What can I do to make my young son eat more?

Dear Dr. Donya,

I am a expatriate with an 18-month-old boy who absolutely refuses to eat. He rejects fruits and regular food such as pasta, rice, etc. I hear that in Indonesia children of this age are fed porridge.

Could you please list in detail how I can make this porridge and what I can include in it. Also please suggest some food that I could give him to increase his weight as he only weighs nine kg. A series of blood and urine tests as well as TB tests were carried out to investigate if anything was seriously wrong with him but all proved negative. Will his low weight impede his growth? He is 83 cm tall at present.

-- Michelle

Dear Michelle,

I am a little worried about your son. He is underweight for his age but his height is fine. Before jumping to conclusions about diseases, you have to answer these questions and see if any of these factors help you identify your son's appetite problems. 1. Does he still drink milk? How many ounces per day? What kind of milk? 2. Does he have any kind of snacks between meals? What kind of snacks? 3. Do you feed him or let him feed himself? 4. Do you have him sit with you or a family member when he eats? 5. Did he gain weight properly in the first year? 6. Did he have any major change during this period? 7. Did he have any illness before he stopped eating?

I ask because if he does not eat but drinks a lot of milk (say more than 32 ounces a day) or has some sweets or unhealthy food before he gets to his "real" meal, then you should cut down on all of that. Try letting him feed himself and also make sure he joins the family for dinner or lunch. Do not make a lot of food for him because when he does not eat, you may feel upset.

To make the porridge, it is easy, like when you make meatloaf: * Rice, 1/2 cup * Water (or chicken soup or broth), 4 cups; * Any kind of meat, fish, chicken, liver, pork; * Any kind of vegetable -- potatoes, pumpkins, carrots, green vegetables (Pak choy, cabbage, morning glory), tomatoes; * Egg, optional; * Salt or soy sauce to taste; 1. Start by boiling the liquid, then add the rice until it is cooked. 2. Add the potatoes or carrots because they take time to cook; then you can add meat, egg, green vegetables and tomatoes -- cook until everything is soft. 3. Add a little salt if you like. For weight gain, feed him fattening, high-calorie foods like fried food or tempura, which you can make by mixing wheat flour with egg and water, then dipping carrot, corn or shrimp in the batter and frying.

Try this for a week and let me know what is the progress.

-- Dr. Donya

Dear Dr. Donya,

I follow your column every week, and look forward to your informative and helpful advice.

Do you know anything about hair loss? A Balinese friend of mine has a daughter, aged about 13, whose hair has been falling out for quite some time.

I asked her if she was stressed about anything, but it seems not. The hair loss is on the top and back of her head. She has seen doctors here and they state the cause is stress and have given her tablets, but I'm not sure what. The hair looks like it has begun to grow back, but it doesn't look very good.

She was taken to a dukun (shaman) and was given some holy water to apply to her hair, but now she has open sores on her head. They look infected; some of the sores are about two cm wide and they look dry in some places but seem infected around the edge of the sores. I asked the mother what they were being cleaned with, but it seems only water is being used. I am sure they irritate her and she scratches them.

I told them that I would e-mail you and see if there is any way you can advise us or recommend a doctor who can help. It is because their confidence in the doctors here is low, that they went to a dukun as a last resort. Do you have a practice here in Bali? I am concerned that the infection will get worse.

-- Roma

Dear Roma,

You say she has an infection in the hair-loss area and also still does not know what is the cause of her hair loss. Two things need to be managed.

First, treat the infection if it is bacterial and needs antibiotics, mostly from the penicillin group (cloxacillin would be good for skin infections). Also, use antiseptics for cleaning that area, such as hibiscrub (antiseptic soap), and if the bacteria is widespread the hair may need shaving. I understand that she is an adolescent and shaving her hair may be a big deal, so just do it around the infected area.

Second, find out what is the cause of her hair loss. * If the girl has patches of broken hair on the scalp or eyebrows, she may be rubbing or pulling out the hair. This signals a behavioral disorder called trichotillomania, if she is a hair twirler. The majority of children who twist, stroke or pull their hair are girls. Hair twirling may appear in early childhood and last until adolescence. In some girls, the behavior may appear at adolescence. * Another type of hair loss, known as alopecia areata, is usually temporary. It affects approximately 2 percent of the population and can involve hair loss on the scalp or the body. It is classified as an autoimmune disease, but the cause of it is unknown. In fact, people who develop this type of baldness are generally in good health. A family history of alopecia areata makes you more likely to develop it. Hair will generally grow back, but it may take several years. * Scalp infection. Infections such as ringworm can invade the scalp and cause changes on the skin's surface, which can lead to hair loss. Once infections are treated, hair generally grows back. Ringworm, a fungal infection, can usually be treated with a topical or oral antifungal medication. * Disease. Diabetes and thyroid disorders can cause hair loss. * Poor nutrition. If you get inadequate protein or iron in your diet or are poorly nourished in other ways, you can experience hair loss. Fad diets, crash diets and certain illnesses, such as bowel disease or eating disorders, can cause poor nutrition. * Recent high fever, flu or surgery. You may notice she has less hair four weeks to three months after an illness or surgery. These conditions cause hair to shift rapidly into a resting phase, meaning you will see less new hair growth. A normal amount of hair typically will appear after the growth phase resumes.

Please take the girl to see a pediatrician or dermatologist. Let me know what is the result.

-- Dr. Donya

Questions? Sanur, Bali-based pediatrician Dr. Donya Betancourt can be reached at drdonya@hotmail.com or you can reach her at features@thejakartapost.com