5yo referred to Pediatrician

[AmieB]

Hi guys so for a while we have been dealing with an extremely fussy eater, our DD is 5 and although okay with cold foods (to some extent), hot food is a major issue.
its been an ongoing issue for a long time however after trying numerous things to get her to eat more and failing we have fallen into the habit of just giving her what she wants.
for context, hot foods she will eat are -
Pesto pasta
Garlic bread
Toast
Chicken goujons/dippers

THIS IS ALL!!!
anyway, we decided to take her to the GP and they confirmed she is on the 2nd centile for weight so have sent a referral to a pediatrician.
my post is really just to ask for any hints/tips on how we can improve her eating, any pediatrician experiences - what can we expect etc?

Thank you!

Morning OP, does your DD have any additional needs? I have a 5 year old autistic DD that is also quite particular with food although her weight is fine. I’ve read up quite a bit about it on here & seen advice from a nutritionist. The way we approach it with her is just to offer her a wide range of foods, we let her graze & we don’t get too het up about eating at particular times. We are flexible about where she can eat so she will eat in bed for example. I know some people will say that’s terrible but it works to encourage our DD to eat. She doesn’t know when she’s hungry & will otherwise not eat & become dysregulated. We also let went through a phase of letting her have Complan (meal replacement drink) & she likes chocolate milk. We don’t attach caveats to food (e.g. we don’t say if you eat your dinner you can have dessert).
Im just thinking that if your DD generally prefers cold food does it matter really? As long as she eats? It could be a sensory thing possibly (doesn’t mean she’s autistic but lots of children have sensory preferences).

Will she except peanut or almond butter on the toast? They're high in calories and nutritious.

@GertrudeSteinsbook no, so she’s not autistic and when we saw the GP he wasn’t too concerned as she has regular poos, sleeps like a dream, is hitting all milestones, very rarely ill etc etc but she is just super skinny!!
Weve tried all sorts from sticker charts, reward boxes, ignoring it completely, praising others at the dinner table, letting her eat on the sofa, putting some of what we are eating on her plate and letting her decide, the list goes on, nothing works.
Personally I feel it is just stubbornness, she knows we want her to eat more and she just refuses to even try things. She instantly said ‘I don’t like that!’ And we are like ‘but how do you know that?!’. If we mention trying something new, she sometimes works herself up and gets upset about it!
It just makes no sense to me and I have no idea on how to improve it!

What else does she eat?
Is it the temperature that's the issue - would she eat cold roast chicken with plain cold pasta and raw carrots sticks for example?
My DD was a fussy eater. I found it easier to deconstruct meals and feed the food over a day. For example she didn't like sandwiches, but would happily eat a slice of bread (no butter), and a slice of ham. She didn't like sauces, but would eat plain pasta, with some plain meat.

@Seeline So cold foods she is okay with, as long as it is something she has had before, sometimes it even has to be a specific brand or she just instantly knows and won’t eat it.
Things she will eat are -
Breakfast - toast with peanut butter, Nutella or just butter, multigrain hoops, frosted shreddies, strawberries & banana
Lunch - usually bread with just butter on, skips, cheddar biscuits, yoghurt, smoothies, mini roll, Soreen bar, breadsticks, strawberries, bananas

She also loves smoked salmon which we sometimes give as lunch or dinner with other bits.
As you can see her ‘cold’ food variety is fine, it’s mainly just hot/dinner items we struggle with.

Take all the details in written down and red book to show changes in weight. If you don't have it try to mark when they have changed clothes sizes on the height section for a rough history.

Don't expect too much to change on the first appointment with every paeds appointment we go to my daughter is weighed and height measured. They will be looking of them to be no more than 2percentiles apart so of he is on the 2nd percentile for weight and 25th for height that's the bottom of normal. The take into account their appearance too my daughter at one point was 50th for weight and 1st for height which would be overweight but they said she she "looked in proportion" they didn't suggest changes. She barely ate and had a very limited diet due to food allergies so weren't keen to change her diet. She's averaged out a bit now and is just below the 25th weight and 2nd for height which they class as normal.

