Please help us figure out DD’s eating

[Essayer]

DD is 4, and about to start reception this September. She was born on the 25th centile and is now on the 6th. DD has no interest whatsoever in eating. There are three types of issues -

1. At family meal times she chews each morsel - we have counted - between 80-110 times, till it is effectively just saliva at which point she swallows.
2. She then spends about 5 minutes between the swallow and the next bite laughing, joking, asking to go to the toilet, standing up in her chair, asking for toilet (even if we have ensured she’s used loo just before), then comes the next mini bite. That is then chewed slowly 80 to 110 times. At this point DH, DS and I have finished our meals and are waiting with her. Eventually she declares she is no longer hungry as she is conscious that playtime is running out/she’s missing out on things. As a result the actual food she takes in is very little.
3. She has a peculiar aversion to anything that is soft and white (cream, mayonnaise, melted cheese), anything that is a salad item and anything that is sweet (such as cakes). She has a limited group of things she will eat - broccoli sweetcorn cucumber green beans carrots rice chips pasta salmon chicken but more - owing to points 1 and 2, hardly 2 spoons go in. Most other foods she refuses to try and declares “I don’t like it”.

We are really worried about her eating. She takes an hour in the morning to get through 2 bites of toast. She will happily live off milk which we try to lessen all the time not solely to make room for other stuff but also because it sets off her eczema.

for context - her brother DS8 - also was born on the 25th centile, is still tracking 25th centile and is a genuine lover of food/cuisines/tastes. He enjoys cooking, concocting dips and recipes with me, and trying any new flavour or taste. I’ve tried involving DD in all of this but no.

any advice?

Not sure relevant but in terms of physical activity - she’s been at FT nursery all her life after maternity leave ended (same as DS was), and currently does Multisports, swimming and football - all of which she loves.

Have you taken her to a doctor? With the chewing thing, could she have an issue with physically being able to swallow solid food? She might be able to see an SLT for help with that.

Thanks yes will contact the GP. I’m worried it could be ARFID…

Have you considered ARFID?

Does she eat at nursery?

Same issue at nursery - where the temptation to go and play once all other kids have finished is huge.

As above I worry about ARFID but I’m also extremely confused as to how she can be so energetic, sporty and sorry for TMI but poo such healthy volumes so regularly - if she indeed eats so little. On the other had I’m also confused how DS8 who eats masses) of all varieties of food continues to stay lean and long at 25th centile his whole life so far.

Has she had any illness or sickness? Has she ever choked?

Also, is she growing?

I was told by the GP that they’re concerned if they eat less than 20 different types of food.

How long after birth did she drop down? Because I was under the impression birth percentile wasn't hugely relevant, otherwise all big babies would be the biggest children regardless of their parents' size which obviously isn't the case. Some people will be small. Having said that, she eats very little from the sound of things. I'd go to the GP. We limit milk until after a meal (I know I just used to fill up on it as a fussy eater) but I'd be concerned your daughter is reliant on it for calories.

Definiteiy one for the GP, but gave you tried feeding her in an empty quiet room with no distractions? What if you give her food that requires minimal chewing eg soup, milkshake, smoothy? With the amount she is eating i would try and i ncrease calorie intake even if it isnt the healthiest food.

I’d be most concerned about the quantities rather than the types of food at this point.
I think you need to flag this with school as soon as possible. School eating times are finite. You need to decide how much you want them to encourage her to eat or if she’s allowed to be let off with essentially not eating anything.
Does she snack between meals, will she eat and play at home??

She’s enormously energetic and active and appears to be growing over the 4 years of her life obviously. I cannot understand how she poos so regularly - I mean what’s coming out of her if what’s going in is so little?!

yes will tell school, and also approach Gp.

If you give her a plate of her favourite foods - say potatoes, carrots, broccoli and some fish - she will pick a bite, laugh, joke, play pranks, graze a bit - take another bite - chew for ages - laugh, play, tell jokes, go to the loo - 2 hours goes by.

no choking incident of note.

Speech & Language Therapists may be able to help with this. It sounds like a swallowing issue to me. Possibly anxiety. Definitely go to the GP first.

Ds was never really interested in food and ate very little. We took him to the gp and he was referred to the paediatrician and he was seen for quite a few years. He just ate enough to fuel but no more and he was very thin. We gave him high calorie of anything he would eat and slowly he began to eat more. He just seemed to not need food. He is now a well 17 year old who eats everything. He still hates the feeling of being full but is well.

Have to considered ADHD? It should like she's is very distracted while eating.

I was a fussy eater. I'll tell you what helped and what didn't help.

Didn't:

1. Comments. Even now if someone comments on what I'm eating (positively or negatively) my appetite goes.
2. Huge plate of food. If I know I can't finish it, I can't start it either.
3. "Wet food" that sounds silly, but there are certain foods (bread is the biggest one) that I cannot eat if it's even thought about being near something wet. oddly, I can dip bread in soup. But drop a crumb into a drop of water on the table, and I will vomit. Yes, that's psychological. I know. I do try (and fail)
4. Foods touching. Not so much now, but as a child the first thing I did when getting a plate of food was separate it into the different things and stop them touching. Interestingly, although I've not done it as an adult, my dd goes through phases of doing this too.
5. Bribery (eat this and you can have pudding). Again, my appetite goes.
6. Pack lunches. It's something about the smell. One of my rare talents is being able to dispose of an entire pack lunch sitting next to my family without anyone realising.
7. Pressure to eat. I hate eating at other people's house. Because I put pressure on myself and feel I should eat everything, even if I know they won't mind. I'll often say to someone "don't worry, I've eaten" rather than accept lunch because I know I will struggle to eat even though I'm hungry.
8. "You ate it yesterday". So... I can't today. Please don't point it out, because that then makes it worse because I don't want to try something because I'll be told that I ate it yesterday.

