When to seek help for 4 year olds diet

[Whentoseekhelp89]

We have ended up with an extremely picky eater. He never used to be, but he is now, not entirely sure when things changed but they have.

He survives on a diet of fish fingers, McDonald’s, pizza, cereal, and ham and cheese sandwiches.

That’s pretty much it. He’ll finish puddings, but he often does not even finish the above meals. So he is fussy, and not fussed for food unless it’s a treat.

He was born small on the 8th centile and is now only 15kg, he turns 5 in January. I had him weighed by the health visitor who said he is a normal weight, but when I use kids BMI on the NHS website he is borderline underweight.

I don’t know what to do. It feels like we’ve tried all the approaches, from being casual and relaxed about it to bribing with desserts. Offering new things or things he doesn’t want with a safe food. Small portions etc. I always offer him what we are having but there is no chance he would eat anything other than the above. He used to at least try, and would entertain a curry or vegetable dish, but even veg is a no go now.

When I spoke to the GP about this around six months ago they said to get him weighed as a first point of call, which we did. But with the kids centiles giving different results to the NHS BMI, I’m at a loss. I feel we need some
help, but on the other hand isn’t it pretty textbook for a 4 year old to be a picky and fussy eater?

No, it’s not textbook to have such a bad diet. Others will be along to tell you their child is worse, but that really is a very poor diet. If I were you I would speak to a dietician.

Don’t get hung up on weight. He could eat nothing but McDonalds and be a healthy weight but his health would be terrible.

I should add he will also eat some fruit, mainly strawberries and apples, and pancakes we make using just banana and oats.

That breakfast is something I’ve given him since he was a baby and I thank my lucky stars he still likes it as I make them for him every other day and it’s at least nutritious!

He has hot meals at school and today he said he ate 2 roast potatoes and one piece of carrot, so now we are going to start doing packed lunches to make sure he’s actually eating.

Firstly, if he isn't already having one then give him a multivitamin.

Is the pizza homemade? If so, can you include some veg in the tomato sauce gradually?

What puddings does he eat? Any that are fruit based? Are they home made?

The only long term approach is to remain relaxed and calm about eating. No bribing, cajoling, no comments on anything at all. Give him food he will eat and introduce one item he used to eat or that you think he might possibly try, put it on the plate but don't say anything about it at all. If he doesn't want it on his plate, I would tell him he doesn't have to eat it but it stays on the plate. It may take 15, 20, 50 times of offering before he might give it a try. Perhaps the same again before he eats some of it properly.

It is better that he eats what he can and mealtimes are calm and relaxed than they become a battleground and a source of stress.

I would also ask the GP for a referral to a children's dietician, for further specialist advice.

Thanks.

He does have a multivitamin daily, yes. But it doesn’t include iron which concerns me.

We often make his pizza at home, and I have tried adding veg to the tomato sauce but it gave it an orange colour which he noticed and then refused.

We have asked questions about it all and he says he doesn’t like the look of things, or doesn’t like the taste of things.

He will happily eat apple crumble with custard or ice cream and he’s pretty good with yogurt desserts too, like muller corners or plain Greek yogurt with honey. He used to have plain natural yogurt and honey every day but now it’s pot luck if he’ll accept it.

If I include things on his plate that he doesn’t like he will tell me that he’s “definitely not eating that”

i was pretty textbook with weaning, he didn’t have any added sugars at all til way past age one. Now I wonder whether that has contributed to all of this.

I should add that when he was at nursery I was repeatedly told that he was a fantastic eater and often asked for seconds! He was picky at home, but not as bad as currently.

So I guess this all progressed within the last six months or so. He has a younger sibling that is 10 months. I wonder if it’s connected.

It's probably related to the younger sibling along with the usual tendency for children to narrow their diet as they get a little older.

If he says he definitely won't eat the unwanted item on his plate just that "that's ok" and nothing else, just move on and talk about something else. No reaction to it. Also don't get into conversations either at mealtimes or other times about why he does or doesn't like things.

I would offer the fruit puddings with as minimal sugar as he'll accept. Could you try adding a tiny bit of celery and onion to the tomato sauce as they won't change the colour really, especially if you add some tomato purée as well.

yes, we do try and limit sugar but unfortunately this results in refusal.

I try to buy no added sugar fruit yogurts (with no sweeteners either) but I actually tried one myself today and it was disgusting!

Whenever I’ve made things like crumbles or banana loaves and muffins with less sugar or a sub like honey, he isn’t fussed for them. He’ll try a bit and then say he’ll have it later and never does which is quite disappointing because each time I think I’ve nailed it and he’ll definitely go for it!

Unfortunately I can’t even do veg muffins or the like anymore as if he sees green he refuses. I actually made him some avocado brownies the other day, you could see the green avocado pieces and hr asked if they were icing. I lied and said yes, they’re special Halloween brownies but he didn’t touch them again after that 😑

So just reduce the sugar a little, things don't have to be sugar free. If he won't even tolerate a very small reduction then don't worry about it. It's better that he keeps eating the fruit and includes those foods in his list of acceptable items.

Some kids go through a picky phase and an adventurous phase. And it takes 10-20 tries for a child to like a new food. So keep offering or putting a small taste of whatever you are having on his plate.

I would start by keeping a food diary for a good 4-6+ weeks, because over the course of a few posts there's already been a few "oh and he eats this" things forgotten about, which has generally been the healthy stuff - fruits, breakfast pancakes, Greek yog etc. He may have a more varied diet than you immediately think.