Ask to do bloods to check for how well their nutrition is and ask for dietitian support. It might help to keep a food diary for 4-7 days before the appointment and all of the approaches you have tried to get them to eat. Ask about any underlying conditions that might be impacting on their food intake. My daughters food intake is linked to her reflux and allergies. When we have had a reaction or her reflux goes out of control she stops eating. Getting a medication review usually helps. The rest of time we stick to her safe foods maybe with a closely relate safe food on a plate next to her in case she is interested. It just has to sit there it doesn't have to be eaten. The next time she might poke at it then she might pick it up. On the 4th or 5th attempt she might have a bite.

We give praise for eating but we don't praise eating. We focus the positivity on the food - oh that looked a tasty sausage was that a tasty sausage? We do the same with sleep on the odd occasion she sleeps through the night it's "did you have a good sleep" rather praise for sleep. Mentally it's easier on me as it separate the reward from the difficulty getting their and she seems to respond better

No real advice OP but lots of sympathy. My 4.5yo is similar with the stubbornness and saying they don’t like things as soon as they’re put infront of them, before even trying them. They’re short for their age and I do worry about them. They started school this September and I’ve tried them with school meals to try and get them eating more if they see their peers doing it. School haven’t said they’re not eating enough yet, or suggested we change to pack lunch, so I’m sticking with it for now.

Following on from my message above - these are the ONLY foods she will eat, the whole list lol so she is basically having the same things on rotate each day.

I think if you have gone down the road of sticker charts etc. then it is going to be hard to rein back from this as food has already been flagged up in her mind as a source of control. I think you need to stop all this reward lark and just offer food - act cool and disinterested if she does not eat it. Just gobble it up yourself!

"Are you not going to eat that? - oh goody, all the more for me!"

Also - serve small helpings on small plates.

Thanks guys!
So for height at the moment she is on 25th centile, but weight is on the 2nd. She is very active, really athletic - can do the monkey bars in a matter of seconds whereas I do 2 and fall (LOL), so I know her low weight may be due to the fact she is so active all the time.
I do just really want to improve her eating because it does stress us out, especially when going to other peoples houses for dinner/restaurants etc it makes things so difficult.
Family have learnt now to just make her something she likes but I don’t want to live like that forever! I know eventually she may grow out of it but I can’t see that happening anytime soon, she is just so stubborn with it!

@Mischance This made me laugh 😆 but I guess it’s a good point!
we have now got to the point where we just give her what we know she will eat and in all honestly if it’s a dinner she likes she will eat massive portions!
I just can’t live like this forever, she eats the same 4-5 foods I just serve them in different combinations each evening 😅

One of mine was a poor eater and underweight. Our GP was great, said he had a DD who had been the same and he was ashamed of the times he'd just told parents that kids would eat when they were hungry and don't pander to them. He advised us to make no fuss and let her eat what she wanted, if she wanted to live on chocolate for a while just let her but put normal meals out for her and then make no comment if they weren't touched. It worked.

It's not necessarily a problem if they aren't lacking nutrients do they have a decent multivitamin
My daughters safe foods reduce to toast and dairy butter, pasta broad beans and corn fed chicken (soya allergy). She might eat this 1-2 over the weekend. The other meals it's nothing.Cucumber or apples for puds or if she has eaten a meal and with oat milk - her dietitian says she needs 500ml for calories and nutrition. She gets a good multivitamin. She drops down the percentile when she's like this but not such much to cause concern according to our team but I find it so stressful! She's 3 so doesn't burn quite as much energy as a 5yo.

That is a vast list when compared to what my DD would eat at 5. Try not to stress as that just makes it worse.

@Superscientist she does have a multivitamin too - my husband usually gets them with his protein vitamins, no idea on the brand but he is a health fanatic so they are probably decent!
I guess I probably just need to let it go, she has been referred to a pediatrician now so will see what they say!

Sorry if I'm missing something op but given what she will eat I don't understand why you're struggling with her weight? I can understand it would be nice for her to eat anything you put on front,but you're saying she'll eat big portions of stuff she likes, lots of cold foods etc. This shouldn't be a weight issue if she is actually eating enough.

Might be helpful to list what she's eating in a day?

@AmieB, it sounds like she eats a pretty good range compared to some children her age especially the smoked salmon. I can see it’s frustrating though when she won’t try things & also when you’re eating with friends/ family. I agree with other posters that if you can it’s best not to stress too much so it doesn’t become a battle. The other advice I was given was to look at my DD’s diet over the course of the week rather than the day as she has some good days & some bad days (I know you said your DD eats the same things on repeat but might help to give it a bit of perspective). Good luck though, I know what it’s like! My family have now got the memo & don’t expect DD to sit up for meals. We’ve ground them down 😂.

