2.5yo extreme irritability - aibu to ask for a blood test?

[Hospitalbaby]

My 2.5 year old has always been hard work, defiant, shit sleeper, shit eater but all round loveable rogue.

For about 3 weeks now he's been fucking awful in every way. Extremely irritable, extremely violent towards us and his older brother. He's pushing against every single thing in the day and I'm having to physically force him to do things like brush teeth and put shoes on.
He's also refusing almost all food except for his evening meal at 5pm, which he reluctantly eats. He is accepting milk in a cup and is now asking for this instead of food.
He's refusing to go to sleep and fighting us at bedtime, shouting at the top of his lungs and thrashing about in his cot in anger.
Basically everything is suddenly a huge fight whereas before 10% of things were a huge fight.

I've had him to the GP twice because it just feels like something must be up. Both times all clear, no ear issues or sore throat, chest is clear. All fine.

What do I do!? Should I push for a blood test?

I KNOW people will say "he's two" but I know two year olds and yes they can be like this but this is extreme. I mean, I've cried every day for 3 weeks. I am at the end of my tether.

If your GP doesn’t see the need for blood tests I wouldn’t push for them. My two kids went through phases of being awful, sometimes you don’t get to the bottom of it and it is just put down to the terrible twos. Could he be teething? Reflux? Constipated? Just thinking of why he might not be eating.

This is good advice. I was thinking something like teething or constipation as this can make them so grumpy. Does he go to nursery? Just wondering if anyone has picked up on any SEN signals.

What do you want them to test for? I've worked in a biochemistry lab and HCPs need to request specific tests to be done, there are hundreds of tests so they can't just test for everything. If you went to the GP you'd get further with them if you had something specific to request

A blood test for what?

This age group is extremely difficult to take blood from and they are too young to understand why someone is holding on to them and hurting them, even if distraction is available. It can be very traumatic for all involved - and children do remember, which makes for problems if they need procedures/tests when older.

Blood tests should only be used when there is strong clinical indication that it is in the child's best interest and even then it doesn't always work and you have to go on clinical assessment only.

Yes he is two - and there is a massive variety in normal two year old behaviour - what you are describing falls into normal development for this age.

Im with others blood test doesn't seem like a solution
Have you contacted your hv or gp about the change? Sounds hard op sorry you're all struggling

Is he going 24 hours every single day without food? 5pm to 5pm the next day?

Some good advice here: https://www.pacey.org.uk/working-in-childcare/spotlight-on/2-year-olds/development-in-2-year-olds/managing-behaviour-in-2-year-olds/

Well the GP did mention anemia but said he didn't seem pale. He is very pale! But always has been. I think that has planted a seed in my head, what with the lack of appetite and the grumpiness too.

I wouldn't go back and specifically say you want a blood test but maybe mention he hasn't improved and is barely eating. You could try withholding the milk and see if he eats more before going back to the gp though?

How do you think he would cope with having a blood test? It's not like they sedate them. DS1 is 17 and remembers the blood test he had when he was 3. It was horrible, took them ages as it's really tricky.
It's unlikely his behaviour is caused by something that there's a blood test for. If you're worried about deficiencies, add a good multivitamin to his diet.

Agree with phases of awfulness, he's my second so I get that. But this is 3 weeks of increasing volatile behaviour. When kids are teething and they are grumpy think that but X10!
He's not constipated, the opposite. And he does have all his teeth now.

This sounds so tough for you all OP. Agree that blood tests are a tricky one as you need to have something in mind to treat for.

They can sometimes just go through phases of being awful but trust your gut if you think something bigger is at play.

My immediate thoughts are:

• pain/discomfort: growth spurt causing aches he can't describe, molars if they're not in yet, constipation, worms, even shoes being too tight!

• sleep: how is it?

• stimulation: does he go to nursery, and do you need to up it? Is he getting enough outside time? Any chance you're pushing him to do too much and he needs a good rest?

• exercise: how much running around etc does he get each day?

