Child is an Extremely Picky Eater

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Forum -> Parenting our children -> Our Challenging Children (gifted, ADHD, sensitive, defiant)

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amother

Tue, Jan 10 2023, 5:28 am

I guess my main question is do I treat it directly or do I leave it alone and hope that with the other therapies, medication, etc. that we are pursuing the feeding concerns will gradually lessen/resolve?

amother

Ebony

Tue, Jan 10 2023, 5:32 am

amother Almond wrote:

Some things you may want to look into in no specific order:

Chronic infections especially strep and Lyme can cause restrictive eating via brain inflammation. Brain inflammation can also be a cause of sensory disturbances. Brain inflammation can also lead to ocd which can contribute to Food restriction.

Food intolerances and gut dysbiosis can lead to a child restricting themselves to foods that give them a "fix", ironically and incidentally those tend to be the foods they are intolerant of, usually gluten and dairy. Food intolerances can also be a cause of sensory disturbances.

Low digestive enzymes and low stomach acid can cause foods to seem bleh and nauseating.

Low mineral status can cause low stomach acid, nausea, lack of appetite.

Autonomic dysfunction and thiamine deficiency can cause appetite regulation issues.

Structural mouth issues such as tongue and lip ties, high palate, narrow airway etc can lead to feeding dysfunction.

I'm sure there are more pieces I'm not thinking of right now.

The treatment will obviously depend on your specific causes.

If you don't want to go down a root cause rabbit hole, you may find homeopathy very helpful.

If any of these feel relevant or you want me to say more, please let me know.

For my son, I know it’s a combination of oral sensory and trauma related to food. Any ideas how I can address those?

amother

Amethyst

Tue, Jan 10 2023, 5:50 am

you write that he eats carbs like pretzel cookies, etc.
for my son , who is an adult already, I realized he needed things to be crunchy, a crispy chicken cutlet, peppers.
he is still a picky eater, but he loves meat now. (along with junk food), so yay!

amother

Eggshell

Tue, Jan 10 2023, 5:59 am

amother Amethyst wrote:

you wrong that he eats carbs like pretzel cookies, etc.
for my son , who is an adult already, I realized he needed things to be crunchy, a crispy chicken cutlet, peppers.
he is still a picky eater, but he loves meat now. (along with junk food), so yay!

Omg- this is my teenage son. Only crispy things… a bagel has to be toasted until it looks (to me) like it’s burnt and barely edible. Chicken cutlets- very well done. Pizza so well done that you can hardly tell it’s made with cheese. He likes eating chips because they’re crunchy.. and croutons but never in the soup because then they get soggy. As a parent, you can go crazy from this type of behavior. I find some comfort in this thread knowing that I’m not the only one dealing with this.

amother

Almond

Tue, Jan 10 2023, 7:52 am

amother OP wrote:

There is a history of PANDAS so I believe that brain inflammation is tying into his whole profile but I still have no great way of dealing with it. We did the antibiotic route a while ago and I'm hesitant to do it again unless the behaviors (for him OCD-like behaviors, tics, etc.) are really impacting his daily functioning. How else did you deal with the brain inflammation?

How did you/would you test for digestive enzymes, mineral status, etc.? Also, because he is so picky, getting him to take vitamins, etc. is not easy so it would have to be 1 or max 2 a day.

No oral structure issues BH.

Thank you so much for your help!

So first of all, disclaimer, I’ve been getting criticism on this forum for pushing the pandas/brain inflammation/root causes agenda. I have no agenda, I share what I feel is hard to come by information, things I wish someone would have told me back when we were where you are. Feel free to take it or leave it, and tell me to stop if you feel I’m being rude or obnoxious.

Having said that, a history of pandas is VERY significant here, and personally I don’t feel you will make much headway on the root cause approach without treating this aggressively and head on. There may be other significant pieces, but the first order of the day is to tame the inflammation. It doesn’t have to be antibiotics, there are many other ways to go about this, and believe me I totally get not wanting to do long term abx, but antibiotics are cheap and relatively easy to administer and work quickly, so sometimes it’s a good choice.

