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?

In general it may be bad advice, but in the circumstances it is the advice which makes most sense.

Ds is 6 and his diet is becoming increasingly restrictive, and he is losing weight so we are waiting for a dietician referral. But on the advice of 3 different peadiatricians in the meantime we are doing exactly what you have been advised, increasing the amount of the fattiest foods he will take - for him that's dairslea Dunkers and buttons ice creams. It goes against everything my beliefs of what children should eat say but it has to be what works for him. Thankfully by some miracle this weekend we have got him to drink small amounts of milkshake so I am hoping that lasts!

It's horrible but you just need to do what is needed to get as many nutrients into her for now. Will she take a multivitamin?

Personally found nutritionists to be on a government script. One told me not to give ds full fat milk as the recommendation is children should be on semi skimmed. I just smiled and thought, yeah right. Then she weighed ds and said, well maybe full fat is ok.

The OP's already covered the smoothie issue by saying she won't touch them. Which isn't particularly surprising given the list she will eat.

This might be stupid advice, but would making a conscious decision to not worry about what she is eating help? I know it's easier said than done, but it might help in the long term if everyone is relaxed, there's no pressure on her and she isn't picking up on everybody else's stress levels at meal times.

I had a dietician come and speak to me whilst my dd was in intensive care following an operation to ask if I'd noticed she'd lost weight I'm still a bit wtf that she did that

I agree all major food groups there. It would be nice if the carb and fat was pasta not cake but the cake will be fine as there is fruit and veg there. I'd probably go for cake over crisps unless she likes low salt crisps but I don't think saying it's OK is ridiculous and I'm not sure what alternative advice you'd have preferred.

A couple of other things that occurred to me afterwards (may not be useful now, but over time perhaps).

I try to put a pot of dinner on the table a couple of times a week for everyone to serve themselves. One that DD will eat. Last week, it was macaroni cheese (I've always used loads of mixed veggies and bacon in mine and let DD leave the veg she won't eat on her plate) - DH served her by accident (dope!), and had to take her plate instead and let her serve herself a tiny portion. But while we were all sitting chatting over the day, and just ignoring what was or wasn't getting eaten - DD actually served herself another twice so actually ate probably more than DH had put on the plate in the first place! It's important NOT TO COMMENT when that happens so she doesn't realize that she has done it (cos she'll immediately stop!).

And we've changed from a roast on Sundays to a buffet type thing. DD has always ate cheese and cooked meats (ate "red ham" (parma or other cured ham) rather than "pink ham" (ordinary cooked ham) for a long time!), and tomatoes. So I got an M&S platter of mixed meats and cheese, put out a second cheese from fridge, and a large plate of veggies (carrot sticks, cherry tomatoes, sugar snap peas, red pepper sticks) and some olives so that I can get some of my healthy stuff. She ate loads, and as it was another "serve yourself", ate more than I expected again. And a heck of a lot more veggies when she was just nibbling off a plate in the middle rather than it being served to her.

So putting things to help themselves can often help as well. Leaving bowl of grapes within reach or raisins or whatever healthy-ish things they might eat. And also giving them the "approved foods" without the guilt trip - and hopefully slowly increasing what is an "approved food".

My DS is 6 and is waiting for asd assessment. We've had issues with food for his entire life, bottle refusal, then refused any form of weaning, and now has a very restricted diet. Thankfully some of the things he will eat are enough to stop him getting underweight (toast, potato waffles, nuggets etc) but he eats no vegetables and no fruit. No milk either. All has to be the right brand, he knows even if he doesn't see the packaging. I go through phases of it really bothering me, but I think the worst thing you can do is to introduce any stress or worry around eating. If I put anything on DSs plate that he doesn't like, the entire meal is lost, so there's no point. He has the bassetts multi vits as they can be disguised as sweets. I do worry what we will ever do if he is ill though, as he will take brand name calpol and nothing else. Thankfully haven't come up against that yet.

hazeyjane

I know it's very difficult, it took time with DN but in the short term the focus was on making the things she liked and would eat more nutritious and in greater quantities. I was doing her childcare 8-8, 3 days a week so I had to be involved.

The most important thing was seeing a doctor who understood gut problems in ASD who worked with an excellent nutritionist. He looked at her food allergies and intolerances, specifically what foods were causing bowel problems - in her case dairy was a considerable issue, tested her vitamin and mineral deficiencies and supplemented those necessary. (Low mineral levels are very common in ASD). We focused on her daily intake of protein, complex carbs, fats and sugars, and battled to get it to normal levels.

So if they like cake - make it from wholegrains or nuts - ground almonds/pistachios that provide nutrients and protein, add banana, apple, carrot, beetroot, pineapple, rather than high quantities of refined sugar. The sugar in complex carbs is metabolised more slowly and provides a more sustained energy release.

As she liked fruit smoothies we added vegetable source protein powder (pea protein isolate, brown rice protein), and highly nutritious superfoods without her noticing.

She quite liked crisps - or rather she liked the crunchiness but not the taste. So I got her onto buckwheat, rice or oat crackers, wholegrain tortilla and vegetable chips, and carrot and celery sticks.

Not only did her malnourishment and nutrional deficiencies correct, but there was also marked reduction in behaviour extremes - hyperactive episodes, mood swings and lethargy.

I would recommend Professor Brostoff and his work wholeheartedly, and others who follow suit.

