Children who have feeding difficulty, food refusal, volume limiting, grazing, and poor weight gain often show decreased appetite and reduced hunger cues. One of the many medications we use in the treatment of patients with feeding difficulties is an appetite stimulant, cyproheptadine (Periactin). It is an antihistamine that is also used to stimulate appetite in a variety of different types of patients. We use it within the feeding team most often after we believe a patient has achieved “gut comfort.” Gut comfort is just a simple way to say that one’s GI tract is comfortable and happy.
We treat GERD and Constipation first with different medications and broken down formulas that are easier to digest. We treat these underlying conditions first, as we do not want to boost the appetite of a child who is in pain or has discomfort. We find the use of cyproheptadine in conjunction with behavioral feeding therapy very effective in stimulating the appetite while gaining improved eating skills and behaviors at the same time.
Many children have improved appetite and desire to eat when taking this medication. We have seen children double their intake, ask for food for the first time in their life, and transition into a routine of eating that is much easier and more comfortable for them which results in weight gain and growth. Many children have also benefited from reduced vomiting and an improved ability to tolerate larger volumes of food/liquid in the stomach, also benefits of cyproheptadine.
The main side effect we have encountered is sleepiness, which may actually be beneficial for the child who has a pattern of poor sleeping, often seen in children with feeding and reflux issues. In this case, we recommend giving the medication at night. Some of our patients taking cyproheptadine have increased activity or hyperactivity, as is also occasionally seen in other medications in the same class (like Benadryl). These patients take it first thing in the morning.
There are times when cyproheptadine does not work the first time, and we may opt to try its use a second time later on in the treatment plan.
For many children, the hunger effect will wear off after a period of time of use. Parents report that the medicine doesn’t seem to be working as well. At that point, we cycle the medication. Some children take it for 5 days on, 2 off; some take it for 3 weeks on, 1 week off; some children never cycle it. The schedule is tailored to the individual needs of the child.
We find the use of cyproheptadine to be very beneficial for our feeding team patients in increasing appetite and reaching our goal of optimal weight gain while more easily gaining proper feeding skills. One of our patient’s parents referred to it as “liquid courage” as his daughter tried foods she had never tried previously while taking cyproheptadine.