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!

Am amazed the drs aren't more worried, def get a peadiatrician ref. He is probably anaemic. He needs specialist help and I would not to fobbed off by 'he will grow out of it'

What does the hv say?

Oh, poor lad. I really feel for your sister, it must be so hard.

What happens if she talks to him about it? Does she explain that people need to eat to be healthy? Whats his repsonse? Has he seen food growing? Does he bake with her? What about shopping?

I'm trying to think about some books that might be useful....like Beans On Toast or Sticky Jam?

She needs to push for a referral.

If he eats crackers can she make a batch of her own with good stuff crammed in?

Good luck. I hope she gets some answers and help.

Push for referral to paediatrician. Go privately if it doesn't happen. Underlying conditions need ruling out. They will refer on to dietician/psychology etc if appropriate.
My own DS is on Fortini smoothies, a fortified supplement for children with low weight. It's great. Only on prescription.

Ps I tried everything with my DS, we grew food, we baked, we read books on food etc. He has gradually put on weight slowly after a full 2 years of hard work.

One thing that's important is not to make a big deal out of it. I found that DC even as a 12 year old would refuse to eat much at my Mums house because that would generate a lot of attention, special meals cooked etc - being the centre of attention with my Mum ranting and raving at me and DH for not letting DC have pasta everyday, while DC would eat - though quite a restricted diet at home.

Just a word of reassurance. My DC would eat 2 pieces of pasta a day supplemented with the occasional yoghurt. The HV would speak to us as if we were thick - have you tried pizza, coco pops etc? As if we did it deliberately. DC is now 17, enjoys cooking and food. Also normal height and doing well at school. HV told me DC would never grow and be mentally subnormal.

What percentile is he on? My boy is just under the very very bottom percentile but he's been there for many years now and the GP's seem happy.

Also how much milk is he drinking? Is there any chance he is filling up on milk and therefor not hungry?

Hm, this made me think of a book I read, just trying to remember what it was. That had a plan meant to help with fussy eaters, but it might just work here, see what you think?

It basically said, give them a small plate with the most minute morsel imaginable of a couple of different things (ideally, the "normal" food everyone else was going to be eating) - literally, one grain of rice, a millimetre square of meat etc, small enough to be ridiculous and hopefully too small to be really scared of, but they would be expected to eat everything on the plate before getting down or having something they preferred.

The book also mentioned what someone said above, about trying the same foods repeatedly so that maybe after 10 or 15 times, they might become accepted.

Once the teeny bits were being eaten and it had become a habit, the quantities would then be VERY gradually increased, but only slowly slowly so it was hardly noticeable, until they got used to eating a little more normally in time.

Do you think that could work for him?

Thank you all so much, sorry for the radio silence - I have two babes of my own so had to go & prep clothes, bottles etc for them before midmight!!@
He has been offered the choice of any food - cafes, soft play cafes, home, supermarket etc but if you're not hungry you don't fancy anything.
Ice cream too cold, chocolate....very occasionally, but he complains it Herts his teeth.
The doctors say as long as he is drinking and eating something there isn't much to do. Sister has pushed for referral. But jot got one...hence thinking of going private.
I think local pediatrician is the way forward.
Take it from there.
Well, back to my own two....who incidentally eat like horses & eat anything :-/

Thank you all so much, sorry for the radio silence - I have two babes of my own so had to go & prep clothes, bottles etc for them before midmight!!@
He has been offered the choice of any food - cafes, soft play cafes, home, supermarket etc but if you're not hungry you don't fancy anything.
Ice cream too cold, chocolate....very occasionally, but he complains it Herts his teeth.
The doctors say as long as he is drinking and eating something there isn't much to do. Sister has pushed for referral. But jot got one...hence thinking of going private.
I think local pediatrician is the way forward.
Take it from there.
Well, back to my own two....who incidentally eat like horses & eat anything :-/

What a worry for everyone.

The only thing I can add to what's been said is it would definitely be worth trialling zinc as a supplement - a deficiency can weaken appetite. And so adding it can stimulate appetite in some people.

My sister does this periodically for my nephew. He is generally uninterested in food but ticks by. It's helped him at those times my sis has felt he's got too thin.

Might be worth a Google?

Yes, the milk could be making things worse not better. Once we stopped offering milk if our dd hadn't eaten her tea, segues what, she almost always eats some. It took her a few days to realise it was that or nothing but it did help.

Am really surprised by the GP not referring and suggesting toddler milk. If he thinks that your DNs diet isn't sufficient and he may be lacking in vitamins and minerals, then the GP should be doing tests at least to rule out things like anaemia.

And I know you shouldn't have to do this but could your DSister take her partner to the GP with her and insist on a referral? My experience of GPs is that they take it more seriously if you both go.

Has he been to a dentist to see if he does have any problems with his teeth?

