4 year old weight loss and fussy eating

[drasticchanges89]

My eldest turns 5 soon and for a while has been a very fussy and picky eater. When he does eat, it’s not much. I’m told he eats at school but that could mean anything, they’re not monitoring exact intake.

He was born on the 10th centile so always small, but has lost 0.6kg in the last 4 weeks and is now underweight according to the NHS children’s bmi calculator, though on 11th centile accorsing to the WHO weight-age centiles .

I had already flagged this with the GP surgery, and had been pushing for a referral to the dieticians. I was told not likely, but now with the weight loss, likely.

In any case he hasn’t been seen by the GP. It’s a nurse practitioner I’ve been speaking to on the phone who’s doing the referral, but do we need GP before dieticians? Or can dieticians arrange bloods etc if needed? He does complain of a sore tummy at least once a day but not sure if that’s just cause he needs the loo!

Do other things need to be ruled out first?

I’ve been concerned about the eating for a while but the weight loss has send me over the edge and I don’t want to do the wrong thing

Up his calories at home. Make sure he has healthier foods with a good balance but feed more often and dense calories. Milk drinks full fat, cheese etc. No low fat. May indicate other issues.

Can you share an example of what he would eat in a day?

This morning we made banana oat pancakes served with fruit. He ate 2 small ones, no fruit.

For lunch at school he didn’t eat the pizza, so just had the pudding of strawberry yogurt.

Mini pack of mini cheddars after school.

For dinner I made home made baked fish and wedges with broccoli, he refused the fish and broccoli but ate about 5 wedges. So I gave him some fish fingers which he also rejected, saying they tasted the same as the fish. I ended up putting them in a sandwich with ketchup and he ate half of that.

Then to up his calories I gave him a lemon muffin, as he will generally wolf down puddings. I have tried home made crumbles and the like using sugar alternatives but he isn’t interested. Same goes for hidden veg sauces etc, he knows and refuses.

We are at the stage where he refuses to eat most dinners unless it’s fish and chips, pizza or nuggets etc. Last night he had two forkfuls of lasagne which took a lot of time.

I was doing this, but he refuses the healthy meals and fats. Then when it’s bed time, he cries that he is hungry and usually has a snack.

The only way to up his calories is to give him what he wants, which is endless pizza and fish fingers, ice creams etc but now he won’t finish those meals either. Depends what it is but he just wants to snack instead, but the snacks aren’t enough and then if I give him too many he fills up and then there’s no chance of meals

He has full fat everything. I read today he should be eating 1,400 calories a day. There’s no way he’s eating that!

It sounds like your offering loads and not making a fuss about alternatives, so I really don't have an answer.

I do know other children who eat in this way, and it's really just a challenge that I haven't seen an answer for....I hope that the dietician referral helps. If I were in your shoes I probably would just continue offering the things he does like whilst letting him try different things off my own meal.

I have DS5 who can be fussy, but a healthy weight so I feel comfortable saying 'no pudding if your veg isn't finished' and things along that line, but I think in your situation, that would turn into a battle and made a bigger issue of food.

I'm sorry I can't be of more help

Can he take a packed lunch to school so that he's likely to eat a bit more than just a yoghurt?

If he's losing weight just from general not eating enough (as opposed to illness), in the short term you probably have to take all calories as good calories, even if it's more pizza and sweet stuff than you'd really like, and then trying to slowly rebalance things once he's eating enough.

Will he accept homemade pizza (maybe make a batch and freeze)? If he will, it's basically bread, cheese, and tomato, there are a lot worse options for a staple meal. Bonus points if he'll eat any useful toppings!

Similarly with sweet things, I know you said he didn't go for the crumbles or sugar alternatives, but a regular pancake recipe is pretty much eggs, flour, and milk. Even if you have to add a bit of honey, syrup, jam, or nutella to make it tempting, it could still be a way to get some reasonable nutrition in. Hot chocolate with full-fat milk, maybe a bit of cream? Banana chocolate milkshake? If you freeze the bananas or other fruit first, you can get a thick milkshake, or even a soft serve type 'ice cream' with just frozen fruit and milk.

I give him a packed lunch when he won’t eat the school dinners available on the day, but again he just goes for the snacks!

The other day in a desperate attempt to get him to just eat a full meal, I packed him something he’s been asking for (a jam sandwich), some strawberries, grapes, a cheese string, a yogurt drink, and a few choc buttons.

