How can I increase appetite?

[JackTheNipper]

DS is a skinny little thing and below the 0.4 centile, he has dietry suplements and we also add mascapone into his food to up the calorie intake.
Since saturday he has had a bit of a tummy bug and vomited everything, even water now I can see he looks obviously thinner but is still reluctant to eat, he vomits easily too, I think this is due to his low tone (CP) and I think his stomach muscle is too week to hold the food in if he burps etc.
Anyway, to the point, what can I do do increase his appetite, unless it's half a dozen chocolate buttons he will not willingly eat and needs a lot of persuation, singing too, distraction (and numerous re-heating)
would a probiotic help?

Would he drink smoothies? This is how I get my DS to 'eat' when he is on one of his funny days. My DS is doddy too so I know how you feel.

In fact DS's smoothie habit keeps Innocent in business I think :o

I will give it or anything a go, I have started giving him some pureed fruit (Ella's Kitchen range) and I get 'the face' with every mouthfull but at least he is willing to have another taste, but theres not many calories in them, I will give the smoothies a go are there many calories int hem?

Besides this current tummy bug, does he have a lot of tummy / bowel problems?

You could calorie up the smoothies. Add milk, cream etc. this website is useful for recipes.

Indigo - No first one ever! he has the (very) occasional constipation but thats all.
zzzz He's 3.2, he will drink water from his tommee tippee cup or tea from his doidy, but not a lot at a time
he is more a meat and vegs boy than anything but will eat pasta dishes eg, spag bol, carbonara, roast meat with steamed veg, all has to be quite finely mashed (he has 4 molars other teeth-all removed a year ago)
he eats best for me but I work so other people have to feed him, he doesn't eat at nursery won't eat in his push chair, (you have to get him out the minute you sit down!)
It's best to distract him with the TV, and slip it in while hes not watching, if he sees the spoon he will not open his mouth, but if distracted with the TV he will
He is usually in his high chair, but if hes just having a snack I will feed him in his floor sitter/my arms, with his snack I'm trying to engage him more with what he is eating.
All of his food had hidden calories such as added butter mascapone pro cal powder, he also has pro cal shots, which he takes really well from a syringe.

oh and he has just got into yogurts, he used to just gip and gag on them before.
Actually he gags on alot of his food but my cousins daughter did this (NT) so thought its just what some kids do?

thanks blue site saved to favorites!

shameless bump!

Is he skinny because he doesn't eat enough calories? (Or is there a mismatch between his calorie intake and his weight)

Could it be a sensory thing? Does he hate the way the food feels / smells / looks / or the texture of it? (As well as obv taste )

Does eating give him a sore tummy? Or stinging wee's? Or constipation? Or make him feel sick?

I've never heard of kids gagging. Does he have a physical problem which is causing him to gag?

we have seen SALT and said there is no problem with the actual swallowing, I personally think the gagging (even at sight of food) is behavioural, and I don't think that he actually enjoys food, except chocolate!
I will try the peanut butter and coconut milk, I think like you say just more snacks in between meals will help.
I think his tummy might have shrunk a bit too, now we are getting back to regular meal times he can't seem to manage as much as he did before, but think that is a matter of building it up again.

To make things worse he have given his bug to me so i'm

JackTheNipper - DD has slow weight gain due to genetic disorder.
The nutrition clinic suggested we give her a zinc supplement, which has greatly
increased her appetite. Obviously, you might want to check with a GP, but
zinc is in most multivitamins (we would have to give her more than recommended dose of multi-vitamins to get to the amount we give her right now: 0.8 ml). We've tried all the high-caloric food tricks and none has worked for us. She's has a small amount of smoothy/mascarpone etc and then stops eating. Until the zinc, her caloric intake was totally consistent, either on high or low-caloric food, so we've given up on the high caloric food strategy (which is officially recommended) and just feed her the same as we eat. Also, we were told to avoid snacking and have 5 meals per day, which also didn't work for us:
she just does not get hungry in between. We have her on 3 meals plus one snack right now, which works much better, because she is actually hungry/has appetite when she eats.

Thats really interesting I'll look into that DS has ABIDEC but not sure if it contains zinc. Will check, and ask dietitian about zinc etc
Thanks glimmer

Sounds very similar to my ds, he too has cp (low tone) and is off the chart for his weight, last weigh in was 25lb and he's 4.6. He has Pro Cal sachets which adds 100 cals to a meal without bulking the quantity which the dietitian prescribed.

