When is Picky Eating a problem?

ElizaBennett

Hi I would really appreciate advice on this. My little nephew, who is almost 4, is who I'm worried about. His Mum has a lot on her plate at the moment and I'd like to seek some advice to help out as I baby sit him a bit. He has one older sister. He's never been a good eater and has really severely restricted eating habits and I'm quite worried about him. In my opinion this is affecting his behaviour a lot. He's a lovely little kid but can have awful tantrums and be really unruly and I believe it's because he's 'hangry' most of the time due to his awful diet. He basically eats popcorn and cream crackers and drinks fruit smoothies (thank goodness!) and that's about it. The other root of the problem is that he drinks follow on milk every day. I'm not exactly sure of the amount but I know he has a bottle going to bed and wakes for one in the night. He's also not fully toilet trained:( He gets by okay during the day but wears pull ups and isn't trained at night at all. Because of her issues, my sister isn't able to do much about any of this at the moment. If we try to get him to eat anything other than the two things mentioned he will keep repeating 'that might make me cough.' and just not even entertain the idea. Forget ideas around baking, making food fun, letting him pick what he wants etc etc. If you're thinking of suggesting any of those then I'm afraid you're not getting how severe this problem is and how stubborn he is. He never has any interest in food or cares what anyone's eating or says he's hungry. When it's been ages since he's eaten or it's time that others are having a meal, he'll get his crackers and that's it. He used to eat chocolate and toast but now he won't touch those and I'm worried will he give up the popcorn and crackers too? What then? In theory I think the answer coudl be to cut out the bottles but I really don't think my sister is capable of imposing that rule at the moment. So the question is, how bit a problem is this? and do we need professional help? Eg he's not getting any protein other than what's in the follow on milk.

He's very skinny and boney, but his older sister is too (both in very low percentiles of weight). She wasn't a great eater either early on but nowhere near as bad as him and she's actually quite good now, eats fish and potatoes and some veg etc.

Could this be an indicator of a wider issue? ASD or something like that? Should we be talking to a GP or is this just a phase and not a big deal? Would love some words of wisdom or to hear from someone with similar issues. Btw, my own sister was an extremely picky eater as a child, right up to her late teens when she left home and went to college, and only ate about 4 or 5 things for years. is this something that runs in families? Thanks

niallb

Coughing violently after eating can be a symptom of a food allergy or some other reason the person wants to expel what they've eaten.

I can remember eating a piece of cake at a birthday party and coughing so much I couldn't see or hear properly.

As a child I was a similarly picky eater and I was in my 40's before I learned I was coeliac.

I've also had what I now know to be acid reflux all my life and was 15 before I learned that the taste of blood in the back of your throat after eating isn't something everybody experiences!

If he's had experiences anything like that it might be putting him off.

Might be worth asking him what did he eat that made him cough and how did it make him feel.

It could be a symptom of many things or just a habit. If his problem with food is texture based ASD is a little more likely,

but it could be any combination of things. Talking to a GP about it would be a great start. At least it puts it on the record that this is something to consider in the future. I'd have had an awful lot less hassle if I'd been aware of what was going on at a younger age. I had an uncle who was very alert to there being something odd going on and I really appreciated it. He travelled a lot and even brought me back food from different parts of the world to try.

ElizaBennett

Thanks, niallb, that's all useful. I'm not aware of my nephew ever actually having a choking incident or violent coughing, he just keeps repeating that he 'might cough' all the time but he's so young that he may well have had a bad experience and not been able to tell anyone. As you say there are many possibe roots to this issue. I just wanted to hear from others what the consensus might be on whether I should encourage his mum to take this further with a GP or specialist. I think I will ask her to bring him - maybe they could even do some blood tests to check his level of health and nutrition. He's not getting any protein whatsoever (and never has done, other than what's in the forumla) and that seems really bad to me. He looks pretty healthy and seems energentic but he doesn't like walks and always gets tired quickly - but that could be normal.

Keano

You try cook something you like to eat next time you have him and keep it basic but let him see you eat. Don't force it upon him but ask would he like to try it, he will probably say no but keep at it over time- the cooking and offering. See how it goes, might not come to much but my nearly 5 year old only last week asked for some of my food, she never usually asks.

ElizaBennett

Thanks, Keano, I think he's so pathologically negative about food that there's no way you'd even keep his attention on a cooking task - but I could maybe try pancakes or baking or something. Worth a try. I feel he sort of knows these ploys people use to try get him interested and he's not falling for it. He seems quite clever.

