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The Child Who Eats Too Little

The Child Who Eats Too Little

By Amalah

Hi there,

So last I wrote to you my now almost 4 year old was happily barfing all over anything and everything. He stopped, as you predicted, around the 6 month mark, right around the time we introduced solids, which he quickly showed ZERO to absolutely no interest in at all. None, never, ever.

He was breastfed until he was over 1 years old (not exclusively, I tried introducing food but he frankly still asks for it) but he’s never um…taken to it? Ever? I’ve seen him turn down birthday cake and ice cream?

At 1 year old he fell off the chart (off, like, not on it) and yet was passing all of the mental tests and every other blood test we threw at him so our pediatrician has never wanted to do more invasive testing. Long story short, he’s tiny. He has some physical issues (not delayed, he’s literally just too small to do them) and it is starting to take a toll psychologically because he can see he can’t do the things others can’t.

He’s not terribly picky, in terms of preference. He actually has a pretty broad range, but it’s just the quantity that is really missing. If I let him, he would wander away after 3 pieces of penne and he would swear he was not hungry until the next day when he would eat a half of a bite of toast and leave it. Literally the only thing he asks to eat is bacon. I am not joking, and I would feed him bacon every day if I didn’t worry about salt levels (so it’s every other day).

In the past few months we’ve had achievement charts for finishing dinner (I shovel the food into his mouth) and that’s at least making me feel better about quantity, but I feel like it hasn’t actually solved the underlying problem.

I’ve had enough of the ‘wait it out strategy’ physically and we’re on the waiting list to see some physical therapists for him. I have scoured the internet for some tips/hints/strategies on getting him to eat. There is very, very little out there for little kids who don’t eat, it’s all about kids that eat too much (FYI I did contact the Satter Institute and they agreed that I have followed the method and it’s not working, but they don’t have a whole lot more for me, so that’s disheartening). Do you have any strategies, or places I could go for strategies? At one point I asked about a feeding therapist but no one will touch a kid that young who won’t eat with no underlying physical issues, they’re all about kids who eat too much.

I’ll take anything!

Thanks,
A formerly barf covered mom

Get a new pediatrician.

Seriously, I’m kind of shocked (and possibly even a little appalled) that your doctor hasn’t pushed for more testing, or at the very least, didn’t point you in the right direction for intervention ages ago. And I don’t know who gave you that COMPLETELY FALSE information that no feeding therapist will “touch a kid that young who won’t eat, they’re all about kids who eat too much,” but you should fire them too.

It’s one thing to have a tiny kid who doesn’t eat that much — a typical toddler does actually do a pretty good job maintaining their own caloric intake — but those tiny kids still generally track to their own consistent growth chart and stay in their percentile, more or less. A child who suddenly, abruptly falls off the growth chart and has absolutely zero appetite/ability to take in enough calories without being force-fed doesn’t fit that mold. His lack of food intake may be stunting his growth and impacting his development both physically and socially. Sounds like he’d benefit from feeding intervention, or at least more evaluation before settling on “just tiny.”

Which brings me back to the B.S. about feeding therapists. Yes, some of them choose to specialize in overeaters, but there are just as many that focus on what you’re describing: feeding difficulties and disorders in the early intervention years. Near where I live, there’s an entire pediatric feeding disorders clinic for this exact problem. I recommend you visit that site and see if any of it sounds familiar:

“A child with a severe feeding disorder does not consume enough food (or liquid or a broad enough variety of food) to gain weight and grow normally. General feeding difficulties are relatively common among most children. For example, a child may be a picky eater and consume a limited number of foods, but the foods eaten span all the food groups and provide a well-balanced diet. A child with a severe feeding disorder, on the other hand, may only eat a few foods, completely avoiding entire food groups, textures or liquids necessary for proper development. As a result, children diagnosed with feeding disorders are at greater risk for compromised physical and cognitive development. Children with feeding disorders may also develop slower, experience behavioral problems and even fail to thrive. Severe feeding disorders can cause children to feel socially isolated and often put financial strains on families. As many as 50 percent of children experience some degree of feeding difficulties, and 3 to 10 percent develop severe feeding disorders.”

Does your son qualify? I honestly have no idea, because obviously this is outside my realm of expertise. I will say that my oldest son’s oral motor delays earned us specialized occupational therapy through Early Intervention and an evaluation at the Kennedy Krieger Institute was at one point on our table of possibilities. Personally I don’t think he was ever delayed enough to qualify for that program, but just wanted to point out that some form of intervention was STILL recommended for a kid with mild texture/swallowing issues that made proper nutrition difficult but did not impact his growth. If he suddenly tumbled down the growth chart, you bet we would’ve escalated up to more specialized treatment.