Did help:

1. Having a selection of food I can just help myself to at any time. Not "meal time" food only.
2. Being able to just pop what I haven't eaten in the bin without any comments.
3. Dry food. A biscuit first can really help me eat, or crisps with "wet food" to trick my brain that it isn't wet. (probably not for your dd but I thought I would mention it)
4. Enough drinks, and actually not water. If the meal is all okay for me then water is alright. But if I'm already struggling to eat then I need a drink of what I describe as something "thicker". Fizzy is the best, but apple juice does as a healthier option.
5. Small portion, with the option to ask for more.
6. Something to suck. This probably sounds odd with my thoughts on wet food, but I'm not just talking about sweets here. Iced Gem bottom actually suck beautifully and can help settle my stomach.
7. New things in small quantities. I was actually quite good on trying new things (ironically my siblings who had the reputation of amazing eaters, were far worse than me). The best was being able to slide a piece off someone else's plate (a siblings was even better because they'd object ) because I had no pressure whatsoever to eat more. I ate chips for years by just taking one at a time of someone else's plate. But that meant I didn't have a portion I had to finish.
8. Being explained why things looked a certain way, in a positive way. You know when you take the batter off fish from a chip shop and there's a bit of skin left. That turned my stomach because I didn't know what it was, until dm explained it. I've half a feeling she told me they skinned them because some people ate the skin as a delicacy and so getting any was a treat, but it worked. 🤣
9. Letting me get down when I'd finished. Sitting at the table staring at what you haven't eaten doesn't do anything except put me off that food.
10. Making sure there is always something on the table/plate that I like.

It is frustrating having a child who won't eat. One of mine is fussy too. There was a time we were down to about 3 foods she would eat. She lived off tinned sweetcorn.
But I also have a thing that if I don't eat, I don't get hungry. The less I eat, the less hungry I feel. And my dd is the same.
I do now get migraines if I haven't eaten, but as a child I didn't, and the "she'll eat when she's hungry" would never have worked. I was quite happy not eating, and the longer it went, the more sick I felt at the idea of eating anything. A small snack before a meal actually means I can eat better because I start feeling hungry then.

Stop the milk as it is so filling!
If it's Arfid then she would surely show other signs of Asd ? It's rarely stand alone surely?

I have two friends with this and I believe it wasn't helped by enabling them to eat only their choices and now as teens it's too late to change .

I would ask for a referral asap to see if you can get early intervention

Some other things prompted by a PP-

1. DD gets extremely upset if foods that aren’t meant to touch, touch - for example if her raisins box touches a sandwich filling and gets a bit wet.
2. cheese is great if grated or slices but not okay if wet/melted/soft.
3. DD hates it if her clothes have a drop of water on them - for example a day out
4. DD will not wear clothes with a tiny rip/thread hanging - gets upset if her tortilla wrap gets a little hole and asks for a new wrap
5. DD has other tiny things that appear “fastidious” such as can’t leave a drawer open, must put lids back on pens even if they aren’t her pens to tidy up. Must put the right cap on the right pen and put the right pens in the right boxes . I am not complaining about this as DS is the opposite but DD is very “specific” about how she wants things. Example - we are walking past her nursery and she spots a random pen and lid undone onthe floor - she will quickly stop, put the lid back on the pen and the pen on the side before she walks away. If she is told to leave it she gets very distressed.
6. For example - her comfort blanket has a specific corner that is of particular significance and must be held in a specific way.

Not sure how this is related to anything food related but the mentioning of foods touching reminded me to bring it up…

In terms of general demeanour - she’s a bunch of lively loveliness - listens, plays heartily, jokes, is funny, empathetic, very kind, reads beautifully already and loves crafts, sports, writing letters, swimming etc and super excited for reception to start.

No advice just solidarity my ds is exactly the same except his list is now, rice, pasta and strawberry it's heartbreaking when they just won't eat.

What happens if you spoon feed her? My ds has, I suspect, ADHD and cannot stay at the table. He gets distracted and just won't eat UNLESS he's on my lap and I'm spoon feeding him, still at 5 years old, and then he will eat a solid adult sized portion of whatever dinner.

It also sounds like she has a non-ige cows milk allergy if the milk is causing eczema. There could be low level gut irritation going on. I'd trial removing milk products for a few weeks and see if she becomes more keen on food.

I'm not an expert but all this sounds like OCD/anxiety related. Please write it all down to show to your GP.

Good luck!

If she has milk will she have smoothies and soup if blended smoothly?

Id be looking at high calorie, high nutrition low volume things for her.
If she thinks a dry consistency then try couscous and quinoa which she can eat with her fingers. Adding ground flax seed to things which she won't notice.
It would be interesting if a drop of food colouring in her favourite colour would get her to eat the white things.

Some children with food allergies and intolerances naturally avoid the problem food in a weird evolutionary instinct way before anyone official knows there is an issue.

All of the things you mention above were similar to early signs in my ASD DS.