Exhausted. Probably need to wean DS off bf but major food issues. Help.

[668neighbour]

DS is 21 months, breastfeeds an insane amount and sleeps very little. I am exhausted and drained and constantly feel sick and headachy because I am so tired and because there is so much breastfeeding.
I am totally aware that breastfeeding is likely to not help with him being a terrible sleeper.

However a lot of the breastfeeding is because he is refluxy, and has yet again refused to eat anything. We are stuck in a vicious circle.
He is allergic to beef, dairy, soy, tomato and potato, is a botte refuser, and is a monumentally fussy eater. Won't eat any meat except very occasional chicken; won't eat eggs or fish.

Basically he lives on (homemade, wholemeal) bread & (homemade) peanut butter; lentil/chickpea/veggie/spinach soup; chicken stir fry with brown rice; lentil/veggie pilaf with brown rice; and porridge with oat milk, coconut yoghurt and chopped up fruit... and the other 70% of his diet is breastmilk. Thus what food he eats is pretty good - all made from scratch, no added salt or sugar, but he hardly eats, so I haven't stopped breastfeeding because otherwise there's not a chance on earth he'd get anything like proper nutrition at the moment. And obviously he's just filling up on breastmilk.

He is at an age where it would be theoretically possible to just go cold turkey on the breastfeeding and force him to eat "proper food" but he's stubborn as a mule with a will of iron, and I have just no idea how to get him to eat enough things to get a decent cross-section of nutrients/protein/fibre/fats etc. I'm severely allergic to avocado, shellfish, most fruit, so they don't come into the house. He doesn't like hoummous. He would eat cheese by the tonne if we let him.

WTF do we do? I am so tired that I really want to breastfeed less (and I'd like to return to being able to eat the stuff he can't eat), but I just cannot get him to eat enough.

Please don't shoot me- but before I say anything else- who diagnosed his allergies?

Paediatricians. I'm a biologist with the ability to read the immunology literature.

It's a chicken and egg situation. He won't eat much because he's not hungry enough and knows bf is available.

Is he a good healthy weight? Before I start suggesting he won't starve!

When I stopped bf in the day I enlisted DH to take over all feeding activities when home. Is there a DP on the scene?

that sounds hard!

Perhaps you need to relax and lower your standards a little?
The things you have said he eats are all really good... great that they are made from scratch etc... but you seem very worried about 'proper nutrition' and the thing is that toddlers in general do not eat well.
Some lucky people may have a child who just eats anything and loves healthy food... but if you look through the threads on here you will find countless tales of toddlers who spent a year refusing everything but pasta shapes and carrots or whatever!
Toddlers can be very fussy for a time but most do grow out of it eventually.
I think perhaps it is time just to go cold turkey to an extent and cut the breastfeeding right down. And if to get his calories up you need to let your son gorge on cheese or something else which might be high calorie but not particularly healthy, then just do that.

I'd totally let him gorge on cheese but it makes him vomit!

Are the allergies intolerances or allergies? And are you sure you know what all of them are? If he is still refluxy at this age it suggests there might still be something(s) in his diet that he is intolerant to.

If it is intolerances that he has, I am surprised HCPs have not suggested that gluten and diary could be the culprit for the reflux. Do you see an paediatric allergy consultant, or a general paediatrician? Have you tried cutting at least those out?

It is common for children with food allergies and intolerances to be very picky with food, as they twig at quite a young age that food can cause them pain/be dangerous. And of course, at 21 months he is at the age where they usually get picky and start self-restricting anyway. You are in a bind...

You say cheese makes him vomit. That right there makes me suspect a dairy intolerance. Has it been definitely ruled out?

To clarify - my high standards aren't really high standards - it's just that any processed food where we live contains milk, soy or both. So stuff like chicken nuggets or fish fingers are coated in milk powder and soy flour; likewise bought bread, bought peanut butter (soy oil), biscuits, etc etc. Can't get him to eat pasta - he gags on it whether it's whole or blended up.

Is he on maximal reflux treatment? A lot of bad refluxers seem to go on to have overactive gag reflexes, which amongst other things make them very sensitive to texture in food. Which would go along with meat being a real problem, but things that chew down to a smoother texture being somewhat easier.

What is his eating behaviour like? Will he happily eat the things he likes, or does he seem disinterested, or does he gag/choke, or does he reject plates that are 90% preferred foods but one disliked food, or does he play with it? Is he happy sticking hands/toys in his mouth? Does he prefer self feeding over being fed (again gagging refluxers tend to)?

For instance, if he's a gaggy retcher, or a gaggy choker, then probably worth looking at textures similar to those he will eat, maximising reflux treatment, and probably a SALT assessment. If he's a good days/bad days picky type, given the allergies may be worth seeing the dietician again.

He's allergic to dairy as in the original post. Also soy. Also potato/tomato, and beef (same protein as dairy products - BSA).

Are you sure the gluten in the bread is ok?

He prefers self feeding, and food texture is definitely part of it. He's a gaggy retcher who can bring up an entire meal on one gag.

Almost certainly also still has things he's allergic to as he also has eczema, but haven't worked out what they are - hayfever is one, but probably food as well. We have no pets.

Sorry I missed the bit where you said he can't eat dairy

Gluten could be one issue, I guess...? Nothing other than the reflux and eczema make me think allergy though - so I am not thinking coeliac as there are no foul nappies (unless he accidentally gets dairy or soy) and he is an extremely healthy size (99.6th centile for height, 95th for weight)

The eczema suggests it's s food. It would be a problem to find it, though, if it's not one of the usual suspects, and of course it could be more than one thing, just to muddy the waters....

My DD is intolerant of gluten, but not coeliac. Never had weight issues either. Only some not too bad eczema. But the reflux was considerable. We see the allergy consultants at St Mary's Paddington, and they are clear there does not need to be weight issues for there to be intolerances. It would be nice if they could do a round robin on that to all NHS GPS.....

At St Mary's they would have referred to a paediatric Castro-enterologist by this age if reflux is ongoing (for possible endoscopy). Has that been offered to you?

That should, of course, be Gastro, not Castro. A trip to Cuba would probably be above and beyond...

Unfortunately we're not in the UK and the only paed gastros or immunologists are 1500km away, the health system here is such that paediatricians see him once every 6 months and they know the immunology literature to the same degree that i do. No useful private options here either.

I took him to see a friend who's a paed immunologist at a big tertiary teaching hospital, when we were on holiday in another country. But friend can't really be responsible for ongoing care, thousands of km away.

Will ask the paeds about skin-prick testing in case there are Type I allergies by now (everything has been exclusion/challenge under supervision, so far)

Have you considered/ readers he'd sensory processing difficulties?

Figured that SID/SPD is less likely than allergy/too much breastfeeing, at the moment. It's worth bearing in mind though.