No, they haven't been to GP together, but they have lost all faith in them to be honest, hence going private. I just wasn't sure WHO to go to, but it seems a paediatrician is the first stop.
Dentist wise, nothing to report. But they aren't very thorough with little people, are they? And he was reluctant about the whole thing too, bit stressful (just having a stranger poking about his mouth, not about his teeth).
On the milk front, he doesn't drink malice quantities by any means. He has plenty of water or juice - but again, not enough to be an appetite suppression.

She has honestly tried absolutely everything that anyone has suggested. She has the patience of a saint.

It must be so stressful for all of you. Has she seen this thread?

I would second, third whatever the dentist. A friend had something similar and it turned out her DS's back teeth hadn't formed properly and were causing him lots of pain. He is 6 and wasn't able to verbalise this. She needs get him to be seen properly by a dentist to rule this out at least. Lots of problems with eating, fussiness and behavioural problems caused by the constant pain.

The book someone mentioned above is My child won't eat.

I think a dietician wouldn't help unless a specialist in these issues. Otherwise they can tell you what to do but not how to do if iyswim.

Terrible things have got this far without any proper support, it must be so hard for you all but especially your sister and her DS.

Definitely see a paedeatrician as soon as they can to find if there are any underlying issues. They can also refer him to feeding therapy courses.

How is he with getting messy and painting and things like that? Any other sensory quirks??

DS2 had feeding therapy as he was tube fed until 2.5 - it really focussed on textures and temperatures and how they felt in their hands, how they smelt, what they looked like. It was months of this before they even broached tasting them!

He's nearly 4 and although skinny mostly eats 3 meals a day, they're quite limited and he doesn't really eat much outside of home as its 'not right'. We can't take the eat it or leave it approach with him, theres so many complex emotions involved in food with him its a delicate balance, push too far and he can go days without eating.

To get him to try a new food takes weeks, we start by playing with it, smelling it, licking it, drawing a picture of it etc and eventually he might ask to try it (and then i secretly get crazy excited!!)

I really hope your sister gets help, its immensely hard and stressful when your child is in this situation but with a lot of help and support they can make progress

It is hard. He's such a gorgeous little soul. And as I said earlier - full of life....a medical miracle given how empty his tum is!!
Will update the post when we have a new medical opinion from our soon to be consulted private pediatrician!!
Thank you all for your support, advice and reassurances.

For me, the less I eat, the less hungry I become. If I don't force myself to eat in the morning, I'll happily go all day with nothing to eat, and not notice.

Will he eat if he helps choose and cook? This works to a certain extent with my oldest who's very fussy.
What about hot chocolate (with a bit of cream in) or home made milk shakes? You can probably also slip a few vitamin drops in a drink, which will give him something.

My oldest was the easiest to feed as a baby and preschooler. Ate everything and anything in as much as you'd give it. Now she'll eat about 6 things without complaining.
Dd2 was the other way round. Only thing she would usually eat was tinned sweetcorn. She would go days with two bites of a biscuit. Now she eats like a horse.

Hope he's similar to dd2.

My mother used to make me (thick American-style) milkshakes with an egg in it to get more protein in me when I was little and wouldn't eat much. It didn't affect the taste - just makes it a bit frothier. Would he drink that?

If he will drink those, maybe start adding fruit for flavour?

It was years before I found out eggs in milkshakes wasn't usual!

Good luck with the paed appointment - there are definitely specialist eating clinics which s/he could maybe refer you to - there is one at Great Ormond Street. Might also be worth seeing a child psychologist, if paed rules out underlying medical issues, for ideas to get him interested in food.

When you say she has tried the eat it or go hungry approach do you mean that he is under pressure to eat at every meal time? That is not going to help, whatever the root cause.

How about a new strategy. Only put the amount of food in front of him that he could be realistically expected to eat. So if he is likely to eat only one mouthful, literally only put one mouthful on his plate. Then, if he feels less anxious about eating it and achieves it, the meal has become a positive experience and the pressure is reduced.

If the plate holds 10 mouthfuls and he eats one he has failed. If the plate holds one mouthful and he eats one he has succeeded. The outcome is the same both ways in terms of food consumed but very different in terms of anxiety and self esteem.

If they can bring themselves to never, ever offer more, they may help him feel more relaxed and in control which is the key to being able to eat. Nobody has an appetite when they are stressed.

Sitting pushing food round his plate isn't going to help, ever.

Goldmandra, he's not anxious about eating. He's just not hungry. He doesn't see it as achieving or failing. He has no self confidence/esteem issues about being at the table and not eating.
He will ask for one cracker or one square of toast & that's what he's offered. He's never over faced with big meals. He is offered whatever everyone else at the table is eating and will always decline. He has tried new foods. He just doesn't like them enough to choose them. He will eat a little of whatever he's asked for & then ask to leave the table.
The eat it or leave it was early days, (after weaning when they hit that faddy stage about 12 months) before things had progressed to this level. He's never been made to feel its bad behaviour not to eat. It's never been made into an issue.
He's simply not hungry. Not interested. Not bothered.