How to care for the fasting child

The middle of May marks the beginning of the month of Ramadan, the time of year where Muslims around the world choose to abstain from food and drink every day from before sunrise until sunset for 30 days in accordance with religious teachings. This is an opportunity for clinicians to be alert of the potential dangers in fasting for long periods of time.

Fasting is a common spiritual practice in many religions. Jews will fast for certain days, particularly on Yom Kippur, the Day of Atonement. Many Christians will observe a fast for Lent, especially on Ash Wednesday and Good Friday. For Muslims, the most noticeable time for fasting comes during the month of Ramadan.

In the western hemisphere the days are long, and Muslims in the Houston area will be fasting for up to 14 hours a day this year.

One can see why children would be enthusiastic as the time of fasting approaches, since it often unites families. Fasting as a religious or cultural practice can have many benefits including discipline, self-sacrifice, social belonging, and an increased awareness of one’s own spiritual beliefs.

One should know, however, that pre-pubescent children, the sick, the elderly, travelers and women who are menstruating or nursing are religiously exempt from fasting. For these individuals, abstaining from food may have detrimental effects. For the breastfeeding mother, studies have shown reduced milk supply as well as decreased, lactose and potassium concentrations suggesting a disturbance in milk synthesis.

Children can be at particular risk for problems that arise from fasting because of their smaller size, surface area, increased metabolic needs, and inability to properly communicate or help themselves to food or water.

Who should fast and how long a child should fast is a question for parents to consider thoughtfully. Children should be part of the decision to fast or not to fast. Parents should assess the child’s ability to fast based on their health, activity level, tolerance to hunger and eating frequency.

A child requires more fluids and a source of energy to maintain a healthy body, especially for brain development. If someone is denied calories, even after a few hours, glucose – the brain’s main source of energy – is depleted.

This reduction in energy can result in a range of behavior changes from short tempers (to which the term “hangry” has been applied) to serious complications like weakness and fatigue. Children have been shown to have decreased cognitive function even with short fasts.

If children are fasting, parents should not expect a small child to fast a full day from the onset. For younger children, letting them fast for only part of the day allows him or her to feel included, but not overly stressed.  Older children can increase the duration of their fast in increments, which helps the child’s body to adjust. Parents and caregivers should keep the following in mind when caring for a fasting child:

• The breakfast meal is an essential part of fasting, especially for children. They should have fiber-rich foods such as whole wheat cereals, wholegrains, legumes, fruit and vegetables and good sources of protein such as lean meats, nut butters, eggs and dairy products in order to stay full for longer.
• They should be encouraged to avoid high-sugar foods, since it will increase their cravings and provide little nutrients within the calories.
• Children should also stay away from salty foods to decrease the risk of thirst, avoid high-intensity exercise, and drink lots of fluid during non-fasting hours to remain hydrated.
• Avoid forcing children to overeat to compensate for the decreased calories. Overeating will only cause indigestion, bloating and discomfort. It may be better for children to split meals to prevent overloading of food.
• Carbonated drinks, spicy, and fried foods should also be avoided to limit digestive problems.

The most important thing when fasting (or not fasting, for that matter), is eating a variety of foods from all food groups, such as fruits and vegetables, whole grains (cereals, brown pasta, breads), dairy products, meats and healthy fats (olive oil, nuts, avocado).

We should all understand that cultural and religious practices like fasting are important aspects of patients’ lives. However, clinicians must also recognize the dangers involved with fasting and aim to find a way to respectfully educate patients while supporting their decision to do so.

-By Omar Jaber, M.D., academic pediatrics fellow at Baylor College of Medicine