That's great that it worked for your niece, but that doesn't mean it will work for everyone.

Op has already said that her daughter will only eat one brand of cake. That is pretty standard for a lot of people with food issues, it's not as simple as make the cake differently because if you do they won't touch it!

No milk either

Have you tried goats milk, almond or rice milk? My ASD DN turned out to have no lactase (the enzyme required to digest milk), and neither do I (altho I'm not ASD). The result of that is that milk is not metabolised properly and you end up with calcium deposits in the gut.

My 3yr old with ASD eats a very restricted diet and when I tried to persevere with a healthier diet he lost a lot of weight I took the dietitians advice and now despite his diet being limited to 4-5 foods and all junk... He's gained some weight and is back on the charts at least. She said the aim is to achieve and maintain a healthy weight - and then as his understanding < hopefully > develops to widen the range of foods

How long did it take you to get from crisps to oat/rice cakes and carrots and what were the steps in between?

It's not only my niece that it worked for, there are plenty of other children that have found benefit from this approach.

I used the cake box of a brand she liked, (Sainsbury's chocolate cake) made my own chocolate cake and put it in the box. Repeatedly.

A lot of children with food issues can tell pretty easily if their normal brand has been tampered with!

Even when something becomes "new and improved" it can lead to a sudden refusal of an old favourite

yesulte

Did she get unwell or lose any weight inbetween?

We tried this approach (actually employing a doc and nutritionist and cook during it) my son ended up in hospital being tube fed

My dd used eat that baby powder stuff in a box that smelt like sick. It was honestly gross and no amount of trying to give her other things that smelt and looked like sick helped

ZZZZZ you have just used one of my favourite approaches - when I get told my child will " outgrow his autism as he gets older" ..." Oh do you say that to parents of children with physical difficulties? No?"

OP, I havent read the whole post and I am sure someone has suggested the SN children board, if not please have a look for it!

Secondly google ARFID or more specifically Elizabeth Shea, she has written a good article about autism and restricted eating!

Calories are the most important thing and if your child cant manage a large range of foods or any new foods you should stick with what she will eat!

I hope no one has said this but children with autism will actually starve themselves and you cannot apply neurotypical parenting advice to them!

Good luck!

No I don't think the advice you have been given is ridiculous. It's better he gets the calories and it's not that bad really. I'd always encourage the cheese after the fruit & cake though to try & help the teeth situation.
It sounds like a case of going with the flow- fighting food issues nearly always backfires.
Good luck op, it sounds really hard.

I can see why they said what they said. calories are important fir growth etc and if your dd is becoming underweight then urs going to require drastic measures at some stage unless you can maintain her weight.

however I do get the concerns re dental health.

would I be wrong in saying that it's a possibility she will "go off" the cake and crisps of given too much?

if she's only eating one brand of cake and half a bag of crisps, although I understand why they said give it, I would also worry that a recipe change (happens with many shop bought items) would render said cake another thing she won't eat and the list is diminished even more.

you urgently need to see a dietitiann/nutritionist who specialises in autistic children.

sounds really tough

I have a dc with ASD. If your dd has such a limited diet then feed her with whatever she will eat and follow the advice! The immediate issue is to get enough calories into her, the quality of her diet can be addressed at a later stage. A close friend of mine has a dc aged 10 with severe ASD, last year he was refusing to eat and lost so much weight he was at the point of being hospitalised, sedated and tube fed. There was a whole team of professionals evolved and school and home worked together to get calories into the child which included giving him coke to drink numerous times a day as it was something he would tolerate (not something his parents would normally allow him to have). It went against the grain to give the coke but it worked. He doesn't have it now and his diet is improving.

Think very carefully before ignoring the advice, it may go against the healthy eating line BUT it is sensible in these circumstances.

My 13 year old DS is NT as far as we can tell, but has always had food issues that are similar to a lot of ASD children - doesn't like foods in sauces or mixed together, is very sensitive to taste and texture which makes fooling him by mixing foods together almost impossible. He is not that interested in food (gets this from me) and also doesn't experience hunger in the way that normal people do (my FIL is the same) - you can't starve him into submission.

We've discovered over the years that he has some quite unexpected tastes - he loves mussels, and black coffee! But getting him to try anything new against his will is pointless - he will gag and refuse to try the food again. Sometimes he will develop such an aversion to foods that even the smell makes him sick.

The good news is that despite getting a large chunk of his calorie needs from breakfast cereals and large pieces of French baguette, he's reached 13 with no health issues and no caries ... He is slender but not underweight and almost never ill.

With my Dd it was dry food so lots of bread crumbs and no mixing she did eat salad veg though which was a bonus it was very stressful she eased into wet food in her midteens and is fit and healthy but the not eating is the worst for a parent i had lots of advice should eat whats put down to her she will eat when she is hungry and i pandered to her it is so frustrating

That sounds very stressful but for a child on the autistic spectrum I have to say that's healthier than most of the other children I've taught with sensory food issues.

I teach a little lad atm (who has yet to get a diagnosis) who will eat chips, plain pasta, boiled potatoes and toast (white with nothing on). We all had a bit of a cry the day he nabbed one of the strawberries from my lunch, chomped into it and promptly spat it out :) It's the closest he's come to trying a new food in a good few years.

I know the advice sounds almost counter intuitive but if I were you I think I'd follow it and giver her the extra cake and crisps like he advised.