to think this food advice for 3 yo from paediatrician is ridiculous?

[JustCleo]

3 yo DD is going through the assessment process for autism at the moment. One of the many things she struggles with is food. She has never eaten hot food and will not touch it. She has a very limited range of foods which is reducing weekly because she gets fed up of the same things repeatedly. The only things she will eat are:

Cucumber
Peppers
Grapes
Pepperoni
Cheese
Crackers
Crisps
Cake

At her last paediatrician appointment I mentioned how her diet has become more restricted than previously (she used to have 4-5 more foods she'd eat) and the paediatrician didn't seem to think her diet was that bad. She said to give her cake and crisps more often to keep her weight and energy levels up Currently she has them 2-3 times per week maximum.

Aibu to think this is crap advice?

[Everythinggettingbigger]

My DS (5) has been to see a paediatrician over his eating habbits, which are getting worse and worse weekly also, although he is not thought to have any other issues just than being a stubborn little thing! He eats a lot less healthily than your DD, and his main source of food is waffles....yes waffles! he takes a jam sandwich in his packed lunch daily as this is all he will eat, along with either a small cake or a packet of crisp and a small pot of either strawberries or grapes or both...the fruit usually comes back uneaten or only a tiny bit gone. I kept a food diary for a week and while the paediatrician said its not ideal, he's been weighed monthly for a few months and they have now discharged him and said that what he is getting is obviously enough for him!

Their main bit of advice was to keep giving him what he will eat to keep his calorie intake up, even if it is crisp and cake, so this is obviously something they believe in.

[MrsBobDylan]

You have no choice. Give her the food she will eat. The paed has to look at priorities and which in this instance, is to keep her weight up.

But I can tell you from experience (food restricted 6 year old with ASD, in a sn school and diagnosed at 2.5 years), what she eats will likely change over the years (for better and worse!) so don't give up hope.

My DS shuts down between Dec and Feb each year because of the stress of Xmas. In that period this year he would only eat chicken nuggets and crisps. We always try other stuff by placing it on a table near him but with no pressure to eat. He's now on jam on bread, some plain pasta, carrot sticks and will eat MC Donald's and of course crisps and nuggets. It's a huge relief! He has a daily multi vitamin and we just have to accept that keeping his weight up is our main priority and not worry about the rest.

It is so hard though so I completely understand your upset and frustration.

[Lancelottie]

Honestly, Cleo, I think your paediatrician is right.

It's far from ideal, but it's necessary.

I'm speaking as a parent of a (now-adult) child with ASD who was a severely underweight child. The best paediatrician we ever saw said 'Forget the healthy eating. If the choice is chocolate Hobnobs or actual starvation, feed him Hobnobs.'

Incidentally, crisps might be a good basis for later. It took about 2 years (and he was older, about 7 to 9), but we did eventually build on the crisps to introduce 'almost a crisp' very thin chips, then slices of roast potato, then whole roast potatoes and finally boiled ones.

Still haven't persuaded my now-20-year-old that mash or baked spud is food, but by now that's his problem, not mine.

[FortifiedWine]

I'm a nutritionist. Have you tried making smoothies? Maybe things like banana, coconut milk, nut butter, a handful of nuts/seeds/berries, some yoghurt, honey and whatever else you can get in there? Maybe get a special cup with a funny straw to encourage drinking it? Avocado is also full of healthy fats, and this can be blended into a smoothie with some fruit to disguise it.

[Wolpertinger]

What other advice can the paediatrician give? You have an underweight child that probably has ASD that will eat cake. So feed it cake!!!!

Your child will come to far more harm from being starved than from eating too much cake.

[toptomatoes]

DS was under a feeding clinic and dietitian at about 10-18 months and they encouraged the most calorific food even if not the healthiest as the most important thing at his age was that he grew. He also had high cal drinks but didn't really like them so didn't drink them very often. He's always enjoyed the healthy food more - fruit, cucumber, that kind of thing - but does eat a good range now at 5. We are still encouraged to slather his toast in both butter and peanut butter.

[Clawdy]

Dd was eating very little at three, and was underweight. The health visitor said "I don't often suggest this, but try giving her whatever she likes,when she likes. Just for a few weeks." It sounded odd, but we tried it, giving cake, biscuits ,whatever she would eat, at all times of the day. After a few weeks,she started eating normally and has done ever since.

[feudebois]

I would give her loads of crisps/cheese/crackers and cake tbh

If there is any way of getting chicken into her then that would make her diet not too bad IMO.

You could try lower salt crisps - I can't believe they are too bad - potato and oil?

and you could make your own cakes which I think are fine for growing kids

then afterwards give the veg sticks - yes they are good for her but they have NO calories

dd is not on the spectrum but would only eat mash, porridge, cucumber and watermelon for about 6 months. She lost loads of weight and it was worrying.

[MrsBobDylan]

...and just to add, we find that DS will often eat a particular food if we can work out which bit of it he doesn't like. For example, jam on bread has to be without butter and cut up onto triangles otherwise it's rejected.

It's often worth persevering with the same item but presenting it in different ways.

We had a very bad time in December when DS started refusing chicken nuggets. But dh worked out he just wanted the breaded kind not battered. Sounds crackers I know but if it's not what he will eat, he would choose to starve.

[DropYourSword]

If that's literally all she will eat, and is losing weight, I'm not sure what other advice she could realistically have given you.
It sounds like you really have tried everything you could. I mean this in a respectful rather than goady way, but what else were you expecting her to advise?

