Non-organic poor appetite/feeding difficulty in children is characterized by persistent poor appetite or reduced food intake without the body-image disturbance or fear of weight gain characteristic of anorexia nervosa. This hypothesis-generating narrative review examines gut-brain axis dysfunction in this condition and evaluates proposed mechanisms of Traditional Chinese Medicine (TCM) interventions. Peer-reviewed literature published from January 2000 to August 2026 was reviewed using PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI). Human, animal, and review studies relevant to appetite regulation, pathogenesis, or TCM were considered, while studies exclusively concerning anorexia nervosa were excluded unless used as clearly identified indirect mechanistic evidence. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I), and A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), where applicable. The evidence was organized across four dimensions: central appetite-regulatory networks, including neurotransmitters; brain-gut peptides; intestinal barrier function; and gut microbiota. Available studies suggest alterations across these dimensions and propose that specific TCM interventions, including herbal formulas, acupuncture, and tuina, may influence related pathways. Evidence concerning microbiota composition and short-chain fatty acids (SCFAs) is primarily preclinical or indirect, and functional restoration of gut-brain communication has not been demonstrated in affected children. Overall, the evidence is heterogeneous, predominantly correlational, and frequently derived from animal models, in-vitro studies, other disease populations, or specific interventions. Direct pediatric mechanistic evidence remains limited, causal pathways have not been established, and no efficacy conclusion can currently be drawn.