He ate the buttons, cheese string and yogurt drink but the sandwich and fruit was untouched. It’s just not enough for a boy that’s running around all day!

We do home made pizza often, again not a full full small one but maybe half. I make it using the natural yogurt recipe for the dough! I once managed to get a hidden veg sauce in as the base but he now reminds me that he doesn’t want the “slightly orange sauce” as he doesn’t like it.

I mean, I’m assuming the weight loss is from poor eating. This is why I’m unsure as to what needs to happen first. GP or dietician?

I've been in this position with an underweight 4 yr old. You will be told to forget healthy eating and go for calories in whatever form he will eat them. Expensive ice cream made with real cream, adding butter and cream where he might consume them eg. Butter and cream in mashed potatoes. Puddings if he will eat them eg chocolate sponge with custard. Food cooked in oil to up the calories. It sounds like he likes some fruits so you'll be told not to worry about variety and veg.

Look up ARFID and see if you think he might have that

Yes, you need to see the GP. You need to rule out any issues that are giving him pain and putting him off eating.

I'd also start to keep a food diary for him - and note down any time he says he has pain.

In the meantime snacks aren't a bad thing - I would try to offer him food as often as you can and definitely any time he shows any interest in eating and as everyone says full fat all the way. Giving him a snack before bed is a good idea, even if he were eating full meals to get him to gain some weight you should give him a bed time snack. Something like a milk shake (full fat milk with ice cream or cream added).

Random but i would also give a worm pill if you haven't recently. My youngest ds turned out to have worms which was causing his sugar cravings / change in eating habits. No itchy bum symptoms for months before i realised.

The symptoms are pretty vague, so it’s difficult to say.

He is obviously very restrictive and often will say he’s not hungry. But on the other hand, he’s only upset and fearful of trying new savoury foods, rarely pudding and treats!

Ask for blood test for coeliac disease.

Another suggestion might be to get him more comfortable around food by asking him to help you in the kitchen - making his sandwiches, cracking eggs, cutting fruit and making fruit kebabs etc. Might not immediately lead to eating it but will get him more involved and familiar with different smells/textures of it

What snacks does he go for? Could you swap them out for something like apple slices and peanut butter? Boiled egg and a little pot of ketchup?

Can you stick something like Mac n cheese in a thermos food flask for his school packed lunch, if he'll eat that?

Porridge with honey and raisins, sprinkle of almonds, full fat milk for breakfast?

Don't think healthy eating - think more calories dense eating!

And get him to handle food while you cook at home "get a potato out the cupboard for me", then move towards getting him to maybe peel potato, grate cheese, chop cucumber (with a kid safe knife). Get him involved with cooking.

Mine eats like a bird and can be so so fussy it's definitely improved by getting involved gradually like this and now they'll eat what they've helped with cooking, mostly.

And we take the "this is dinner" line so there are no swaps if something is rejected (and we've definitely seen an improvement with eating now this is firmly embedded!), but we always make sure there's sides that they'll eat for certain, e.g. with fish fingers and wedges we'd serve with peas, a slice of battered bread and cucumber sticks with yoghurt dip.

Good luck

With the tummy ache thing, I'd want a GP appointment, even if the nurse has referred him.

Thanks for the reply and ideas.

He’s good with Apple to be fair!

Eggs and porridge are a no go, frustratingly. I use egg and oats in the pancakes he has, but he barely touches them these days.

Snacks he will eat are mostly processed crap like Soreen bars and mini cheddars, but he does like hummus which is the main hit of health we get in at the moment!! But absolutely no legumes, pulses, rice

I think the issue might be that you are being a bit fussy with what you offer him. If you need him to eat and put on weight, then offer him healthy ish food he’ll eat.

Apples, soreen and mini cheddars is a great snack. His friends from school are likely going home to packets of crisps and biscuits, hence why they are eating more.

Nothing wrong with pizza. It’s tomato and cheese on toast basically. No need to make some special crust or add hidden veg. Pizza with whatever veg or extra protein on the side he’ll eat is a perfectly fine meal for a 4 year old. Same with fish fingers and wedges. I’d make your own if you can and he’ll eat it, but really it’s what lots of kids are eating multiple days a week. Once or twice for dinner is perfectly okay.

I would feed him actual food that he’ll eat with some fruit or veg on the side where possible. I’d just cut out the puddings/yoghurt. Give him toasts before bed if he says he’s hungry.