When adopting a child internationally, there are a host of issues you’ll want to be aware of, many of which you probably already know. These include language integration, ailments like hepatitis and cleft palate, and attachment issues.

One topic that is not discussed nearly enough is that of poor nourishment and the impact it can have on your child. Here is what you need to know:

Adopted children sometimes enter the family with nutrition issues. Due to neglect, overloaded state facilities, or simply poverty, some adopted children may have food issues. These may include sneaking food when they are not supposed to, overeating when stressed, or behavior issues triggered by hunger.

Some adopted children may experience “food anxiety.” If they came from a background in which hunger was an ever-present factor, they may eat until gorged, hoard food, or be impatient waiting for meals. This behavior is normal for those from an impoverished background. A transitional diet and eating habits may be necessary.

Children adopted internationally may seem like picky eaters. This is not because they are actually picky, but because it may take them time to adjust to American cuisine. Remember that the foods you and I take for granted may seem slightly unusual to a child used to something else, causing them to be hesitant about eating or “picky.”

Hunger can impair a child’s development. This applies to both their physical development as well as their mental development. Hungry children consistently score lower on tests and have more difficulty in school, and also have higher instances of health problems.

Children with better nutrition are better behaved. In many cases, behavior problems in children can be improved when their nutrition is improved and their hunger alleviated, according to studies in Massachusetts, Maryland, Minnesota, and Rhode Island.

Once you have come to understand that your child may have food-related issues, you’ll want to address them. Thankfully, with a little love and patience, food anxiety and other issues can be overcome by almost any family. Here are five things to keep in mind:

Do not use food as a reward or a punishment. It’s hard to truly grasp how deep impoverishment and hunger can change a person, especially a child, unless you have suffered through it yourself. Using food/meals as a reward or punishment can be stressful for a child from such a background, sometimes even traumatizing.

Make clear there is always food available. Ensure they know you will never run out. Easing their deep-seated fears in that regard will take time, but with patience you will overcome.

Set aside a special stash of snacks they can easily access. Dana E. Johnson, M.D., Ph.D. recommends allowing your child to access these snacks at any time. This will instill a sense of security in them and help alleviate food anxieties.

Create a transitional diet. You may want your child to begin eating healthy right away, but to avoid difficulties in getting them to adjust, ease their way into your desired meals. Allow them some “comfort food” and cuisine they are used to, slowly presenting it side-by-side with your chosen diet. And remember, they may need to be exposed to a new type of food upwards of a dozen times before they accept it.

Be aware of your child’s nutritional needs. Impoverishment and nourishment issues can lead to childhood health complications, and some may linger. Be aware of any potential issues and of their dietary needs, and gear your meals around that knowledge.

Poor nourishment can have a negative impact on a child’s early life, but armed with knowledge and patience, you can help them get on track to a happier, healthier life.