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?

Love the idea about disguising the cake! I tried things like that and out of the whole family he was the only one to smell a rat! I sympathise with you, it dominated the lives of the whole family for many years.
For our own sanity, I used to have a couple of days a week when I forced myself not to worry about the food intake of ds and let him get calories from any source on his limited list. Mainly white carbs.
He is 24, very fit, healthy sportsman, normal weight and height. I despaired he would thrive. Some foods he still will not try, never had a baked bean or rice for instance.

As I said refined carbs and sugar are OK in the short term, but it's not good advice to rely on that in the long term.

To imply that I'm somehow suggesting that calorie intake is not increased is false. It's important to find nutritionally sound ways of increasing calorie intake in the long term.

With a malnourished child, weight is not the only issue but energy too. It's important that the sources of calories are providing sustained energy release through the day, not simply spikes and troughs.

Ironically, my son claims he can't remember being a food refuser or having such a restricted diet for years, but my other older children can remember all too well the battles and tears. Obviously affected the rest of us more!

Yseulte - it takes time (a long time) to try to change what a child will eat when they have severe food issues - how do you keep them alive whilst making these tiny tiny changes to improve the diet?

Its all very well to say that these things are empty calories and may have a negative effect on their behaviours (this has been researched but is not proven) and they need xy and z - but if a child will not eat xy and z, then we need to find ways to change their diet, whilst keeping them alive, growing, and trying not to make a child's relationship with food full of negativity.

My ds sees a specialist dietician ( not a nutritionist, or a community dietician) her advice would be similar to the paed, but with a programme of how to introduce new foods, and working with a specialist OT wrt sensory issues and food

Just wanted to say I am in the same boat as you. My DD is autistic, underweight and has a restricted diet. I've learnt to go with it just to get something in to her stomach. She has minimal interest in food and even food she likes she'll eat only very small amounts.

Every now and then we'll have a tiny breakthrough, largely when she decides she'll try something from her brothers plate (and then I have to persuade him to let her try it!). Recently she's decided she'll eat meatballs not just sausages - I can make those myself, hurrah!

Do get some further advice if you can access it - we've had a dietician come to us, the problem was that they didnt understand quite how sensitive her palate is and no amount of hiding veggies in sauces was going to work.

For what its worth my brother (not autistic) only ate jacobs crackers, lumps of cheddar, heinz tomato soup and finders pancakes until he was 11 (when he discovered roast chicken!). He's very fit and healthy now.

YABU, I don't think you have had bad advice.

My DS is underweight due to severe food allergies and the advice we were given was to not worry overly about healthy eating, but to get calories and fat into him. If that meant cake 3 times a day then so be it.

They recommended unsalted kettle chips, would that be a possibility?

DH is very glad that DS2 (3.8yo) likes baked beans because we can easily sneak his daily vitamins into the orange gloop. He won't have them otherwise, he gags and vomits.

I have been known to make him hot chocolate and dispense 7.5ml of calpol into it in order to get medicine down him because if he sees it (guess what?) he gags and vomits.

This is a fun game.

If her diet is that restricted, why is it bad advice? Ds1 has food issues so I have always fed him lots of cream, ice cream, macaroni cheese (made with cream!), crisps (Ready Salted are healthier), crumbles and cakes. He has vitamins in fruit juice at breakfast. What is it with Pepperoni? He adores it too, but at least he also likes sausages.

I make a mean courgette chocolate cake. You can put other veg in and it's invisible! Will she eat cooked food which is cold eg. a cold pizza with peppers on it?

The docs thought his diet was good as he will eat about 4 different hot meals (though goes off them too as gets bored). It's like: well, he is fine. And I am thinking: yes, but he is v thin and this is not normal. So what do I do? Mostly used MN to be honest.

I feel for you, OP, I really do, as it is frustrating and sad. But you just need to work with what you have and let her see you eating other stuff I guess.

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

Did you see smoothies on the list?
Or anything that would suggest this child will drink a smoothy.

The common trend with everything on that list is they are all either dry or individual pick up items it's highly unlikely one with that food list would do anything other than puke and refuse when handed a smoothly.

Do you have any idea just how much hope, time and energy parents with ASD children with severly restricted diets have totally wasted by going to see nutritionists who then give then utterly useless advice like drink fucking smoothies?

