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?

@Essayer these are all asd traits

Obvs I can't diagnose her over the internet but I have a son with SN and mix in these circles and it is all very familiar . I also have a 21 year old dd who has high functioning asd . She suffered terribly in her teens due to the fact we had no idea and eventually we paid for an assessment when she was 16 as it was never picked up during her school years and ended with a terrible few years after puberty with depression , anxiety , self harm and anorexia .. she is only now coming back to us after years of therapy and getting the right anti depressants .. had I known I would have chased an Ehcp and got her into a school more suitable that a busy MS .. because she was bright and masked no one noticed her and her struggles .

Please look into getting a pead referral as early intervention and diagnose will help get her the right schooling and support

Obviously she could just have an eating situation but as my post above it's rarely stand alone and is usually a 'side effect ' of a bigger diagnosis .

Have you tried nutrious smoothies? No chewing

What would happen if you did a "living room picnic"? Blanket on the floor, plates of food she likes, nothing touching. She can pick at food whilst she's playing.

My 16yo was diagnosed autistic last year, and is suspected ADHD. The "fussy eating" was an early sign, she always took ages to eat. She now never eats at a dining table and that helps her relax around food. We often did indoor picnics because we found she would eat more overall if she was allowed to graze.

She gets on remarkably well with picnics but not all means can be picnics I guess … she lives rice and curry for example.

Re ASD traits there is literally no other trait she displays. Her social skills, mood, behaviour, conduct at home, at nursery, on holiday, at play, in known and unknown social situations, at parties, at quiet weekends - is all just fine. She’s a happy, energetic, engaging, empathetic, communicative, caring, sporty 4 year old. She listens, shares, is jolly, carefree and I’m slightly unsure About the ASD thing.

I’ll absolutely raise the eating issue With her GP on Monday and to her teacher onthe home visit this week before she starts reception and take it from there.

Foods she loves -

Milkshakes
Grated cheese
butter
curry and rice
Pizza
pasta
garlic bread
carrots
broccoli
cucumbers
sweet corn
green beans
roast potatoes
salmon
stuffing
Yorkshire pudding
chapati
parathas
tortilla wraps

perhaps the variety is bigger than I thought - the amount is absolutely an issue though.

It does sound like ARFID.

Did she have reflux or silent reflux as a baby?

She could have physical issues with swallowing. Or she could have ARFID relating to neurodiversity - no signal from brain to tell her she is hungry, profound dislike to all sorts of flavours and textures.

She's old enough now to explain to her what food is for. Explain that food gives you energy to play, grow tall and strong, make your brain clever etc and that hidden inside food are little units of energy called calories and she needs enough of them each day.

DS2 is autistic and had severe ARFID. He was just like this. I honestly don't know how he stayed alive. Two bites. no more, ever. I learned to pack as many calories into those two bites as it is humanly possible to do. (Tiny postage stamp sized sandwiches with full fat cream cheese, peanut butter and jam half the time.)

But if she has eczema, she may have a lot of food sensitivities. Have you had her tested for nuts and peanuts? If she is okay with them, can you try sneaking nut butter into her, as it is pretty much the most high calorie food you can eat in tiny quantities.

Can/do you toss pasta, carrots, chips etc in a bit of extra butter and oil? Not enough to make her taste it or make them greasy but even a tiny shaving of butter is calorie dense.

Have you tried letting her eat UPFs? Counter-intuitive but rules for ARFID children are almost the opposite of rules for feeding other children. DS would sometimes eat lots of cheesy wotsits at kids' parties. Better to have calories from any source at all than none.

Do you add Abidec vitamins drops to her milk? (Highly recommend you start this if you haven't yet)

Keep introducing foods and explaining the powers they will give her: salmon makes you clever, chicken makes you strong, pasta and chips help you run around, carrots and other fruit and veg help your body fight illness etc. If she is neurodiverse, it takes (ime) about 2000 introductions of a food before a child will trust and try it. Neurotypical children are familiarised with new foods after twenty introductions to it, but for autistic children multiply that by a hundred. Don't give up. I was in despair for years about DS's eating. Because I had no idea he was autistic, I didn't realise he was likely to have a very restricted taste in foods so I kept on offering them without pressure, for years and years and years. He's now an adult and eats as wide a variety of foods as any other adult. In retrospect, I'm glad I kept trying though it was a massive source of stress at the time.

That’s a pretty good range of food. Does she get distracted doing other things or just meals? What happens when she leaps about, tells jokes, stands up etc?

My son has ASD & ARFID. Some similarities I recognise. Good luck because it’s been a real fight to get any help so far and still waiting.

That new long list is great @Essayer .

Can you add tiny amounts of nut butter, cream and protein powder to the milkshakes? - a teaspoon of each should be easily disguisable but would make a difference. I used to introduce microdoses of new foods (eg pureed veg in curry sauces) and increase them by a teaspoonful each time until they were at normal levels.

One thing I learned to do was 'post' food into DS's mouth when he was busy. Again, the opposite of healthy eating advice for non-ARFID children - but ignore meal times as the main chance to feed her. Make meal times very relaxed and sociable with zero pressure to eat. make her sit at table with you because having dinner together is a fun family time. But once she is down from table, tuck tiny squares of buttery garlic bread or pizza into her mouth, or spoonfuls of curry and rice. I used to do this when he was immersed in a film or building lego.