I found the paediatrician and dietitians largely useless as they all pedalled the usual NHS healthy eating dietary advice which is difficult enough to get a typical child to follow, let alone a restrictive eater with a very limited diet. I followed Ellyn Satter's Division of Responsibility model instead to great effect. I went from an underweight child who would only eat chips, peas and garlic bread to a healthy child willing to try new things. He's now at university and cooks for himself and his diet is not at all limited. It does take time but it works. https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/

@SleepingStandingUp I don’t know why she is so skinny either! She may not eat a huge variety but as I mentioned above, if it is a meal she likes for example pesto pasta - she will eat tonnes!!
She has a good breakfast, a lunchbox for school, a snack when she gets home then dinner & usually a yoghurt or fruit bowl for dessert!
I think her weight is purely because she is so active!
however the GP has raised it as a concern so now I’m concerned! lol xx

For example last night for dinner she had 4 chicken goujons, 3 bits of garlic bread and a huge portion of pasta followed by a yoghurt and then a bowl of dry multigrain hoops. For me this seems a good dinner to be eating so she’s not exactly not eating enough xx

My daughter was such a difficult and restricted eater, it stressed me out so much, for YEARS. Nothing I tried ever made a difference. I bought books hoping they would suggest something I hadn’t tried. She was so stubborn, and would rather go hungry than eat something that wasn’t one of her “safe” foods. They’ll eat when they’re hungry? Pfft. She wouldn’t.

The worst thing for me was the judgement of other people, like I was weak and I’d caused this massive problem because I didn’t try hard enough and wasn’t firm enough. It didn’t help that a lot of her safe foods were bland and processed and beige.

When she was coming up to her 8th birthday I started to notice that she actually had quite a lot of autistic traits, and her sensory issues with food, and rigid list of safe foods (including particular brands) was one of them. She was diagnosed at 9.

Op, you do need to chill about the variety of food.

my 12ds doesn’t eat cheese, milk, dairy, eggs, tomatoes, banana and many more. So no cereals, no sauces…

he will eat the same foods daily (since yr1 I have made packed lunches, often the same for years, but then a new food will become an option), he eats tuna mayo now so that’s the only sandwich option (before that it was only luncheon meat)
he will eat broccoli and corn on cob so has that daily. It’s vegetables!
he will eat 1 type of pasta,

keep providing what dd likes, hot/ cold doesn’t matter, get the calories in her (smoothies?), chill about meals, Involve her in shopping, preparing food if possible

it’s tough 💐

I just can’t live like this forever, she eats the same 4-5 foods I just serve them in different combinations each evening 😅

I honestly think you need to ask yourself why this is stressing you out so much. Why cannot you live with this forever? What makes you think it will be like this forever - can you honestly see her out and about with her teenage mates and refusing to eat!!??

It is a phase, which needs not to be fuelled by loading on your anxiety. The less notice you take of it, the sooner it will pass.

She sounds good and healthy and eats heartily when it is something she likes, so nothing wrong with her appetite.

I am going to tentatively suggest that it is you who has the problem!! - sorry ......

Food and eating have become a big "thing" in your mind and your DD knows this. What is needed is for you to chill out, and simply all eat your meals with no comment whatsoever on what she is or is not eating. Nothing at all .... not even encouragement or praise. People eat because they need fuel, not to be praised. It all needs to become a non-subject.

Give her the stuff she likes, plus a small helping on the side of whatever you are having - she will either eat it or not. If she doesn't then do not comment - just eat it yourself. If she does - then equally no comment!

Just do not talk about food at all - provide it, but don't talk about it.

This is a not uncommon problem because a mother's instinct is to nourish her child - when that seem to be rejected, it cuts deep.

Food needs to be completely off the agenda as a topic for conversation - until you relax about it the problem (if it even is one) will continue.

I knew of a child who would only eat cauliflower and chocolate - my late OH (a doctor) said it was a perfectly balanced diet and not to worry - it would pass in its own good time.

Seriously - chill out!!

@Mischance I'm guessing you've not had a child with serious eating issues.
It's really not easy to 'chill out'.