I suppose, while suggestions and ideas are welcome, what I really came here to find out is if this is a) very unusual, b) a problem according to most people and something to take seriously and c) could he be malnourished or could there be a behavioral issue or possible diagnosis of something that's going on behind it all.

victor8600

https://www.boards.ie/discussion/comment/118320075#Comment_118320075

Whatever the reason, eating only popcorn and crackers is not healthy. It is a problem to be taken seriously. My son is on the spectrum and eats quite a limited variety of foods, by various tricks and by explaining the nutritional value of different foods to him, we have managed to create a habit of eating a few types of vegetables for him. Otherwise he would be eating just pizza and sweets.

I am not saying that your nephew has any psychological condition, but it would make sense for a child psychologist to see him and provide some strategies for dealing with the eating issue. It would need to be a private consultant, in the public system, it is likely he will not see a specialist until several years later.

Wanderer78

yea hes showing classic signs of autism, but it could very well be other issues, professional advice is the best way to go, he may have sensory sensitivity, hence the eating issues, tantrums are also classic signs of asd, but..... asd is also a genetic disorder, so......

awec

This sounds more extreme than just picky eating so I'd probably start with a trip to the GP and see what they think.

ElizaBennett

Thanks everyone for your help. My own son, now 24, is quite possibly on the ASD spectrum but it's something I only started to realise over the years and he hasn't gone for diagnosis. I also suspect that my father, now deceased, was autistic. So there could be a genetic factor here. I really appreciate this help as it can be so hard to know what is or isn't typical behaviour, especially when we as a family have become used to it and maybe accepted it. I do think that daily tantrums at almost 4 (birthday in Jan) isn't the usual to be be expected but I wasn't certain on this. We also feel that his bad moods could be as a result of being hungry and maybe there's a vicious cycle at play here.

Advice much appreciated and I'm going to gently suggest his mum seeks help in the new year.

madeiracake

Definitely look into getting assessment. Waiting lists are long and it will be a factor in getting him into a school. Sounds like ASD but without proper assessment it's hard to know. In the meantime try vitamin gummies at least then you know he is getting some goodness in. I get the iron ones from Holland and Barrett and multivitamin ones too. My lad is anaemic due to his picky eating. And will also get very hangry because he doesn't realise he is hungry. Smell and texture also play a huge roll in eating. My guy won't eat soft foods (except icecream), yoghurt and mashed potatoes/veg are out. He eats mini waffles. he does eat grated mozzarella on its own. It is very stressful for all involved but just suggest trying new foods and don't get het up if he doesn't. Easier said than done I know! It's so hard to help them when they have eating issues.

Wanderer78

https://www.boards.ie/discussion/comment/118321066#Comment_118321066

i was only diagnosed myself later in life, the only one in my family, so i can relate to not knowing whats normal or not, as its very likely most of my family are also on the spectrum.

informing loved ones of the possibility can be very tricky one, some can become very offended and upset by such a suggestion, so pick your moment and think long and hard of the approach.

diet definitely affects mood, i think we all can relate to that, but we all need sufficient amounts of the usual suspects, very difficult for those of us on the spectrum though, with sensory sensitivities, which tend to be far more acute in childhood, as mine were

theres no harm in checking out the work of clinical psychologist tony attwood, for more info on asd, its also probably a good idea to keep in mind, this equally may not be asd at all, only assessments can truly say that.

unfortunately public services are atrocious, particularly for assessments, so if possible, private is the way to go, but its not cheap, excess of a grand is common

awec

https://www.boards.ie/discussion/comment/118321066#Comment_118321066

Tantrums at 3/4 would not be that unusual IMO, at that age they are old enough to know what they want and not getting it can set them off. Hunger and tiredness are probably compounding the issue rather than being the sole cause.

houseyhouse

I definitely wouldn’t be taking him off the follow-on milk until you’ve spoken to a GP/ nutritionist. If that’s his only source of protein and you cut it out, you might make things worse. The fact that he takes the smoothies is good. Are they homemade or shop bought? If they’re homemade you can get a lot of goodness into a smoothie, including protein. Could you add a small amount of a new ingredient and gradually increase the variation?

It strikes me that the kinds of foods he eats are the types of things I ate when dealing with pregnancy nausea. When he says it might make him cough, could he mean retch? Perhaps he is dealing with a stomach issue that you aren’t aware of and it’s causing him to restrict his eating.

He’s not eating well and he’s still only 3 so I wouldn’t worry about the tantrums too much. I know they’re hard to handle in the moment, especially if his mum has a lot in her plate. And yes, persistent tantrums can signal all kinds of issues but they are not uncommon for a child his age. Same with the pull ups at night. Some kids, especially boys, just mature more slowly. My son still had tantrums at that age and was wetting the bed and he’s a very well adjusted and capable 9 year old now. If your nephew is in ECCE, you could ask the teachers about him and they may be able to reassure you that his behaviour is fairly common.

notAMember

I suspect he is getting his daily calories at night in those two bottles...

manonboard

What you described op was alot like me. Turns out i was autistic and i had a massive sensory sensitivity to textures and tastes and smells. Honestly i dislike food immensely to this day. I actually use liquids to get my nutrition and it has helped my life immensely. Since you mentioned the kid takes his milk well, i would certainly keep him ON the substances he is finding easy to intake. Theres alot of odd pressure from people to eat in specific manners, but quite often this goes against what the Childs body finds easy. That can lead to really bad relationships with food.

