Eggs are one example. A serving of two eggs provides 17 different vitamins and nutrients including 12.7g of protein, around one-third of the recommended dietary intake for many school-aged children. They also provide omega-3s, B vitamins, vitamin A, iron, iodine and are high in vitamin D and choline – all important for children’s growth and development.
Other options such as nuts, dried fruit, dairy-based foods and peanut butter can also help support nutrition when daytime appetite is reduced.
For many families, success will come not from dramatically increasing food intake, but from ensuring that the food a child does eat contributes meaningfully to their nutritional needs.
Supporting children between specialist reviews
Most cases of appetite suppression can be managed successfully through education, monitoring and practical dietary strategies.
Where concerns about growth, weight gain or nutritional adequacy persist, referral to a dietitian can provide additional support and tailored advice. If growth concerns persist despite these measures, coordination with the child's treating clinician can help guide ongoing management.
Appetite suppression is best viewed as a management issue rather than a treatment-limiting problem. By understanding appetite patterns, monitoring growth and helping families make every eating opportunity count, GPs can play an important role in supporting both healthy development and the ongoing management of children receiving ADHD treatment.
Key points
Managing appetite suppression and growth in children taking ADHD medication
Appetite changes are common
- Stimulant medications are commonly associated with reduced appetite, particularly in the short term.
- Appetite suppression is typically most noticeable during the day while medication is active.
Monitor growth routinely
- Regular monitoring of appetite, weight, height and BMI is recommended.
- These measurements should be plotted on standardised growth charts.
- Individual responses vary, making ongoing monitoring important even when most children are doing well on treatment.
Differentiate cause and effect
- Consider whether eating difficulties were present before treatment commenced or have emerged following medication initiation.
Work with the appetite pattern
- Encourage children to eat before medication takes effect and make the most of times when appetite is strongest.
- Consider nutrient-dense snacks (e.g. eggs, nuts, dried fruit, etc) and adjusting evening mealtimes if appetite remains low later in the day.
If growth concerns emerge (i.e. crossing centiles on the growth charts)
- Review medication dose and regimen (if prescriber).
- Consider alternative formulations or treatment approaches where appropriate.
- Seek input from a dietitian or growth specialist when concerns persist or growth deviates significantly from expectations.
Professor David Coghill is a child and adolescent psychiatrist at the University of Melbourne and Royal Children’s Hospital Melbourne, internationally recognised for ADHD research and clinical expertise.
More resources
Cortese S, Holtmann M, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Dittmann RW, Graham J, Taylor E, Sergeant J; European ADHD Guidelines Group. Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents. J Child Psychol Psychiatry. 2013 Mar;54(3):227–46.
ADHD Prescribing Guide for the Continuation of Care and Co-Managed Care in General Practice https://aadpa.com.au/product/adhd-prescribing-guide-for-general-practice/
