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?

That's annoing for you, Cleo - hope that can be rectified!! Have you spoken to the nursery manager about it? And pointed out that your DD is mid-process for getting a diagnosis?

I would suggest when you get the confirmation of which school she is going to phone up and make an appointment to meet with the senco, take all the information you have so far and a list of your concerns. That then gives you and them time to work out an initial plan before she starts.

Ds is in year 1 and has no formal diagnosis yet - we are just waiting on the Ados - but they are still supporting him in school, applying for the EHCP and generally doing what is needed for him to cope.

I agree it's probably worth you having a look on the SN boards (SN children and sn chat are the most used) as they are full of helpful advice and some of the posters stay in the 'safety' of them rather than using the rest of the board

Fatmomma, that's a very inaccurate, potentially alarming and depressing statement (he must be very severe) - not to mention absolutely UNTRUE.
I know a number of children who've been diagnosed age 2 or 3. My own son wasn't diagnosed until 6.5 years but it was glaringly obvious had any of us (parents, family or teaching staff) been familiar with Asperger's / HFA (which we were not). Early diagnosis is not only possible but hugely helpful to those who have it. It would undoubtedly have saved us from years of turmoil, confusion and heartache.
Late diagnosis does not indicate mildness of symptoms or condition. On the contrary, its indicative of having endured years of 'unknown' and distress for all concerned.
Diagnosis of 'severe', as you referred to it, (degree of difficulties encountered by those with low or high functioning autism), is not indicative of progress over time and I'd hate for OP to be left thinking that her child is bound to have 'it' severely and feeling hopeless when this is certainly not the case. Her assessors will be able to give a clearer and more accurate indication of his level of need.

As for food, OP, my nephew has autism too. His parents were v concerned about his limited diet (potato, tuna, chocolate milk, crisps - NOTHING ELSE). They were referred to an autism-savvy dietician at a top London hospital. She assured my SIL that his diet was ok and he would grow and develop well despite his dietary limitations. Some people manage to give their children vitamins in one for or another.

how much of the cake does she eat at a time?

a slicing of the batternberg is 135 calories.

not much really, if it's going to be a risk allowing it more often in regards to "going off" it?

that's nit to say don't hive it. many peope are qualified to say that and I'm. not one.

just wanted to say now you have updated and I had feared it would be a more plain cake like. that (rather one with lots of chocolate or nuts or cream which would be a bit more complete)that I understand why you are wary.

She tends to eat just the pink squares and marzipan and only a small slice because it's so sweet.

When I know what school she's going to I'll be meeting with the SENCO. I've spoken to the nursery manager but while her teacher is doing the minimum in asking dd if she wants to eat and saying dd is just difficult, nothing is being put in place to help her.

I have one child with a huge range of allergies who is also fussy. Still bf, and with food we just give her what she will eat and can have. I insist on plenty of fruit and a little meat, then whatever will get calories in - cake or biscuits (home made), crisps (ones with no salt), chips. She eats so little that if it isn't high calorie she just won't maintain her weight. Her brother had such a healthy diet at her age - so long as DD is eating and growing, I am happy!

So do whatever works for your child. Can always add the jelly sweet vitamins!

Sounds honestly like it's pretty negligible then. I can honestly see both sides

it's probably the worst cake it could be as the marzipan and squares basically just offer sugar and colourings nutritional wise it's pretty low fat too.

it's the 16th April isn't it? allocation day?

not too much longer to go. and sadly it's probably not worth changing pre schools at this point?

unless you were thinking of deferring a term and try her elsewhere in the nursery/pre school?

do you have any friends who's children have extra needs? is there somewhere they recommend that's more hands on and supportive?

Have you had a referral for a "sensory diet"? They have specially trained NHS staff who look through what your child will/can eat, and then work out a balanced meal plan and suggest other foods kids with similar ranges eat so you can try to expand it a bit. Your paed should have suggested it but if they didn't, and you've not had a referral, ask?

DS will eat more widely when relaxed. His range contracts when stressed. At one point all he would eat was plain boiled pasta and some simple fruit; now, he will eat plain homemade pizza, homemade chicken nuggets, a particular form of chicken curry (so bland it barely qualifies!) baked fish, fish fingers, baked beans if in a very calm mood, scrambled eggs if same, very plain cheap ham if the bread is white and crusts off cut into fingers. He also eats most fruits, and ice cream. Will tolerate peas and sweetcorn and raw carrots, again if calm. He likes bland - so white bread, mashed potato, vanilla cake, vanilla ice cream. Hates chocolate cake. He can't even be in a room with a chopped capsicum pepper or a naice olive (deli kind, in oil - can handle the cheap in brine ones in his presence as they apparently are scentless to him) as the smell overwhelms him.

I'd say that's very young for a diagnosis... where I live they won't usually accept them until kids are around 7 (because there's so much development up to that age). If they are considering a disagnosis, your child must be very extreme.