If you’re somewhere else in the country, I would recommend checking out your closest children’s hospital to see if they have a similar program, or have anyone on staff who specializes in this sort of thing. Google “pediatric feeding disorders” and your location and see if there’s a stand-alone center or local therapist/specialist. Unfortunately at almost-four he is too old for Early Intervention (which gaaaahhhhh whhhhyyy didn’t your doctor refer you to EI right away), and your school district’s special needs preschools might not be fully equipped to handle this particular issue. (He might qualify for help if/after you get an official feeding disorder diagnosis, however, that can support his treatment plan and help him not feel so left behind and isolated from his peers.)

Again, I am NOT diagnosing your son with anything over the Internet. I just feel like something might be getting overlooked here and he needs to be seen and evaluated by proper specialists. (And I don’t think a physical therapist is the right choice initially; they can certainly help him with some of the physical side effects, but aren’t going to be able to really identify or solve the underlying problem.) Those specialists are also the people who can really HELP you with a strategy to safely and productively increase his calorie intake, even if they decide it’s not a “disorder,” per se.  If it really does come down to, “he’s fine, he’s just tiny and doesn’t need to eat all that much, ” GREAT. AWESOME. SORRY TO ALARM YOU, NEVER MIND. But I’m not convinced he’s been evaluated thoroughly enough (and by the proper people who actually live and breathe this sort of thing) to be fully comfortable with that assessment just yet.

Photo source: Depositphotos/Klanneke

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Amalah
About the Author

Amy Corbett Storch

Amalah

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Ama...

Amalah is a pseudonym of Amy Corbett Storch. She is the author of the Advice Smackdown and Bounce Back. You can follow Amy’s daily mothering adventures at Amalah. Also, it’s pronounced AIM-ah-lah.

If there is a question you would like answered on the Advice Smackdown, please submit it to amyadvice@gmail.com.

Amy also documented her second pregnancy (with Ezra) in our wildly popular Weekly Pregnancy Calendar, Zero to Forty.

Amy is mother to rising first-grader Noah, preschooler Ezra, and toddler Ike.

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Comments

  • Myriam

    (Re-reading myself, I sound a little condescending, but please don’t take it this way. it’s really not! The “tone” I’d like doesn’t translate very well in written form)

    1) I’ll say it even though you’re probably doing it, just in case… Are you boosting his food? Not for nutrition, but calories? Like giving him chocolate milk instead of white milk? Putting sugar in his oatmeal? Olive oil on his veggies, or dips for raw veggies? Serving guacamole with pita chips for snacks?
    2) Also, as the Satter people might have told you, force-feeding your child might be creating an avoidance feedback loop. The more you force, the more he “resists” (consciously or not).
    3) I often heard of 9-12 month-old taking a dip on the growth chart, related to returning to their “natural/genetic” curve, rather than the “baby-fat” one… my related question is “is your child’s growth at a steady, albeit slow rate for the last 3 years”?
    4) Is he enrolled in some kind of motor activity (gymnastics/martial arts/circus) where he will learn to use and control his body? Even if he is small, he can learn to develop his strength and agility to do anything he wants to do (his peers are doing). That might even have the bonus side effect of bumping up his appetite!
    5) I agree with Amy that you need to seek a second opinion for your child. You might need to mentally prepare to consider, if that second round of investigation comes up with nothing, that your child might simply be small, but healthy. Good luck!

    • Alpha Mom (TM)

      Thanks, Myriam. I appreciate your feedback and look forward to it.

  • Jen

    Pediatrician here. I second everything Amy said about getting your son evaluated, and also agree with Myriam below. Some other ideas to increase caloric intake while waiting for evaluation are a Pedisure shake every morning (you can add a packet of Carnation Instant Breakfast to it for additional nutrition), adding avocado and butter to everything, making sure all dairy is full-fat, giving him smoothies with yogurt and/or avocado. These are not long-term strategies (though some of them may be recommended for a good long while) but may help in the short term.

  • Tiffany

    My son had weight issues around this age, too, although they weren’t specifically eating related (had no spare weight to begin with, then a bad case of pneumonia dropped him off the charts completely), so that may affect what’ll work for you. But I remember our Doctor saying to just cram in the calories however we could. Every piece of bread or toast gets butter, lots of butter. Oatmeal, baked goods, smoothies, etc…. gets made with whole milk, no water, maybe even some cream initially just to give him a boost. Push the dried fruit as it has less volume per calorie, and with fresh fruit & veg, pick things that are higher in calories and lower in water content. Use a heavy hand with the parm cheese on spaghetti. We basically googled “easy ways to cut calories”…. And did the opposite of whatever it said.
    Best of luck, hope you see some improvements soon!