[feudebois]

Sorry meant to say I just pandered to it and she started to improve - added chicken and broccoli (oh happy day) which she eats nearly every day now

[MrsBobDylan]

Sorry, last post but have you tried cereal without milk but with a cup of water to drink alongside? It has saved us a few times.

[hazeyjane]

My ds is under a specialist dietician, as his diet is very restricted, she works out exactly what Ds is lacking nutritionally and we try and work out ways to fill the gap. She made me feel better about the few things he will eat (mostly unhealthy, no fruit, one vegetable) She prescribes a vitamin powder,but it is hit and miss whether it goes in, so she said to use whatever I can disguise in a drink of squash (Boots own brand baby vitamins in our case). We have just had advice from an OT who specialises in food issues, and she is working outs programme of how to try and introduce new foods. But otherwise ds eats what he will eat.
The worry now is that ds has started to go down the centile scales.

[itsonlysubterfuge]

I agree with other posters saying she needs more calories from whatever you can get into her.

My DH has AS and an eating disorder. His eating use to be extremely limited and was very underweight when I met him. However he's learned to trust me and I've actually been able to help him with his eating. I increased him food portions and the things with more calories. For example he really likes potatoes with butter, so I'd add a bit of extra butter. I've also gotten him to add extra foods to his diet by encouraging him to try new things constantly. He likes chocolate, so lets try this new chocolate bar, etc. I know how difficult it can be and we have had a lot of failures, but we've had successes too. Although it doesn't actually help him with nutrition to eat a new chocolate bar, it does show him that trying new things, although scary can be rewarding. I've since been able to add a lot of new foods to his diet.

We set a goal in our house for him to try 1 new food a week. It didn't matter what it was it just had to be different. Maybe you could ask her if she felt up to trying something new and she could pick anything she wanted from the store at all? I know it seems impossible at times, but actually it looks like at least she's getting food from all the food groups. My husband for most of his young life ate chocolate, bread, and potatoes, that's it. I also realize that it's different getting an adult to try things rather than a child.

I wish you the best of luck.

[Theleavesonthetrees]

I don't think it is bad advise. Children need fat and calories and your daughter, from your own description, especially so. You have to remember that a lot of mainstream food advice has been written to ward off the growing levels of obesity amongst children. Clearly that does not apply to your dd at the moment.
The advice I have read about extreme food refusers is that parents should not restrict access to any foods,such as cake,as this can lead to the child becoming underweight.

[TheOddity]

I think it is realistic advice for a child like this at this stage. Make healthy cakes like banana loaf etc, maybe not the crisps too often but certainly lots of cheese and low salt crackers. A banana is a banana even in a cake, cheese and crackers is virtually a cheese sandwich. I would go with it as your doctor said and try to encourage a small taste of something very similar each day until you slowly add another food. I know there is a recipe for cake which uses veg oil instead of butter and fruit yogurt instead of synthetic sugar. Creativity!

[Yseulte]

Doctors have 0 nutritional training so you may as well get dietary advice from a vicar.

I would search out a good nutritionist with experience of working with autism.

Ironically there is some evidence that good nutrition may help manage ASD symptoms, and severe autism has been linked to low levels of certain nutrients. (Google for relevant research).

I would definitely avoid excessive cakes and crisps - as sugar and refined carbohydrates can cause blood glucose spikes and crashes which can impact behaviour.

[hazeyjane]

If you get referred you do need to ask for a dietician who specialises in specific food issues, because otherwise the advice is to give smoothies, hide veg in sauces, play with food, eat as a family -all of these things are great advice, but when you have tried all these, eat as a family and have a child who could eat a whole block of butter given the chance, but hides under the table at the smell of a banana, and who won't have anything smoothie like or sauce like near him, then you need someone who will come at it from a different angle.

The alternative when a child is dramatically losing weight because they start refusing all foods is tube feeding - ds was nearly tubefed due to aspiration when he was younger, and we managed to avoid it, so if he needs pork pies or ice cream to keep his weight up - then that is what he will have!

[MsGee]

My DD is 7 and recently diagnosed with ASD but had food and sensory issues from age 2. Its incredibly hard so my only advice is to make life easy on all of you. Once I stopped worrying and simply fed her more of what she was happy to eat, life became easier. Sensory issues are much worse with anxiety so if she is worried, the smells and textures will be more pronounced.

The only rule I had is no backsliding - I just worked to make sure she didn't stop eating anything on the OK list. Which means sticking to her rules - for example I ruined spag bol for 3 years by trying to hide veg in it. I don't do that now - a child who can tell the difference between different brands of the same food will know if you hide food in drinks or sauces!

I'd try and follow the paediatrician advice but up the intake of whatever she will eat. There is no point introducing new foods at a stressful time.

It does get better I promise. In the last two years DD has started eating new foods, so things do change. It just has to happen when they're ready for it.

[upthegardenpath]

Crisps everyday is normal for a child? Pardon???
Not in this house!
Not adverse to the potato or fried bit, but I'd be very concerned about the immense amount of salt in crisps, which is far too high an amount for a child.

[hazeyjane]

Making cakes with hidden ingredients is ok,but it sounds as though the ops dd will only eat shop bought cake - also there is sometimes a danger that a child will avoid a food altogether if it has been tampered with.

[Theleavesonthetrees]

You can find the advice sheet on extreme food refusers on the infant and toddler forum.org. It has been the best, well only, helpful advice I have come across.