DS was diagnosed at 5. He's not extreme; in fact in many ways he's high functioning. Strong social interest, unimpaired emotional empathy, immensely loving and affectionate, and exceedingly academic. But he's very plainly and apparently autistic to anyone with expertise in the area. Early intervention is essential for good outcomes and a diagnosis is usually needed to unlock that. DS was a mess before he had his diagnosis, and the targeted interventions have made his life a lot easier. We are lucky, I think, in that there are several autistic people in the family so we knew what we were looking at, and the HCP knew that the genetic factors made it the likeliest cause of his fairly profound social and emotional difficulties. He needs a lot of scaffolding and support and understanding to cope with his life, but with all of that in place he is thriving at the moment.

I think the "not till 7" thing for autism is very outdated - certainly it's seen as such here, where all the thrust is to identify and support early. Suitable for dyslexia, etc., sure, but autism in the early years is so subject to support making a long term difference to outcomes that it isn't sensible to cut any child off from that support with an arbitrary date.

Just popping on to say I've known two parents with food refusing underweight children (one with a SN , other not diagnosed with anything). Both were told by paediatric dieticians to forget 5 a day/healthy eating and just let their child eat whatever and as much as they will, the higher calorie the better. And try and increase the calories if you think you can so eg cream on cereal if they will eat it, but don't push it (so a tiny drop of cream in the milk and if they don't notice very very gradually increase it, if they do notice stop - but I appreciate that might not be the best advice to someone with a an ASD child).
There is something else to be aware of (and makes me mad!) when they start school, if they do 'healthy eating' it will be all aimed at overweight children/preventing obesity.
I was furious because my healthy build/good eating DD came home and stopped drinking blue milk without telling me because she was 'too old'...
But worse one of those very underweight children also started to refuse some of the only things they would eat (also blue milk), questioning their portion size (they shouldn't be eating more than 2 slices of pizza) and they shouldn't be eating crisps more than twice a week (they had a bag a day)....I think I would have been ready to murder if that was my child!

Have known other autistic children given same advice you do need to keep up the calories or otherwise you will end up going down the tube feeding route.Try beetroot crisps etc? Generally is a texture thing though as well as taste so they like things like Shreddies, and Pringles.

Surely for weight gain/growth, protein is the way forward?
Our chemist does protein milkshakes (Pediasure) aimed at helping kids who have a limited diet. Might be worth a try?
Perhaps you could try making it up together, if she likes mixing things.
My brother used to eat only frozen peas (green ice cream) and beetroot for about 3 months, when he was that age!

The shakes only work for a child who will drink milkshakes thought

Also weighing in on the Battenburg question - as marzipan is primarily made from almonds, it's far better than a standard icing, so that's actually a huge bonus. Extra protein in the cake - hurrah!

I thought the same zzz

I had a look to check the almond content..Dr oertkar marzipan is 25 % almonds the rest is sugar and sugar syrup.

so it's maybe not as high as expected

Sensory diet relates more to occupational therapy and an individual's need for reducing or adapting the sensory environment around them, often by implementing specific and tailored exercises (not the sorts of exercises we carry out in PE lessons, by the way) to reduce the sensory stresses experienced by a child.

That's not to say she shouldn't eat ot obviously. nut if you do look at the info fir the batternberg cake. 1 slice offers less than 2g of protein, less than 4G of fat and a whopping 18.1 g of sugar so.i can see why she is questioning it

My DD is six, has no special needs but she's a typical 6 years old, with a limited appetite for food experiments. So I try to walk the thin line between healthy cooking and indulging her a bit so she gets some calories in her.
She won't eat spinach or sweet potato but she will gobble down ravioli with spinach and sweet potato filling so that's what she'd get. We try to avoid ready made foods but I gave her home made rice pudding yesterday because she hurt her face and lip and needed something with smooth texture.
DH tends to go ballistic because she'd survive on sweet crap if you let her but I keep reminding him that we weren't exactly broccoli and hummus eating examples of healthy eating either when her age and we had to grow into experimenting too so we have to give her a bit of space. Funny enough, I don't remember a lot about foods I ate and loved but I pretty much remember foods I hate and still can't eat them (mashed potatoes for example, hate them with passion). I agree that in that age children need calories first, especially if they are active and still growing.

I don't think AIBU is the place to get advice for anything to do with kids with ASD.

The paed probably realises getting her to eat other stuff won't be that easy and so it's better for her to have cake and crisps than nothing.

I wouldn't take the word of AIBU posters over the one of a trained paediatrician, unless they have lots of experience in the same situation.

Can you ask for referral to an NHS dietician?

I googled your Prof and he seems to be well respected with allergies/intolerances, but I really don't think that's at the root of my dcs difficulties which may be why your techniques differ so from mine?

No I think you just have a narrower mindset and won't try something because you think it's 'daft'. That's up to you.

Afaic, and more importantly my sister, if doctors have had good results using these methods with some children, then it's worth a try. If it doesn't work, and it won't work for everyone, you've not lost anything.

I've not seen it argued that allergies and intolerances are the 'root' of ASD difficulties, simply that they may play a role in the overall makeup and treating the symptoms can lead to an amelioration in some children.

I think it was treating the gut inflammation, digestive disturbances and intolerances that helped with my DN's food refusal.

AnotherTimeMaybe has made exactly the same point, as she apparently experienced a dramatic increase in the foods her sons would tolerate from treating gluten and casein intolerance.

These children not unique, nor does are they not 'real' ASD.