• development: could it be his speech or motor skills are about to do a big spurt?

• is it age appropriate boundary pushing? Do you need to offer choices (red shoes or blue shoes YOUR CHOICE), do you need to adjust how you approach transitions between activities? (When the timer goes off in 5 minutes it's time for diner, the timer will go off in 2 minutes, 1 minute... do you want to push the stop button or shall I?

• could there be any SEN?

Ah when you say the opposite - loose stools at this age are a sign of constipation. He could be impacted and have overflow? Ditto worms might be bothering him?

I suspect the behaviour is his age.

However, if you aren’t exaggerating and you have a child on your hands that eats reluctantly, once every 24 hours I would see the doctor for that alone. Unless he is eating a vast, calorie dense meal I would be concerned by this. You mention in a further post he is the ‘opposite of constipated’ - does he have full blown diarrhoea? What’s his weight like?

The biggest indicator of my DD's coeliac disease was her behaviour. It didn't suddenly change like you describe but she always found life really difficult and was incredibly variable about food. The fact you say he's always been pale harks back to our experience. Could it be that he's actually just really hungry but knows food is making him feel uncomfortable? Might be worth looking at some of the other signs and symptoms of coeliac.

Was just going to suggest coeliac disease.

Possibly to SEN. But his speech and understanding are great so hard to get anyone to care at this stage.

He has very soft bowel movements but not watery. They seem healthy.

In 24 hours he will refuse more food than he eats. He will pick during the day and maybe have a few crisps, few grapes so not cold turkey but very little food apart from the evening meal.

Is he drinking more than usual OP? Peeing more often?

Does he get screen time? If so, stop. Saw a HUGE change in DS' behaviour after drastically reducing screen time and only occasionally allowing not-so-stimulating shows and films (mostly stuff from the 90s like the original Thomas the tank engine, Postman Pat, Pingu etc from that era). Studies have shown that excessive screen time promotes aggressive behaviour and it's not surprising given how stimulating new kids' content is. It's information and sensory overload. And at this age the recommendation is 1 hour/day. Music is also a really nice alternative to screen time. Hope this helps!

Oh I'm so sorry for what you're going through... I've been there. It's so hard!
I wonder if perhaps this is more a developmental phase as opposed to an illness. J say that because my youngest would trim from Mr affection to the devil and then whack out a new skill after a few weeks! It was typical for him.... just something to consider!

This is interesting. Thank you.
How did you find out about the celiac?

Celiac is diagnosed with a blood test.

I agree i think you should investigate in case he's got tummy problems. Soft stools aren't normal (although i suppose if hes having lots of milk and no solid food that could explain it) . The food refusal reminds me of my DD before we figured out her allergies - she subconsciously stopped trusting food because it hurt her body.

If I were you I would go through the top 9 allergens. Keep a food diary and photos of his poos in a separate photo album on your phone. Then one by one eliminate each allergen for a couple of weeks at least. It sounds like the culprit is likely to be something he has in his diet regularly, so he has wheat or eggs daily id start there rather than sesame or fish if those arent every day foods for him.

Btw if you do get him tested for celiac then gluten needs to be in his system for the test to work.

@muggart Thank you. He was a cmpa baby so couldn't have cows milk. We did the milk ladder when he was 1 and he didn't have any problems. No rash or blood in his poo so now we say he is fine with milk. Perhaps it needs revisiting. He does drink a lot of milk and if it gives him any kind of issue that would make sense.
I'm trying to think what he eats a lot of and I can't think. He won't touch eggs, barely eats anything carby like pasta or bread so in reality probably probably eating hardly any wheat. He eats potato plenty so really he is fairly gluten free as he is. He eats tons of fruit and veg.
I wonder if it's dairy.

@Hospitalbaby ah yes it sounds like it could be that.

As a heads up, lots of people with dairy sensitivity will cross react with soy because the proteins are chemically similar, so i'd be careful not to replace dairying milk with soy and also be really diligent about checking labels because they will be in all sorts of things that you don't expect.