Other than antibiotics, you could try for ivig if you feel more comfortable with that. There are lots of good natural Protocols as well, but they will be much harder to follow and administer.

Again, homeopathy might be a good choice, resilience naturopathic in California specializes in pandas. It is not a cheap route. Some people respond quickly and dramatically, some more slowly and subtly, and some are non responders, but the upside is that it’s extremely easy to administer and you don’t have to chase causes, nutrient levels, minerals, gut health etc.

In terms of gut testing and nutrient levels, we personally saw an integrative md who ran functional testing for us, but it’s not necessary. All kids with pandas have gut issues and mineral deficiencies. I can tell you which supplements makes most sense to start with, but it will be hard to choose just 1 or 2. Maybe you could start with patches and footsoaks to get him to a better place?

Last but not least, the structural issues. I know you said there are none, but honestly unless you’ve seen an airway informed orthodontist, myofunctional therapist, other airway specialist or informed tethered oral tissue provider, you haven’t really ruled this out. A lot of pandas kids have at the very least enlarged tonsils, which is in itself a structural issue and also indicative of other oral structural issues. We are just now addressing a tongue tie in my 10yo with pandas. I never suspected one because she didn’t have latching issues as a baby, but it’s still there and I believe it contributed to her pandas and eating restrictions In several different ways.

amother

Almond

Tue, Jan 10 2023, 7:54 am

amother Ebony wrote:

For my son, I know it’s a combination of oral sensory and trauma related to food. Any ideas how I can address those?

I would need more information. I don’t usually consider sensory issues an actual root cause. It’s usually a symptom of other things, but also very often people think it’s sensory when it’s really other things. Trauma around food can happen, but I will say that one of my children I was sure had food trauma, ended up being dependent on a feeding tube, complex medical history including intubation and months of vomiting, but what got them eating wasn’t addressing the trauma, it was addressing the appetite piece.

amother

Eggshell

Tue, Jan 10 2023, 8:01 am

amother

Mint

Tue, Jan 10 2023, 9:48 am

Although smell and taste can be major offenders for sensory kids, my 9 year old finally verbalized another major issue for her which I have long suspected - that it is the texture that makes a huge difference too. She just can't handle certain textures even if she likes the smell and taste. Meat and chicken are the hardest for her due to texture, but there are others. Carbs are generally easy. Fruit is easier, vegetables are harder. Some kids hate textures and some kids actually crave them, it is individual depending on the sensory issue (over sensitive or under sensitive)

Also, she really avoids eating foods that require effort (e.g., more chewing, or other stuff I can't quite pinpoint) we just found out that she doesn't open and close her jaw completely evenly, though I could never tell. Apparently a specialist on the genetic condition that dd has told us she moves it ever so slightly to the side, completely not noticeable on the outside, but this could actually make chewing harder work for her and she avoids anything that is difficult physically no matter how small. I also noticed she chews using one side of her mouth much more than the other, which could be related. So although there is no structural issue, and all the doctors, dentists, and other who have seen her missed this very tiny movement issue, it seems to have a bigger effect than it appears.

Also, she does have slightly low muscle tone, and so avoids things that require physical effort and so also avoids food that requires more effort to eat (I have yet to fully understand what foods require more effort, but it seems to be the case). Many carbs and soft dairy kind of melt in your mouth with less effort. Many vegetables have a bit of fiber which can be more difficult even if it seems like it is the same texture as fruit, apparently it isn't.

Interestingly, foods with a lot of liquid can also be something she avoids, she told me last year it is because she says it feels like the liquid drips back out of her mouth - although there is no visible drooling or other sign of this at all from the outside, but apparently even a drop coming out of her mouth or making it wet is apparently such a sensory issue on her face that she can't handle the food, but I never would have thought of this or noticed it. We tried different size spoons to help, it has improved a little.