Add loads of tiny snack times to her day - straight after school when you pick her up - a bit of buttered chapati and cucumber. When she comes in from school some grated cheese and carrot. Before bed a shot-glass of milkshake and a cocktail sized pizza.

@MargaretThursday i am 76 now and I read your post as it I could have written it. I loathe the term ‘fussy eater’ . Your post was the best I have ever read on the subject and the advice sound.

@Essayer but all of the things you
Listed are asd traits

Asd in girls especially high functioning is completely different to boys and they mask .

My daughter was absolutely NT ( or presented as such ) until she was a teen .
She did none of the things your dd does in your list .

Thanks everyone. Hopefully the GP will be a useful first step.

I disagree that explaining why she needs to eat will help her. Living with no appetite, never feeling hungry, not having the hunger symptoms that most people have is her real life. As it is mine.

Writing out the list of things she eats is a good exercise . You are doing your best to provide a wide variety for her and your main concern is the volume. I would definitely show that list to the doctor.

There are 9 things on that list that I could not eat. My eldest son, his eldest daughter and another granddaughter all have the same issues. Like your daughter the girls a very athletic and sociable.

i understand why you are worried, but hope you take into consideration her general physical health.

Does she snack? It sounds like she'd get more calories in with a grazing diet rather than the standard three meals system. That could be a stop gap while waiting for GP referrals etc.

Tbh if she got energy to run around and joke, plus poos normally all while growing, I don't see much issue.

Some children/peoole are just very slim.
Some are from newborn stage quite chunky and need to manage weight..
I was skinny child but in 30s got to perfect weight.

Yeah there are no issues with energy levels, activity levels or pooing. She’s also a total water baby and loves Multisports. She will very happily tell jokes or ask to play rhyming games or craft or write or read instead of eating though.

Someone mentioned UPFs - we don’t go out of our way to include a whole load of UPFs, but I can also guarantee that if I offered her a large box of garlic crackers she would happily eat half a box. Or Pringles. Or garlic bread. The issue perhaps is that these aren’t regularly the foods that are offered to her.

She could also be naturally petite. As I said - her brother - who eats an amazing amount and variety is skinny and lanky and has not once surpassed the 25th centile he was born on.

this has been a useful thread. If I had to provide her a plate she is guaranteed to eat it would be - 1) Rice with butter 2) cucumbers 3) carrots 4) raspberries 4) fish fingers/smoked salmon 5) garlic bread 6) broccoli 7) cheese on the side. Obviously not all together. Perhaps we need to offer her things she is definitely going to eat..

If you were to give her a meal of buttered rice, salmon, cucumber and cheese, would she still eat a tiny amount and chew it into oblivion or does she eat these things in reasonable quantities at a "normal" rate?

Do four year olds mask?

This.
Forget mealtimes.
Forget 'plates' of food.
Instead, put small amounts finger foods into her hands whilst she is playing. Be prepared to sweep up crumbs later, or wipe toys with bits of food on them.
Anything to get the calories into her.

She can sit at the table for mealtimes, as part of the social experience, as that is important. Help her join in with the conversation, and have age-appropriate expectations of how long she should sit before getting down, but just give her a very small plate or saucer with a tiny, tiny amount of food on it. Ignore 'table manners' or forcing her to use cutlery if she prefers finger foods.
(There is plenty of time later, when she is older, to teach her the norms of table-dining situations).

She does like she has some type of autism. It presents differently in girls, and has a very wide range of symptoms which not all children have anyway.

Yes finger foods she definitely enjoys. A bowl of buttered rice with some grated cheese and cucumber in the side and salmon would possibly actually get eaten.

ill try to design meals around things she will eat and see how it goes. But also GP and letting school know.

I cannot understand how she poos so regularly

How often does she poo? very frequent pooing and eczema are both signs of gut issues. Could it be an underlying distrust of eating because she subconsciously associates it with stomach pain?

My DD has allergies and she barely ate, just lived off milk, until her eczema was gone. I think these things can have a psychological impact on them that not even they are aware of.

How much milk is she drinking? Enough of it could account for the fact she still poos a fair amount.

She poos once a day or at most twice although that’s rare.

She had severe constipation as a baby around 1 years old and we massively decreased milk at the time on GP advice as it appeared to be firing up her eczema and constipating her. Since then milk is heavily reduced but she does have a habit of asking for milk in a cup. I think this perhaps needs to stop at the first instance.

Speaking of lists things she actively hates are -

white sauces
mayonnaise
melted cheese
most white yoghurts
whitish dips (sour cream, hommous)
green leaves
tomatoes

Her top favourites are

rice with butter
chapati
Garlic bread
breadsticks
cheddar cheese
milk
raspberries
strawberries
cucumbers
brocoli
carrots
fish fingers
salmon
chicken
grapes
peanuts (she loves peanuts to the moon and back)

sure - I could keep serving her these but family meals tend to look/feel different as food is not in the form of single ingredients but cooked into something….

but still I’ll try to offer her these sorts of picky foods and see where we get.

It sounds like she has some sort of sensory issues around food and the chewing to oblivion is her way of actually being able to force it down.

I'd be giving her meals that are predominantly things she likes, with something new as well. E.g. from her list, chicken, rice, carrots and peas. It may take several offerings before she even touches a pea, and several more before she actually tries it, but it's about her feeling safe at mealtimes and being able to trust what she's being given. Don't be tempted to try and trick her by hiding things, that will undo any forward progress.

The rest of you can eat your normal family meal and she can try some if she wants to, but without the pressure of having to. She's far more likely to experiment that way.