skeletal 4year old: Does NOT eat ...help?

[sallybean]

My nephew is 4.
He does not eat.
And I don't just mean he's fussy, I mean he functions for 5 or 6 days at a time on two dry crackers. He has never, ever eaten a proper meal. He has been to the doctors repeatedly (due to so many and varied ailments from his lack of immunity and general bad health) but they just say he will "grow out of it". It breaks my heart because he is so very thin. He looks emaciated and pale and suffers so much with his health. But he has no appetite. The whole family have tried everything we can think of, but nothing works.
It has been suggested that he is seen (privately) by a professional, but I'm not sure where to start?? pediatrician? Dietician? ...???

Any ideas? Any advice? Any experiences?

Thanks in advance!

The child of a friend of a friend was tube fed at night because they did not eat. Afaik there was no medical reason for not eating but that is the (drastic) path they ended up on.
On supersize vs super skinny it often seems that the less a person eats the less appetite they have, so I guess he could be in that cycle or maybe there are more complex psychological issues?

Yes- the less eating/less appetite seems spot on. And when he's ill & doesn't eat for days at a time, they are back to square one again.
No underlying issues. He is a happy little lad, full of energy, Weirdly! Loving family, good circle of friends at preschool. Nothing traumatic experienced.

Wits end :-(

Have his parents asked you for help? If not, and I know this must be heartbreaking but there is very little you can do.

Has he been referred to a Paed? If he really is that thin I think the GP should have referred him already. Do you know what his height and weight centiles are?

That's so sad. Hmm you could try a child psychologist with an eating disorders specialism, I would think it may be worth a shot. It sounds like it has a strong psychological component. Maudsley hospital has an eating disorders unit, they may be useless but they may be able to help with a specialist or if you google children's hospitals and eating disorders you may find help there.

Ironically, my sister is a nurse at a children's hospital so she's fully aware of his chart measurements- but the surgery don't seem to use these as a marker for much (& to be fair, there's always going to be kids at both ends of the measurement spectrum..it is an average after all!) The GP has, repeatedly, just said he will grow out of it & whilst sympathetic, aren't offering any referrals but admit pediatrics isn't their specialism. I think its unfortunate when he sees the doctors that he is so 'full of beans' during the day (but does sleep for 14/15 hours at night)
Oh, & yes, his mum is keen for any help/support ... I thought I'd consult mn in case anyone had any wisdom :-)

What does he drink? Just interested really and has she got him on a vitamin and mineral supplement?

He drinks water and juice. Sometimes a little bit of a smoothie. He has no problems taking on fluids & will ask for drinks if he's thirsty.
He's been on vitamin drops and then tablets from about 5 months (may have been a little later)

My friend's son was like this, but now he is 8 he is finally eating not as much as a 'normal' child but having 3 small meals a day. And the amount and varity (sp) is increasing all the time.

What changed for his appetite to return? Anything trigger it off? A lady I met, had a son who was shamed into eating when he started university!!???

It does all sound pretty extreme and I thought our dd was fussy!

What happens at mealtimes? Are you ever there to see or does your sister tell you?

Would drink meal replacements (I'm not sure if adult ones are fine for kids) or protein shakes? My eldest was an appalling eater and it affected her teeth as they grew. I was at my wits end.

They say don't draw attention and all that cobblers but it's a mothers instinct to feed her young.. its agonising.

I think he needs private paediatrician. I dont want to be alarmist but are all other areas of development 'normal'. I only ask as my brother has autism and limited his diet a lot throughout childhood. I think you can get milkshakes to supplement diet.

Yes, this goes beyond fussy!
Initially she tried the 'eat it or go hungry'. Then she made a whole variety of meals at each meal time as he was getting so thin. She was so patient with him. Never made a big drama, but always reinforcing the positives. Now he will sit down at the table while others eat but doesn't eat anything. He moves food around the plate but doesn't eat. He will eat a couple of spoonful of cereal on a good day and sometimes a couple of crackers... perhaps once to three times a week.
I honestly don't know how he exists.

He needs to be assessed by a paediatrician to rule out any physical cause.
Consider dietician and/or psychology input.

In the meantime I'd try to get calories in him by whatever means necessary: will he drink fruit juices/milk shakes/banana and vanilla ice cream shakes? Finely pureed homemade soup? Full-fat yoghurt?
Add cream/cheese/butter to every little morsel that he eats.
Full-fat milk instead of semi-skimmed.
Porridge made with cream.
Indulge any whim.

But yes, I'd get him checked out.

Tried the meal shake things....he says they taste horrid and won't drink them.

All other areas perfectly normal. I'm an early years teacher & would have no issues with his academic, verbal, social, emotional development. And as I said, my sister is a nurse &..aside from not eating and the consequences of that.. he has perfectly normal physical development.
It's really odd. But so difficult.

Oh yuck, yes, the meal replacement shakes are horrible and really not suitable for a child.
Also 'build-up' drinks (Fortisip etc) should not be used without dietetic input and they also taste rather weird.

Google the expression 'food neophobia' - I've decided this is what my DS4 has

As far as I know she just cooked/made what she knew he would eat but put a small piece of whatever they were eating on a side plate next to his and no comment was made whether he ate it or not and over a year or so he started to try things. He still eats only a limited amount of food but as i said it increasing and he does ask to try new things now.

My dd was never this bad but she was beyond fussy. I followed hv advice and did the "eat it or go hungry" routine, but no drama. Hv said she wouldn't starve herself but she did. Lost loads and we were referred to a dietician. Advice from her was just to let her eat what she wants which was chips even if it was for every meal. Which is what happened for about the next two years. She ate cereal at breakfast but just had chips for lunch and dinner for years. She's grown out of it now and eats ok.

She has him on some special toddler milk for the extra vitamins & nutrients.
He won't eat anything 'sloppy'/wet so soup, porridge, sauce etc are a no go. He won't eat anything hot and recently said that things hurt his teeth (unsurprising as his teeth can't possibly be very strong)
Every tiny morsel she can get into him, she does (the waste is unbelievable).

So push for a dietician referral.

Viva: the problem is he doesn't want to eat. He doesn't have an appetite. He never asks for food.

It certainly sounds extreme, how worrying for you all. I think it's disgusting that the doctor has practically turned him away. I dont know how it works, but wonder if your sis can pay for a private consultation with a private doctor, who coukd then refer to paediatrician if his doctor wont.

Yes- dietician or pediatrician? Psychologist?
Not sure where to start, who would be the best?

We have all said we are willing to pay to see someone privately. A sad reflection on the NHS, especially ad my sister works for them!!!