Toddler eating. Picky? Arfid ?

[CheeryAzureOtter]

How do you tell the difference between Arfid? Picky eating? Ed

I have a child, which is 3 1/2 will be 4 in couple of months. Since my child was 2ish I have struggled so much with my child’s eating. And I feel like it’s just got even worse this week. I don’t think I could even name 10 things that he eats. But the last two weeks have been awful in regards to eating. Last night I sat down and made five different dinners for him and he didn’t eat anything. I’d let him choose what he wants and I’ll make it and then he just doesn’t want it. I feel my child is surviving of strawberries.
used to have Weetabix every morning for breakfast, but now he can’t stand them and he doesn’t like any other cereal he doesn’t like toast.
Dinner time dreadful because he barely likes anything. He will even scream and not eat it or chuck it on the floor. And when he does, he will normally have about three mouthfuls and just play with the rest of it.
things he likes
*pie
*sausage roll (frozen)
*noodles
potaotoe waffles
lasagna (hit n miss atm)
spag bowl (hit n miss atm)
pasta
and I’ve tried these things all week and only thing I’ve got into him is the waffles and that was tonight,
im running out of ideas. Im finding it so stressful. He doesn’t like chicken nuggets or anything like that.
contacted doctors which they have passed me to predi but that’s a waiting game.
he likes fruit and will eat veg but everything in regards to food is so difficult.

wont eat sandwiches or anything like that.

Afrid comes down to the impact, severity and the underlying cause. Typically a person with ARFID will not eat fruits or vegetables as these foods can be extremely unpredictable in there taste and texture.

It does sound relatively age related too, seems like he could purposely testing the limits all very normal but could also be mixed with some sensory differences. Sensory different sre not the same thing as arfid. Does he have any other underlying concerns that arent related to food?

He is being referred for autisim. My concern is he literally barely eats anything. I cannot get any type of meal into him. He lives off the above foods. & right now they are hit and miss. They are his “safe foods” but now he is rejecting them. He does have sensory issues from what I can see and what others can see. Hv said he defo has type of additional needs that’s why he is being referred. I’m just at the point where I really don’t know what to do. He has dropped a centile when he got weighed recently. This has been like this since he was about 2. He cannot eat at families house. If we have people round he will rather eat on the floor or we go out for food is the same. Or he will go somewhere private to eat when he is at nursery he barley eats also unless they have pasta or yogurt with fruit/smoothy

Has DS been referred to a dietician?

Keep offering a range of his safe foods and giving DS anything he will eat.

If DS’s will eat yoghurt and strawberries, will he drink a strawberry milkshake or smoothie? You can make them quite calorie dense.

I appreciate DS hasn’t eaten them this week, but he has a range of safe food normally.

Many with ARFID don’t have fruit and veg on their safe list, but some do have some.

My advice is to keep a food dairy for a week, it might be that over the course of the week he eats more than you actually think.

My next bit if advice is only offer safe foods, and do not get stressed out at feeding times as this can heighten his anxiety around food and therefore he'll likely eat less. I also wouldnt be making different dinners ect if he doesnt eat what is first served leave it and make something else abit later. and have no pressure on him to actually eat as this can be stressful for autistic individuals, and with him wanting to eat in private it seems like that is likely an issue for him already

I feel my daughter has ARFID, we have an appointment with the dietitian next week. This is what she eats everyday. She is diagnosed with asd. She is nearly 5.
breakfast - cold toast she won’t eat until it’s stone cold
lunch - cheese, yogurt, chocolate, peperami, Philadelphia cheese and bread sticks ( she doesn’t eat the breadsticks but licks the Philadelphia cheese off them ) cheese and onion crisps.
Dinner - I make her the same meal we eat each day she never eat it even if it’s gone cold, but it about giving her the option. After 1 and a half to 2 hours later of her not eating it she either has cold toast or lunch again.
she doesn’t snack or even ask for food throughout the day.
only drinks one flavour drink.
she was starting to loose weight from not eating enough but now she is having lunch for a second time she is back putting weight on.

My second daughter is older and I’ve tried getting her help for years she eats. She is still waiting for assessment for asd. She is 15.
breakfast - toast which is more like warmed up bread
lunch - ham in rolls and cheese and onion crisps
dinner - plain pasta and hotdogs.
no snacking.
only drinks 2 different drinks.
I have tried giving her the same dinners as us her whole life but she never eats it so I have now given in to what she will eat.

I think if you have concerns I would try to get a referral to the dietitian but I’m not sure all areas of the country will diagnose ARFID.

