What are the possible causes of food refusal?
Food refusal can be triggered by various reasons. One of the most common is poor appetite, which may result from physical or psychological problems. Physical causes include gastrointestinal diseases, hormonal imbalances, or side effects of certain medications. Intoxication of any origin (e.g., cancer‑related or infectious) can also cause loss of appetite. Psychological factors – stress, depression, anxiety – also play a role. Some people refuse food because of body dysmorphophobia (distorted perception of one’s appearance) or eating disorders such as anorexia or bulimia. It is important to consult a psychiatrist to identify the causes and develop an individual treatment plan.
How is swallowing difficulty different from food refusal?
Swallowing difficulty (dysphagia) and food refusal are two distinct conditions that may occur simultaneously or separately. Dysphagia means problems with swallowing – often due to physical issues like muscle weakness or esophageal narrowing. The person may feel pain or discomfort when trying to eat. Dysphagia is very often a consequence of a stroke, in which case a neurologist is involved and prescribes medication to restore swallowing function.
Food refusal, on the other hand, is an active decision not to eat. It may be linked to loss of appetite due to illness or stress, unwillingness to eat certain foods, or a desire to control body weight. Lack of interest in food and loss of appetite can be signs of a serious illness or psychological disorder, where a psychiatrist or psychotherapist should be involved.
What are the signs of food refusal (anorexia)?
Signs include:
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Decreased or complete loss of appetite.
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Sharp reduction in portion sizes or gradual decrease in food intake.
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Attempts to hide weight loss or developing a negative attitude toward one’s figure and weight.
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Excessive preoccupation with food – pickiness or avoidance of certain food groups (usually high‑calorie foods).
If you notice these signs in yourself or someone close, seek professional help. This condition is called anorexia, and in such cases, a psychiatrist often recommends hospitalisation.
What are the signs of swallowing difficulty?
Signs include: difficulty swallowing, frequent coughing or choking during meals, a constant feeling of a lump in the throat after eating, and unexplained weight loss. The person may also express fear of eating, or show apathy and loss of interest in food. If these symptoms appear, it is advisable to see a specialist for a thorough medical examination and further treatment.
What are the psychiatric signs of food refusal?
Psychiatric‑related food refusal may manifest as:
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Gradually reducing the number of meals or avoiding certain foods.
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Avoiding places where food is offered and hiding the loss of appetite.
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Physical symptoms: muscle weakness, low energy, weight loss, changes in skin and hair.
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Early stages may benefit from a psychotherapist.
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Mental symptoms include sleep disorders, mood swings, and concentration problems.
If you notice any of these signs, you must consult a psychiatrist for evaluation and treatment.
What to do if a person cannot swallow?
If swallowing is partially or completely impossible, a doctor may recommend:
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Changing food texture – pureed or liquid foods.
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Using sauces and liquids to make food softer and easier to chew.
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Serving small portions to avoid overloading the mouth.
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Using special devices – such as sippy cups or feeding tubes that deliver nutrition directly to the stomach.
Placement of a gastric feeding tube (nasogastric tube) is an important medical procedure. It restores food and fluid intake when a person cannot swallow on their own. It also allows administration of prescribed medications. Indications for tube placement include:
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After strokes or other brain diseases affecting swallowing centres.
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In very old age.
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In severe dementia (e.g., toxic encephalopathy).
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Oesophageal diseases that prevent swallowing.
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Coma – also requiring a catheter for urine output monitoring.
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Advanced cancer (palliative care).
The nasogastric tube is inserted through the nose, then through the throat, oesophagus, and into the stomach. The procedure is painless but somewhat unpleasant – discomfort usually lasts about 10 minutes. Insertion in unconscious patients is no more difficult, sometimes even easier.
Our specialists can place a gastric tube at home. The procedure takes from 10 to 60 minutes, with many nuances that cannot be fully described here.
After tube placement, the doctor gives a detailed lecture (often longer than the procedure itself) outlining an individual feeding and fluid plan, calculated in grams – because it is important not only to give fluids and food but also to ensure that the body accepts and digests them.
After tube insertion, the doctor always leaves a contact number and remains available for remote support, answering questions and helping with any issues that arise.