Or any idea how much service money is wasted by doing it?

A child with ASD and restricted food varity intake is nothing like a NT child with the same issues these children can and do end up making themselves incredibly sick when well intentioned but no knowledge people start piss arsing around with their food lists.

In these circumstances food refusal is rarely a choice it's also rarely something that can be dealt with in the same way as a nt food refuser.

DS1 (3.6) is very restricted. e eats small amounts of the following.

Cheese on toast dipped into 'red soup' (homemade soup with chicken stock and everything orange and red i can blend into it)
Cheese and tomato pizza
Sausages
Breaded fish (i make nuggets with blended cauli and broccoli and salmon and mackerel egged and covered in wholemeal breadcrumbs)
Chicken and mayo sandwiches
Ketchup and mayonnaise
Oat bars
Biscuits
Cake

He only drinks water and some watered down fresh juice

The paed said she thinks his diet is actually quite good compared to others she has seen. I also make cakes and oat bars/biscuits to sneak things in like eggs and dairy and fruit.

He seems so thin to me but he is on 91st centile line for both weight and height and hasn't moved off it since birth.

It is soul destroying tho OP. Especially when you have other dc to cook for too. Everyday my heart sinks at what i am going to cook.

Sounds sensible to me. Focus on getting enough calories in first, then later can focus on trying to improve the nutrition.

My ds is on 3rd centile for weight and 75th for height (I think, roughly). Oh, and I forgot to mention all the sweets, jam and nutella he is quite happy to eat.

JustCleo
I had a 10 yr old DD with ADHD and Aspergers (now called ASD).

We have also had (and continue to have) massive food issues - she will eat certain things, go off and back on others, constantly refuse some, etc.

DD was always slight, and always had a smaller appetite. And now that she's on meds for the ADHD part, they also affect her appetite.

But I have learned to step back.

Firstly - concentrate on making sure that your DD is eating - SOMETHING!! She looks like she does eat a variety of foods - congratulations. Make sure she has access to enough actual calories however they are made up. And fats are important, so while "crisps and cake" sounds stupid, they contain fat which is essential for growing bodies and running around and developing brains/nervous systems as well.

Does she drink milk? Keep that up and make sure it's full fat for her (we have low fat for DH at home and full fat for DD - I now only use skim at work to avoid overcrowding fridge!). And my own DD was still getting a bottle/large cup of warm milk at bedtime way past "give up the bottle" time - she still takes a smoothie-maker bottle (likes the big opening) of warm milk or a large mug of hot chocolate most evenings at bedtime. Not only is it useful from the "warm milk to wind down" at bedtime perspective, but its extra calories to fill her belly and get absorbed overnight so she's not hungry. And if it's hot chocolate, I add squirty cream (from a can) and marshmallows - she thinks its a treat but I see the need for the fats of the cream and the marshmallows are an incentive to drink it all.

Cheese is great - especially if it can be a variety of cheeses. Cream cheese added to sauces, or grated hard cheese on top of toasties etc or in sambos. And, if she is open to trying new flavours of cheese, it might be a way to slowly widen her tastebuds in time.

DD won't eat a sandwich for school - so has chicken nuggets in a hot food flask most days instead. She will now look for the bag of popcorn and cereal bar in her schoolbag if she is still hungry (for a long time, there were raisins or cereal bar or popcorn that were ignored most of the term - but she's finally eating them on hungry days) - I leave things that are long-life in there, and ignore them once I know DD knows they are there (just check if need to replace).

I also know that she usually comes out of afterschool club in foul form - partly overtired and verging on meltdown from coping, but often something like chocolate immediately in the car will help. She nearly always wants something (but will now accept cheese, cooked meat or tomatoes instead of "junk") as soon as we get in before dinner is ready. But that was a slow move to "healthy" stuff, and there are days when a packet of crisps is needed then.