ARFID is now a recognised diagnosis in the DSM-5 so all areas should diagnose if meets criteria, although its not an easy diagnosis to get as its not a dietician or paediatrician that dx it, ots a whole multi disciplinary panel that have to agree to diagnose it.

I also wouldnt hold out much hope for the dietician they're useless and will just tell you to give them anything to get calories in. For us they told us to just give chocolate if they eat that, as its all about maintaining weight and growth, if child is growing (and doesnt fall more than 2 centiles below what they were previously tracking).

Its also important to get occupational therapy involved as they will help with sensory sensitives weither it is arfid or not , qlso just a really good service to be under for autistic individuals, And maybe therapy (dependant on the child and their agility to access therapy) to work on the underlying cause of the food issues if it isnt caused by sensory sensitivity. It will also be important to contact your GP and ask for a blood test, as people with ARFID are almost always deficient in some nutritions

Not all ICBs commission sensory OT on the NHS.

While ARFID is in the DSM-5, not all areas have a service that can diagnosis. Although you can request a referral out of area. In services that do diagnosis, the professionals who are part of the service varies.

I disagree that all dieticians are useless. Some are excellent, some are good, some are poor and some are very poor. They vary. Just like in any other profession. DSs’ is an integral part of their healthcare team.

I said it to mean more dont expect much from them especially not at the start, they told me to feed my children anything and every thing theyll eat to get cals in (3 different ones) and ive heard the same from most people in the same boat as me. They can be very useful but when it comes to autistic kids and food issues they really lack

As I said, some are better than others. Just like any other profession.

Getting the calories in is an important part, especially in DC who are not otherwise having enough to eat. That doesn’t make them all useless and lacking. It makes them concerned about a child’s nutritional state.

Do you think they won’t do much if my children are maintaining a good weight now? I’ve contacted the doctors over my eldest daughter for around 10 years and they have only said to give her what she will eat she will grow out of it and make sure she has multi vitamins. So I don’t hold out much hope. My youngest daughter has always shown sensory issues towards warm / hot foods and different textures, I’m not really sure what anyone can do to help a child eat different foods, I think I mostly need something put in black and white because she is about to start school and they won’t allow her to drink her safe drink there ( she won’t drink anything else ) and snacks ( they won’t let me send in her safe food as snack ) they said they need a letter from a professional saying why she needs different drink / food for medical purposes. She will not be going to school without a drink, how wrong is that. We have community paediatrician next week aswell so I’m hoping between dietician and paediatrician they will write something for me to give to the school.

There are still services that can help even if DC are maintaining weight.

they won’t allow her to drink her safe drink there ( she won’t drink anything else ) and snacks ( they won’t let me send in her safe food as snack ) they said they need a letter from a professional saying why she needs different drink / food for medical purposes.

They are fobbing you off. They don’t. Push them on that. It is a reasonable adjustment.

Compared to everything on her ehcp I never thought I would be in a back and forth argument with the school over allowing her to drink her safe drink and eat her safe foods, I won’t back down they can’t expect me to send her with no drinking and if they try to give her water she will refuse to drink completely. I have forwarded all the conversations around this to the community paediatrician ready for next weeks appointment because this appointment has been made by them to make sure she has the right support in place before starting school.

Your not getting much nutrition with just eating chocolate though are you? It took for my child to be NG fed before we got any real help or advice

@Curlycookie5 so you are aware for the next annual review, it is something that can be included in the EHCP.

@LocoCoco13 you are getting more by not limiting the safe food(s), even if it is only chocolate, than you are by limiting the safe food(s), though. That is the point in encouraging as much safe foods as DC will eat since, for the vast majority, the initial focus is about maximising oral intake to get calories in. The point isn’t that chocolate alone is enough forever more.

I also have 2 DC who have enteral feeds - gastrostomies rather than NGs. Dieticians (as a whole profession, because, as I said, some are better than others) aren’t useless for that either since they are involved in the care of patients receiving feeds.

Brilliant thank you, I will make sure this is put on there, I never thought it would be a big issue so it never crossed my mind, reports with that was sent with her ehcp shows it but it’s just not on her ehcp. It’s due to be reviewed in September, they have said they will be doing it in October so they have a term to monitor her, wait to see if they will get extra funding and amend the setting for her safety risk, I will be pushing for a 1-1 at this point. It would have been nice for everything to be sorted before she started school but it won’t be so she is on soft starts until then.

It shouldn’t be such a big deal, EHCP or not. It is a basic reasonable adjustment.