Underweight 12 year old

[Rainingdogsandcats]

DD is 12, she'll be 13 at the beginning of May. She has Asperger's.

She weighs 5 and a bit stone, she's around 153cms. That makes her over a stone underweight. Less than the 1st centile.

She has a limited diet of salad, chicken, Nuggets, pasta, fruit, veg, baked goods such as tea cakes, croissant for breakfast.

She doesn't like to eat sugary foods.

She doesn't like any type of potato or rice but will eat plain pasta with cheese. Shell eat a roast without the potatoes.

Doesn't eat foods like lasagne, etc but will eat spag bol. Doesn't really eat bread but will eat wraps, bagels.

She's in age 11-12 clothes but you can see her bones when she's undressed or in thin clothing.

On the NHS website it suggests doctors but I don't want to give her something else to obsess about. She's lively, acts, dances, sleeps ok.

Would you be concerned?

I have a DS with AFRID. AFRID has an association with autism and sensory processing disorders, so could that be a factor here? When it comes to DCs with AFRID the main objective is to get calories into them, so forget about unhealthy foods, or how bad snacking is, or how sugar is the enemy. None of these things apply for AFRID DCs. Have a look at Direction of Responsibility and see if that helps her expand her safe foods and/or add larger quantities of them.

Has she ever had blood tests done and do you think she would comply with a blood test? It might be worth checking for common causes of weight loss, e.g. thyroid, endo issues, etc. as well as effects of being underweight, e.g. anemia. Pediasure is the go to supplement for the parents in my AFRID groups, but if she doesn’t like milk it might not work. You won’t lose anything by trying though, so I’d get a box of each taste (chocolate, vanilla and strawberry) and see if you get lucky and she likes the taste.

Finally, could she had body image related eating disorder like anorexia or bulimia?

Sound very similar to DD, especially the not eating when anxious. Fun, given its GCSE year! When she's hungry she'll eat a decent portion, albeit of a limited range of foods, so I do feel the anxiety is most of her problem.

We no longer get her to try and wait for the meal if she's hungry, but try and catch those time shes is an make sure she eats then, She'll nibble bits here and ther so also trying to have around some reasonably healthy easy to grab options available, she'll eat things like dried fruit and nuts, toast with various spreads if everything is to hand, but not really waiting for anything to cook.

When I was struggling with no appetite when I started new medication, my dietician suggested eating a starburst type sweet, somehtign that gets the saliva flowing as a way to encourage eating, which sometimes helps DD. The other thing which sometimes help is a small glass of orange juice, o think sometimes of she leaves it too long before eating she ends up feeling sick due to low blood sugar and the juice can help pick it up. It's made quite a difference in terms of getting her to eat some breakfast.

Boo that makes a lot of sense now regarding the advice from the dietician. I thought it would be all about getting him eating healthy foods but it was far more about eating anything particularly high sugar/calorie food.

Punxsutawney my experience with AFRID is that a lot of the usual advice, e.g. “Tell him to eat his main meal or there is no desert”, “Wait it out, no child ever starved”, is complete and utter rubbish. Children will starve themselves because of stress, anxiety, sensory issues, overload and all sorts of other things that we are not even beginning to understand. All the advice about what you should eat is also out of the window because faced with an underweight child who refuses to eat, food becomes food and any food is good food because the alternative is no food. Have a look into Direction of Responsibility and the Mealtime Hostage group on FB, they have helped us a lot.

Some good advice here thank you very much.

She doesn't like nuts so unfortunately no peanut butter or other nut butters.

Haba" DD also has high pain threshold, hadn't connected the dots on how that could be why she never feels hunger pangs.

I have no idea what AFRID is so I will check that out now.

That was me but I was thinner. It delayed puberty for me but got there eventually. Food is hard. It’s feeling sick with anxiety stopping you eating.. It’s sensory hell. It’s smells of food that put you off. Weird or unexpected textures.

I’d go with safefood. (Autistic term for current favourite safety food) Stuff she can eat without worrying about it. Small amounts more often. I can forget to eat until I get dizzy, prompting snacking helps avoid this and may promote better appetite.

The foods you mention she eats are all very consistent in texture and form. No surprises. Better limited diet with no anxiety than anxiety inducing choices.

I’d not introduce it as a discussion. Quietly work on more snacks and more opportunities for eating. She might eat more if watching tv. Basically any opportunity - food availsble, with no comment or expectation.

I’m sure she’ll be fine OP. It’s unlikely to be restricted eating for anything more than sensory and anxiety.

Oh and read up on interoception

Autistic people are frequently not great at recognising their own bodies messages, hot,cold, tired, pain, hunger, needing the loo. That’s another reason to do food at intervals. And drinks. Wouldn’t be a bad idea to say go to loo and wash hands before meal to get rid of needing a wee sensation knocking about in her body which can distract from eating without knowing that’s what it is.

Sorry it’s ARFID, for some weird reason I persistently misspell it. It’s Avoidant Restrictive Food Intake Disorder, pretty much extreme picky eating.

It is poorly understood and seems to have many causes. In some DCs there is a physiological reason like palate issues or reflux. In others it starts as a result of trauma, e.g. a chocking episode or an association between food and pain. In others it is a sensory issue and has to do with food textures and colors. In some DCs there associated heightened smell issues, e.g. my DS vomits in smelly places which include what we would all call bad smells like the vets but also what other people find pleasant like restaurants with an open kitchen. Some ARFID people are believed to be supertasters, I.e. they experience heightened tastes which make a lot of tastes unbearable. In some DCs it’s an expression of stress and anxiety, possibly an attempt to control one of the few parts of their lives they can control.

I weighed 3 stone when I was 12! I’ve always been incredibly healthy. They thought my mother wasn’t giving me food at one point. I stated a size 4 till I had my children at 30. I’m now a size 8. All my family are super skinny. My kids were 2lbs. And 2.5 lbs. both had bad growth. It’s probably something genetic. But they and me have had tons of testing. All come back perfect. We are just not destined to be big. Simple as.

I am 27, have ASD and have has periods of being underweight but am now a healthy weight.

Interoception sounds like the issue here. I used to go days without eating because I just did not feel hunger, ever! Particularly when stressed or anxious. I now have a calmer lifestyle so feel it a little but not a lot! Sometimes the first time I realise I haven’t eaten is when I feel dizzy and faint and even then, food doesn’t occur to me.

The secondary challenge is the sensory issue of food. I am fussy over both taste and texture so limited choices, particularly in unfamiliar places. When I am very anxious or tired I can barely tolerate anything in my mouth.

The best way to counter this is to use another feature of ASD- structure, routine and rules! Set routines and times for food and rules about quantity eaten, even if it is her safe foods. Empower her with knowledge- our bodies are growing/functioning and to do this they need fuel so we must eat regularly. I even have calendar reminders about what to eat and when. Predictability over what I will be eating also really helps as it seems to lessen the sensory issues when I am expecting it!