If he's eating cereals maje sure they're fortified as this will help his mineral intake. Most are - brand names and supermarket own, but not all - Aldi and Lidl cereals generally aren't.

My son was similar. He ate anything and everything and literally overnight stopped and has a very self restricted diet. He's autistic and for him it's a sensory thing. We've always taken a very zero pressure approach and now he is starting to try (and sometimes even like!!) new foods.

It’s tough. I have three boys and the middle one eats garlic bread, sausages and chocolate spread. And fries. Occasionally cucumber or peas picked from garden. I just feel I messed up somewhere, the other two eat fine, the 3rd in particular eats everything happily …I’ve been very conscious of never giving him another option if he complains. Whenever he has he just ends up eating in the end. It’s maybe where I went wrong with 2nd. Good luck. We had son weighed and all
bloods done, etc and he came back fine so drs aren’t interested.

I actually wouldn’t stress at all about how much he’s eating. So what he only ate 2 roast potatoes and a piece of carrot? Great, better than McDonald’s! Keep with school dinners (they’re free too) as they’ll encourage him to eat a wider variety of foods than he’s getting at home. Offer normal healthy meals and snacks. No puddings. If he doesn’t eat, he doesn’t eat, but he can have more of whatever he will eat. If he is truly hungry before bed, piece of toast and a cup of milk. Anyone would live off junk food if given the opportunity. But I would just persist with normal nutritious meals at home. He really will not starve.

That diet isn't even that bad, at first it looked bad but then you keep adding more in comments like cucumber/peas/apple crumble and custard. My two would never eat a dessert or custard, they eat cupcakes without the buttercream and vanilla ice cream with no bits in. My 5yo is especially bad but he is on a waiting list for a AS assessment two I think it could be linked as it's quite extreme. The 3yo is also picky, but not quite as bad. It's really hard because all anyone ever says is keep trying it, put it on their plate anyway even if they don't eat it etc
They both will cry or remove the extra thing off their plate if it's something they won't try , I struggle to give them enough at tea times because I'm lost for what else I can possibly add to their plate so I give a slice of dry bread with it (eldest will have this but won't eat butter, youngest won't eat sliced bread)
People with good eaters don't understand

Don't move away from school dinners if he's eating potato and carrots there! That's better than most of what was on your list.

I agree with pp, make a comprehensive list of what he will eat because there more you remember the less restrictive it sounds. Is he tracking the 8th centile or has he dropped?

That's not true, Aldi crispy rice, cornflakes, choco hoops etc are fortified.

They all have to be fortified by law, because they're a shit breakfast and offer next to nutrition otherwise.
White bread is fortified for the same reason!

Definitely keep the multi vitamins!

go cold turkey on McDonald's. It's junk really.
He'd be better eating a homemade apple crumble than a crappy nuggets with chips meal from McDonald's

Is he even hungry at meals times? Or does he snack a lot. My DS had 3 spoons of carrot and coriander soup and a bit of bread for dinner at 6
Turns out his auntie had given him a babybel, a yoghurt, a banana and an ice lolly after school!

It's very easy to hide veggies in things if you're worried about nutrition. I put all sorts in pasta sauce and make it redder again with tomato puree.

Anyway, what does a typical day look like food wise for him?

Don’t swap to pack lunches. I’ve got a very picky eater and despite a few occasions of not eating much for school dinner, he now eats a reasonable amount every day. He will eat food at school that he won’t at home.

Stick with the school dinners

@NuffSaidSam according to the clinic when he was weighed, he was on the 25th centile.

By BMI he’s on the 3rd.

A typical day -

Breakdast - Cereal (this is new, we never did cereal before but I wanted to give him more options) or banana oat pancakes.
Lunch - Sandwich, yogurt lolly or school dinner
Dinner - This he usually refuses unless it’s pizza or fish fingers. Any other typical family meal he won’t touch. Occasionally he will entertain spaghetti bolognese but he has gone off the old favourites like Mac and cheese.

When he’s at home I’ll give him some afternoon snacks , I try apple with peanut butter which he’ll nibble at, cheese, cucumber sticks, carrot sticks, but he’s uninterested in anything but the apple, and will request a yogurt lolly or some processed crap like ham or mini cheddars.

In the end come bed time he tells us he’s starving, so we offer toast, sandwich, and he has a glass of milk too.

You’re right about the food diary. Even typing this out I’ve realised he eats a bigger variety than I initially thought, but actual meals are very limited and I can count on one hand main meals that he will eat. Which makes it feel like he’s very restrictive.

He also never, ever finishes his meals.

If he asks for fish fingers, I’ll give him fish fingers, chips, beans and broccoli. He’s likely to eat all the fish fingers and a few chips. That’s it.

My now strapping 24 year old lived on bloody chicken nuggets,bananas ,marmite toast and fruit for about 2 years when he was 4. Paediatric nurse recommended grazing,snacks around the house etc ,he did have severe reflux.
It really does get better and the less you stress the easier it becomes.

The only pasta sauce he’ll eat now is bolognese, and even then it’s a few mouthfuls. He wouldn’t eat a smooth simple sauce with pasta.

I made one a couple weeks ago that was actually delicious. I roasted peppers, carrot, sweet pot and blended with cream cheese and tinned tomatoes. He took one bite and refused. It tastes great.

Having some sugar in foods is better than having no food. Low sugar yoghurts tend to be low fat too, he needs full fat foods for the calories and calcium.
my DH hates peppers, I make a tomato sauce for him with roasted red peppers and blend it smooth. He has no idea there’s peppers in it!