  • M

    My understanding is that speech therapists, not physical therapists, handle feeding issues. You might want to look for a speech therapy clinic in your area, and see if they have someone who specialized in feeding, or can refer you to someone who does.

  • I would see if you can find a myofunctional therapist in your area for assessment. it really is a good option for eating issues as it focuses entirely on the mouth and tongue and assesses bite function, tongue function, jaw placement/tension, etc. They can also assess for tongue tie, and they address the underlying causes of crooked teeth and can assist in prevention of the need for orthodontics at an older age. I came across their work when dealing with a tongue tied infant and a mouth breathing preschooler!

  • Moi

    You might get his growth hormone levels checked as well. My niece was very very small, and the doctor told my brother she would be a little person. She also never ate, though, so they checked her growth hormone levels, which were way below normal. Two years on growth hormones and she is normally sized and eats wonderfully. She has actually stopped taking the medicine now and you would never guess she had once been so tiny.

  • MR

    Everyone else has already said everything. But, in the meantime while you look into all of their suggestions, let him eat bacon every day. If that’s all he will eat, don’t worry about the salt. Most other countries who are way healthier overall don’t ever worry about salt content, and he needs the calories at this point. Good luck, Momma. I have a little one who is VERY low on the chart (she was almost off it completely too), but she eats. She just has a health issue and really likes the healthy, low calorie stuff (veggies and fruit). I have to work to make sure she gets enough calories. Does your son like pudding? Pudding is ridiculously high in calories if you can find the full fat kind. Swiss Miss makes a triple chocolate flavor, and I try to get her to eat one of those every day. 240 calories in one container. But, finding the full fat stuff is kind of hard these days, since everything is low fat. When my daughter was younger, and didn’t want to eat much, she got French fries and chips and cookies (strawberry newtons have a lot of calories) all sorts of stuff I would never have given a child regularly, but the calories were the most important at that point. So, I’d suggest ignoring all worries about cholesterol and salt for now, and just focus on calories until you can get him in with someone new to help you figure out what is going on. ((hugs)) Good luck.

  • MR

    Also, we had a dietician recommend liquid heavy whipping cream when my daughter was still a baby. We used to give her milk with liquid heavy whipping cream in it. Like an ounce of cream and 1-2 of milk. Liquid heavy whipping cream tastes disgusting, so I’d recommend using it in smoothies or something else with flavors that will help cover that taste. But it is by far the highest amount of calories for the least amount of bulk.

    Also, check out this site if you haven’t yet. I found it really useful when trying to get my daughter back on weight. http://www.feeding-underweight-children.com/

    • Liz

      thank you for this website! It is going to help my tiny toddler so much!

  • Amy

    I had a friend whose son was like this and it turned out he had a gluten allergy. He ate little and was way down on the growth chart. You should definitely seek more testing.

  • Liz

    We are dealing with a similar issue with my almost-2-year-old. it’s really scary, so I am sending you a virtual hug. After 6 months of failing to gain weight, the pediatrician sent us to a gi specialist. he did some blood work, and prescribed Pepcid, just in case it was acid reflux. He was not showing any signs except for not eating much. Well, we are only on day two, but so far signs point to that it is acid reflux. He is sleeping better and eating better than he has in months. (He had acid reflux as a baby, but we thought he grew out of it around his first birthday in February. But his weight has been steady since May, so I guess we were wrong. Poor kid has been suffering all this time. But at least now we know. And we are going to try the GERD diet that we found on the website MR linked below. Here’s hoping we all end up with much bigger, happier kids soon!

  • Ann

    OP, that sounds nerve racking, and I hope you get to the bottom of this.

    I don’t know what blood tests you have done, but just want to mention an experience I had on the off chance that it helps. When I was nursing my oldest kid, I tried a fenugreek supplement and had a very unusual reaction. I completely lost my appetite. Even my favorite food looked as appetizing as cardboard. I knew I had to eat to support myself and the baby, I tried to shovel food into my mouth, but it’s surprisingly difficult to eat enough when you don’t feel hunger at all. No idea what would have happened if someone hadn’t suggested to me that it might be the supplement. Later, after much Googling, I found a couple of mentions of fenugreek messing with blood sugar. Your son’s attitude toward food sounds painfully familiar, so maybe checking out his blood sugar levels (and thyroid and other hormones) is worthwhile if you haven’t done it yet.

    That said, I was also totally not interested in eating as a child, to the point of being labeled failure to thrive, and my family spent a lot of time telling me long stories at dinner and shoveling food at me. It was no big deal in the end. I’m not too tall, but not too short either, and other than that incident with the fenugreek, have had a very good appetite since my teens.