I have to cut all chicken and meat into teeny tiny pieces for her in order for her to eat them. And against the grain. When my husband cuts it for her, it looks similar to me, but apparently the way he cuts it has a different texture and she can't handle it. Or sometimes when something is cooled or if it is reheated the texture changes very slightly and she can't handle it (for example, fresh pasta apparently has a slightly different texture than pasta which has cooled or has been heated the next day (even if I can't notice it; or warm hard boiled eggs have a different texture then cold ones, even if I haven't been able to tell the difference). So sometimes even slight variations in food prep can affect the texture or how easy/hard it is to eat.

Moisture levels can also affect things greatly, so even slight variations in how things were cooked can make a difference. Or how noodles feel in soup is bad to her, but noodles plain are ok.

Also, she seems to have trouble with bites of food that involve multiple textures or have different levels of chewiness, even if they seem very minor to me - like if there is any fat on her chicken piece, she cannot handle the combination.

Sometimes, adding a desired texture helps. She doesn't like soup (even shabbos chicken soup). But if we add barley or wheat or rice to any soup, she is much more likely to eat some of it since she likes the texture of that so much, that she will eat those out of the soup but inevitably some of the rest of the soup comes with it and she tolerates it.

I don't know if any of this will be helpful to you, but maybe it will give you ideas of what to look out for. I have tried to keep a record of characteristics of what she will eat and what bothers her, aside from smell, taste, or ingredients. Maybe try and keep track of textures, chewiness, moisture levels, temperature, size of pieces, variation within the food, and other factors. Sometimes these patterns can be helpful in coming up with new food ideas that the child may eventually eat because they satisfy whatever sensory criteria better than others, or are less offensive to their sensory criteria.

amother

Banana

Tue, Jan 10 2023, 9:59 am

I have ARFID, and this thread is making me really sad. It's so hard to be hungry, but not be able to eat anything that you have.
You should definitely take him to get bloodwork, and see what vitamins he is missing with his diet. That should be your first priority, whether giving him vitamins or incorporating those foods into his diet.

amother

Eggshell

Tue, Jan 10 2023, 11:00 am

amother Banana wrote:

Do you mind sharing what your diet as an adult looks like and if it changed since you were a child?

amother

Whitesmoke

Tue, Jan 10 2023, 11:05 am

mha3484 wrote:

I was a horrible eater as a kid. I was always tiny and at one point my mother used have the teachers watch me eat. I did not eat tomato sauce until 10th grade. I had a very small list of what I would eat. For me it was very related to a lot of challenges I had as a kid that slowly got better in HS and then as an adult much better. Now I will eat almost anything and am a big foodie. I think I was grasping for control over situations that were out of my control (ADHD. learning issues, social issues).

Wow I could have written this post myself…I had to take nutritional supplemented beverages up until I hit high school age.
It’s interesting that you mention the learning issues and social issues. It never occurred to me but I also had that.
Either way I’m also a huge foodie now and will eat most things.

#BestBubby

Tue, Jan 10 2023, 11:15 am

amother OP wrote:

He is EXTREMELY sensitive to smell! He has been receiving OT services for years. Overall there has been a lot of progress in his sensory integration functioning, ability to sit and attend, etc. but there is not much they can do about the smell sensitivity...

He currently eats mostly carbs (pretzels, crackers, chips, cookies/cake). Even within the carbs group he is limited to specific brands, etc. He will sometimes eat nuts or seeds. Fruit and peanut butter are sometimes options but not consistently. He will not eat meat or chicken. The only dairy he ever eats is yogurt but he is super specific about the brand, flavor, etc.

Foods to try: instant oatmeal, cook it 10 minutes, stirring, so it is very smooth.

There are nut butters besides peanut butter.

Try a blended potato soup. Potatoes, water,
salt, pepper

amother

Banana

Tue, Jan 10 2023, 11:21 am

amother Eggshell wrote:

Do you mind sharing what your diet as an adult looks like and if it changed since you were a child?

