To let DD have pudding/treats when she isn’t eating meals?

[DrSeuss84]

As a bit of background my DD has been having issues around eating for a while. It started at school getting easily grossed out by other kids showing eachother chewed up food in their mouths as a joke and spitting food out if they didn’t like it etc etc. it escalated to a point where she wouldn’t eat lunch at school at all. Felt sick at the thought of it and would go literally all day without eating. The school were very helpful and arranged for her to sit at the back of the class (during covid they had to eat in class) etc but nothing really worked. She would eat absolutely fine at home and has no body image issues. It is just being too close to other people eating that was the issue including if we take her to a restaurant or cafe and it is busy. She recently had the government growth test done at school and is borderline underweight and on the 3rd centile. Very very slim and at 11 not far of starting periods. I became really anxious about her being underweight and started trying to increase calories with lots of treats and deserts as well as frequent high protein and carb meals. However the last week or two she often eats very little of her meal saying she is bloated/stuffed etc after a few mouthfuls but when offered cake/ice cream etc 5 minutes later will happily eat it. If I say “if you don’t eat the dinner you don’t get desert” she will simply say she can’t eat anymore and will fairly happily go without the desert and go to bed on an empty stomach. I’m at a bit of a loss. Is it unreasonable in the short term to let her eat what she wants to get her to a healthier weight even if it’s too much junk and not enough real food?

I have done this, in the past, when one of mine has had issues with eating. We just made sure that what was on offer wasn't completely nutritionally void so fruit, banana bread, crumbles, alpro desserts and so on. We hot to the point where he would eat his dessert then polish off the rest of his meal - he'd not eaten all day at school because he hated eating around other people eating and had lost his sense of hunger by the time he got home.

He's a (slightly too) strapping adult now. His eating is still disordered but he's more inclined to binge, these days.

Can you offer desert first and then some “proper” food after?
Sometimes being hungry makes you feel a bit sick so you don’t fancy real food until you’ve taken the edge off with something else.

Will she drink a glass of milk? At least it’s a bit of extra nutrition

I would second that about the fruit for desert. Maybe offer snacks after school like you minus and carrots and apple slices to dip in peanut butter. So try and squeeze in nutrition around the sides.

Also does it/would it help if he helped you prepare the meal? The connection with the food on her plate would be different then and possibly she'd be more comfortable eating it? Maybe not cooking meat from scratch if she's sensitive, but veg prep at least?

Also if she helped with meal planning - not free rein more like tomorrow we can have burritos or pasta, which would you choose? That could cause you more stress if she turn doesn't eat it, but just another idea in case it's useful.

No pudding without dinner doesn't tend to work well. I would tend to have a break in between dinner and pudding to dissociate the two and try and get healthy stuff into the puddings such as focusing on options with less sugar but incorporating fruit, eggs, milk.

Give her the pudding at the same time as her dinner and leave it up to her which she eats first and how much she eats of each, no strings or conditions attached. She'll get more calories across the two than she will from one alone.

I give it all at the same time and let them choose what they eat.

I don't think encouraging her to get most of her calories from cake and ice-cream is great, nor is having those everyday. Could you look into more balanced yet calorie dense foods - full fat yogurt with granola and berries is tasty and (portion dependant) high in calories and good fats, while having nutritional value.

I could be a picky eater when I was younger and was always allowed pud of fruit, yogurt, or even bananas and custard. And I think that was a good approach as it meant meals were not stressful forcing myself to eat things I really didn't want to.

I would, that way, you are not giving any food more status/value than another. No such thing as good foods and bad foods and denying pudding might create more of a food stigma later on. Agree with others though maybe offer both at same time

Would she drink smoothies and shakes? lloydspharmacy.com/blogs/weight-management/protein-shakes-for-weight-gain

Definitely do not withhold food, all food is good food if she is underweight. Anorexia can be triggered by weight loss (it's actually a genetic/biological illness rather than a mental health illness) so I would focus on getting as many calories into her as possible.

Does she eat at school now?

I'd be focusing on dessert that is balanced and not too high in sugar e.g. homemade puddings and fruit, yoghurt etc and serve it at the same time as main.

Very very slim and at 11 not far of starting periods. I don't really understand this. Do you mean because she is 11? Presumably if she is very, very slim she won't start anytime soon. Most women need to weigh around 45kg+ to menstruate.

My advice would be to stop thinking in terms of pudding / treat, and more as simply another course of a healthy meal. So instead of cake or ice cream offer something more nutritious, not as a treat but just add another part of the meal.

I was also going to say that you don't want to think that because periods don't come along soon it is something to worry about. My dd was a very athletic slim child and didn't start her periods till she was nearly 14.

Give her puddings for now to maintain some calorific intake and nutrition and seek professional support via GPa

Tinned fruit is a great idea.

Could you try involving her with meal planning and cooking. Perhaps giving her choice over what she is eating will help. Something like homemade pizza (naan bread base) or chicken wraps with salad, dips and tortilla chips. Ice cream smoothies with fruit.