If anything i would increase the amount of the foods he wants to intake, then as the relationship and stablity with foods increases. Thats when to bring new things to the table that follow the same patterns of the stuff he can intake. Eg: I can use smoothies now easily since im so used to drinking my milk. etc

At the end of the day, whether it is ASD or not. The treatment is going to be along the same lines of improving his relationship with eating, and supporting his existing well functioning eating habits more. Change is completely fine, but change for stuff like this needs to be taken by choice and pleasure. Otherwise there is always a push back that becomes habit then becomes the rule. It get internally reinforced so often that the brain just stops considering alternatives.

So i would suggest bringing him to a nutritionist that specializes in kids with ASD eating issues. They exist but can be hard to find. Providing more of the foods they like to eat, and very very very slowly adding foods that are very similar to existingly liked foods.

The Black Oil

OP, read up on ARFID.

ElizaBennett

Thanks you so much, everyone, for all the great advice and tips. I agree with the point that, whether ASD or not, the approach to helping him is going to be the same: ie plenty of patience and taking it slowly. Also reassuring to hear that it's okay to let him keep drinking the formula, there's no actual harm in that if it's giving him some nutrition and if taking it away isn't going to necessarily make him suddenly want a roast dinner. He mostly only has Innocent smoothies but one idea I had was to use the bottles add homemade versions with extra different veg and maybe peanut butter blended in for the protein. There might be sneaky ways like that to add more to vary his diet. I'll keep an eye re the tantrums but already he's unfortunately got a very bad reputation for being a little monster among the wider extended family, as there's never been a kid like him among my siblings etc. Eg what we used to call 'bold' back in my day:) Loud, demanding, shouty, climbing on things, screaming when he doesn't get his way etc. This is all a daily occurrene and far worse than any typical child we've encountered. I know he's a great little kid underneath all that and he's so happy when playing with lego in particular and getting lots of attention. He's not a lost cause and I know the food thing is either the root of a lot of his behavioural issues, or indeed a symptom of them - either way it's pretty significant in his life and it would be great to get even some tiny improvements happening. Good idea to chat to teacher but I guess I'll have to do that through his mum. She's going through a lot at the moment but I'll find a good time over christmas to touch on this topic with her.

You'be been a great help, much appreciated.

Wanderer78

https://www.boards.ie/discussion/comment/118326856#Comment_118326856

preference to solitary playing is also common with asd, apparently lego is also a common one, he may also have adhd, but again, who knows for sure, im co-morbid with add and dyslexia

houseyhouse

I was also going to say it could be ADHD with the comment about climbing on things in particular. Many kids with ADHD can be calm and focused when doing something they enjoy but wild the rest of the time. But one of my kids is waiting for an ADHD assessment so it’s at the front of my mind at the moment and I’m seeing it everywhere. If his behaviour is causing problems beyond the usual, you could see about getting him referred to CAMHS for assessment. The waiting list can be very long and Covid has made it worse, but there’s no harm having him on the list. The GP can refer him but it would have to be his mother who gets the referral. Our GP said that even the father can’t get the referral without the mum also present, which is bonkers.

bee06

In relation to his night time pull ups, nighttime dryness is developmental not something that can be trained. The body needs to start producing the hormone that stops urine production at night. It would be a concern until he’s closer to 7.

fits

One thing I would look at doing is moving that night bottle later by degrees until he is taking in those calories in the morning. It could be moved by 15 minute increments maybe. Follow on milk at night wouldn’t be great for the teeth.

and yes definitely go to gp. I’d say input of dietician/ OT is needed if possible.

shesty

3.5 year old boy here -jesus he is fussy, and nothing you do or say can persuade him to change his mind on foods if he doesn't want them.Now I do put the foot down, and insist he eats meals but it can be an awful struggle. He does not have sensory issues or similar though, he is just 3 🙄My girls were the same.That little lad, I would remove the night-time bottle I think -I mean the one during the night - for now, and then definitely see about an assessment.Behavioural issues will be made worse by hunger, we have this all the time with just regular stuff.

If mum has a lot on her plate, that may be part of his problem....ie, maybe he doesn't have a diagnosis but is picking up on the mum's issues? But certainly starting with a GP is a starting point