Also, and I know it is not always the case, but once DD started to cook herself, she would eat what she made. So some evenings she will make her own snack (maybe cooked chicken in mayonnaise mixed with mild curry powder) while I cook dinner, and she can also make a few recipes herself entirely so if she really won't eat what I've cooked, I let her make penne arrabiata for herself (the most frequent request) - pasta, tomato sauce (from onion, garlic and passatta, and chilli powder), bacon pieces. As she often only objects as I am dishing out - so I can use her portion for my own lunch tomorrow but I am not starting on making another dinner myself at that stage. Tuna melt mix is another she does herself - and that is easier for smaller ones to learn too - we make it with tuna, sweetcorn, spring onion, red peppers, mayonnaise and sometimes tomato as well - and if they get involved in making a bowl for themselves and having control over what goes in (Mum and Dad like peppers, but you don't so yours won't have them) and the amount (you like more sweetcorn than we do, so put more in yours). We do grow some veggies in the garden too - DD always loved peas straight off the vine, and tomatoes too. And I always keep peas in the freezer (petits pois rather than larger peas - it matters!) in case she'll eat the dinner but not the veg, or just have plain pasta and peas sometimes. Sauce separated from rice, sauce in the middle of rice, no rice, no sauce, sauce but no XY or Z in it.....we've been through them all!

Yes, it feels wasteful, and like you are not doing right by "giving in" - but you're not. You are getting nutrition into her. And eventually she will (hopefully) start to get better habits and wider variety. And there will be "2 steps forward, 1 step back" times (or even 2 forward and 3 back again sometimes!). But honestly, when I started to let go the reins on "you need to eat healthily and properly", it made a lot less stressful household.

Hi OP, I have no experience with autism but from a nutrition point of view I'd go with more cheese and pepperoni rather than more crisps and cake. The fatty foods will give her calories in a longer lasting way, are better for teeth compared with the starch and sugar, and also may be better from a behaviour perspective.

Best of luck. She does at least eat something from all the food groups so it's actually not that bad.

Have you tried nuts? (I guess you have!) I just mention because they seem similar to your list in that they are dry and "nibbly" and they are very nutritious.

Oh, and a recent thing was about an hour after bedtime, suddenly being "starving" - she now often eats an apple in bed, which is supposed to be bad for you but she actually eats it so she is really hungry (she was looking for biscuits/chocolate/crisps). Again, on this one, we said no junk but if you are really hungry you can have cheese or an apple - and she does.

The paedatrician is right, sorry. I have a child with autism and my hv told me to stop giving her a bottle of milk because it was limiting the amount she would eat. She became really underweight as she still ate the very limited foods minus the milk we were refered to a specialist dietician who told us to feed her what she would eat, plus the milk and not to treat her diet like a normal child as she wasn't a normal child! So yes, if she'll eat cake, feed her cake. It's just as important to encourage different textures

Op Absolutely the right advice for a child with autism. Your dd is in the assessment process, she wouldn't be there if it wasn't a strong possibility. ASD children's eating issues are NOT the same as NT children who are just fussy. Take a look here for some enlightening info - it helped me massively to understand food issues.

I think your thread would also be more helpful for you in the special needs section.

Oh, phew, NeedaSockAmnesty has saved me writing that post about smoothies.

When DS was 16 he agreed to come with me to a dietitian to discuss strategies he could try to increase his range of food tolerance.

He is intelligent and articulate, and really wanted to improve his diet, so he was a bit disheartened and bewildered when she ignored everything he said about actually gagging at the feeling of thick liquids, cream, sauces and warm food, and kept suggesting bloody soup and smoothies 'or lots of buttery mashed potato'.

What would you have the paediatrician say?

You cannot force feed an autistic child.

All of the 'they will rat when they are hungry' on the world just won't work.

My son would starve himself into unconsciousness. Three days is the most I managed.

Not I let him eat what he will. High cholesterol is better than comatose.

My son exists on white carbs, omelettes, chicken dippers, chocolate milk, and smoothies.

Nothing else will work. He'd really, literally, rather starve.

Thank God there has been a wave of sensible asd related posts!

I think the paed gave the right advice.

DS2 wouldn't touch smoothies with a bloody bargepole! He has always hated anything creamy or sludgey. I don't think he's on the spectrum (a friend who works in child mental health and assesses it for a living says not, anyway) but his food requirements are certainly reminiscent.

OP I know it's not 100% ideal, but I looked at your list, and thought, actually, you could live on that. It's got all the major food groups, so on that basis, if you need to make up the calories with cake, so be it.

Sorry you're going through this though. It must be v stressful.