DS losing too much weight - who to see?

[SeagullsAreLikeThat]

Looking for ideas / advice, please. DS (8) is having problems eating following a food-related incident a few months ago - everything now has to be chewed to within an inch of its life and consequently he's taking five times as long to eat, meals are going cold / he gets fed up and is eating only about a quarter of what he would generally eat before. He's always been slim, hovering around the 25th centile. He's lost weight since this started and is now (according to the NHS calculator) underweight and on the 1st centile.

We've already seen the GP re anxiety relating to food. His view was "it's just a phase, it will pass". DS has had general anxiety for at least 3 years that hasn't "just passed" and I'm not convinced this will either. Have read other old threads on here saying "do go to GP", "don't go to GP", "ignore, it will pass", "get him some psychological help" and I am now lost as to what I should be doing. To see GP again seems like an over reaction but should I see practice nurse or school nurse or just watch and wait and track any further weight loss? Any thoughts appreciated.

[Badders123]

I would suggest asking for a referral to a clinical dietician

[SeagullsAreLikeThat]

Thanks for the response, Badders, it's appreciated.

[Badders123]

In some areas you can self refer to services...maybe check this out?

[SeagullsAreLikeThat]

Will do, thanks. I know there are plenty of services round here you can self-refer to so hopefully that will be one of them.

[TheAussieProject]

Meanwhile, could you try thick soups, risottos, polenta, .... Italian cooking has plenty of nutritious blended dishes.

Have you tried involving your child in the cooking and for example if the food that caused the incident was a potato, telling him you will never ever buy potato again and make a theatrical gesture to throw away all product in the house containing potato. I am saying this so he has one culprit, a specific food and not the whole category of food.
Also, if he was doing something else while eating (watching tv, reading, gaming, eating lying on stomach) again blame the behaviour and try to explain that this won't happen seating at the dinning table (it is not true but it will help the anxiety).

I hope someone here comes with better ideas but I didn't want to read and run.

[SeagullsAreLikeThat]

Thanks for that. I think you're right and "sloppy" stuff is the way to go at the moment, just to get some quantity of food into him. I suppose it could be worse, at least he is eating something (and in fact will eat everything he previously did except the offending item), it's just not in enough quantity to keep the weight on him because he's eating so slowly.

[Meloncoley2]

It doesn't sound as if your GP is terribly helpful. Is there a different GP you could have a telephone consultation with? and also try ringing your school nurse to see if she knows the best way to move forward.
It sounds ( correct me if I am wrong) as if this is a psychological response, so the help available depends on the individual practitioner's experience, but may be someone like SALT/dietician/psychologist. It may be worth ringing your local CAMHS to see if this is within their remit, or where they would point you to.

[dairymilkmonster]

camhs!
See a different gp and ask for a referral.
nb. I am a psychiatrist.

[SeagullsAreLikeThat]

Thanks for the latest responses, sorry I've not been back before now. CAMHS round here will only deal with really urgent cases unfortunately. There is another body which deal with non-urgent (which I'm sure this would be considered as) but the waiting list is around 12 weeks. We're on it, but still have a couple of months to wait. The school nurse is going to be involved, and school are being really good but things need to change quickly. I just wish I could find the magic words which will help him but once he has an idea in his head (ie that any food is capable of making him choke), he finds it so hard to change that view, regardless of the consequences.
Thanks for the replies. Will go back to GP if the school nurse can't help.

[canyou]

Will he drink smoothies? If so some with added protien etc might help but you would need to speak to a professional. But a normal fruit and veg smoothie after meals not as a replacement might help

[momb]

While you are awaiting your psych and/or dietician referral just get any calories into him you can. Smoothies, milkshakes, soup, whatever. When you aren't getting enough calories you become sluggish and ironically your appetite goes down, so it becomes a vicious circle. You will need to address the particular issue with over chewing but you need help for that: getting him fed would be my first priority, even if it isn't necessarily the most nutritious stuff.
Good luck.

[LonnyVonnyWilsonFrickett]

Second Cahms and I would say it is urgent.

You could also try a dietician for weight management strategies, DM was refererred after her cancer treatment as she lost so much weight. But there may be a waiting list for that.

As pps have said, meantime focus on sloppy food with high calories. Switch to full fat milk too.

[SeagullsAreLikeThat]

He does drink milk fortunately so I'm pouring that down him and smoothies with extra protein are a great idea. You're absolutely right about the loss of appetite though, he just has no interest in food - he'd rather not have to eat at all.

[fraggle84]

Ask the GP for a high calorie build up drink? Dd had them at 1 years old due to weight loss from a milk allergy. She was put on neocate advanced which is for 1-10 year olds but is dairy free there must be a non dairy free one though