We also found Rolo desserts and Milky Bar desserts very calorie dense without being big quantities and like you have to distract him with tv as he eats or else he really wouldn't bother

Can definitely sympathise with the vomitting as my DS did an awful lot of this though caused by reflux and ended up having a fundo to cure it. Still now though when he's poorly you can see the weight drop off him very quickly and like you he doesn't eat when in the care of others.

Just wondering if he has reflux? My LO has it - causes gagging, retching, puts him off his food - he has a very poor appetite too. Reflux can be silent (ie with no actual vomiting). Vomiting can also become habitual when it happens so often, not necessarily a deliberate behaviour but a learned response. Reflux can be treated fairly easily, with a combination of medication.

We had a SALT referral to rule out an over-sensitive gag & they were also able to advise on play-related food activities which helped him enjoy his food a wee bit more.

He is now on the dizzy heights of the 2nd centile (started off below th 0.4th) so it's been a long slog. He's still not particularly interested in food, but is getting better.

If he likes yoghurt, a good thing is marscapone mixed with fruit puree - very calorific but tastes just like yoghurt. Or else you can add double cream to ordinary full fat yoghurt. Also use fatty/luxury ice-creams, rolo/milky bar desserts, aero pudds, cream in soup, cheese for a snack - plus cheese straws, raisins, chocolate raisins, peanut butter/philadelphia with breadsticks. I cook all his meals separately in bulk & freeze individual portions. Favourites are macca/cauli cheese, fish pie (all made with Jersey milk, double cream) spaghetti carbonara etc

We give him a toy to play with at mealtimes as a distraction.

If he'll only take small amounts, the idea is to make his food as calorie-dense as possible & limit low calorie foods eg fruit & veg

I think ABIDEC is only vitamins, not minerals

It can be pretty stressful having a poor eater - remember you're only responsible for the food offered, not what he actually eats

Thanks Feargalthecat our DS's sound very simelar! excuse my ignorance but what is a fundo?

Lotsofcheese, thanks for the tips, I'm really wondering now if he has reflux?
He has always had feeding problems right from word go, he had colic 24/7 for 4 months. It was a really tough time he was breast fed and needed feeding hourly to help with the colic but the more he fed the more air he would take in making the colic worse, it was a vicious cycle

we also make lots of food and freeze, it's just one less thing to worry about.

The fundo (fundoplication) was keyhole surgery to tighten the muscle at the top of his stomach, DS was loose and as a result the food in his stomach could come out very easily hence all the vomitting. Reading your post you are thinking exactly like I did I guessed his stomach didn't work normally because like you say DS couldn't just burp, there would always be sick with it.

He wasn't diagnosed with reflux until he was 2 and the only real symptom was the constant vomit so it maybe is worth getting it checked out especially as it's common in cp children. Medication is usually tried first and this may fix the problem.

You are doing all the right things but I know the feeling so well of stressing about what they eat because it feels like it should be the easiest thing in the world x

Jack - I agree with your suspicions of reflux - I wonder if the "colic" was in fact reflux, right from the beginning? The symptoms are very similar.Breastmilk unfortunately makes reflux worse as it's thinner than formula. I was told my baby was "windy" and it took us until he was 2 to get a proper diagnosis as well.

He's on medication now, we're back seeing the gastro consultant this week & since he's been really puky the last wee while, we're looking at 3rd line treatment with ondansetron, possibly an endoscopy, blood tests to rule out coeliac disease etc.

Keep a note of all his vomiting episodes & take to your GP - who will be able to refer to Gastro - good luck

x

I'd echo all of the above, as I've had a terrible time getting my son to gain weight.

However, last year DS had a gastrostomy fitted, and it has worked wonders. DS slipped below 0.4 centile and it was starting to have other effects so they opted for a mini button.

He is slowly creeping back up the centile, and it has made less issues for all of us around meal times (as this was a battle).

DS is also on fortini shakes, has calogen (4 calories per ml) and Scandi shakes which can be added to foods to really bump up their calorie value.

Obviously only discuss a gastrostomy if you have to, the other supplements I have recommended work really well and should be relatively easy for your GP to prescribe.