I wasn't so picky as a child. It's definitely gotten worse as I've gotten older. It's not that I necessarily don't like certain foods, it's more that I have a lot of anxiety of the food making me sick. So anything that tastes or smells or looks off is scary for me.

amother

Wed, Jan 11 2023, 8:09 am

amother Almond wrote:

Other than antibiotics, you could try for ivig if you feel more comfortable with that. There are lots of good natural Protocols as well, but they will be much harder to follow and administer.

Again, homeopathy might be a good choice, resilience naturopathic in California specializes in pandas. It is not a cheap route. Some people respond quickly and dramatically, some more slowly and subtly, and some are non responders, but the upside is that it’s extremely easy to administer and you don’t have to chase causes, nutrient levels, minerals, gut health etc.

In terms of gut testing and nutrient levels, we personally saw an integrative md who ran functional testing for us, but it’s not necessary. All kids with pandas have gut issues and mineral deficiencies. I can tell you which supplements makes most sense to start with, but it will be hard to choose just 1 or 2. Maybe you could start with patches and footsoaks to get him to a better place?

Last but not least, the structural issues. I know you said there are none, but honestly unless you’ve seen an airway informed orthodontist, myofunctional therapist, other airway specialist or informed tethered oral tissue provider, you haven’t really ruled this out. A lot of pandas kids have at the very least enlarged tonsils, which is in itself a structural issue and also indicative of other oral structural issues. We are just now addressing a tongue tie in my 10yo with pandas. I never suspected one because she didn’t have latching issues as a baby, but it’s still there and I believe it contributed to her pandas and eating restrictions In several different ways.

I am not comfortable with IVIG because I am concerned about possible side effects and the fact that it is a blood product. It's not something I would pursue now but if symptoms worsened I would look into it again.

Is homeopathy a good choice for a child that won't take vitamins without a lot of encouragement/incentives?

I would love some ideas for improving gut health and increasing nutrient levels. Thanks

In terms of the structural issues, he did have his tonsils removed but the ENT did not feel that there were additional structural issues. I would still look into this. Any recommendations for an airway informed orthodontist, myofunctional therapist, etc. in NJ?

amother

Wed, Jan 11 2023, 11:25 am

#BestBubby wrote:

Foods to try: instant oatmeal, cook it 10 minutes, stirring, so it is very smooth.

There are nut butters besides peanut butter.

Try a blended potato soup. Potatoes, water,
salt, pepper

Thank you those suggestions but most of them will cause a huge meltdown. Oatmeal smells, potato soup smells, etc.

He doesn't specifically like soft, smooth textures. He actually prefers crunchy/spicy food. He eats foods of varying textures but generally not mixed together. It's not a texture-specific issue but it's very difficult to expand his repertoire.

amother

Beige

Wed, Jan 11 2023, 11:47 am

amother Banana wrote:

Are you in therapy?

amother

Raspberry

Wed, Jan 11 2023, 11:53 am

Quote:

He doesn't specifically like soft, smooth textures. He actually prefers crunchy/spicy food. He eats foods of varying textures but generally not mixed together. It's not a texture-specific issue but it's very difficult to expand his repertoire.

I really get this.

amother

Almond

Wed, Jan 11 2023, 11:57 am

amother OP wrote:

I totally hear you about ivig. I feel the same.

We have used some excellent herbal protocols that work almost as well as antibiotics minus the strain on the gut but they are involved and need kids to be OK swallowing lots of capsules and or yucky tasting herbs.

Homeopathy is an excellent choice for kids who have a hard time taking stuff. It's literally a pellet of sugar under the tongue or some water that has no taste. My kids beg for it lol.

In terms of gut health and nutrient levels, again that will require lots of swallowing. Also diet restriction that doesn't seam to be an option at this point. Though if you are able to remove gluten and dairy to any degree it might help. Without having to swallow stuff, you can do magnesium footsoaks, vitamin patches, castor oil liver packs. Maybe bone broth? Can try to look for decent tasting things as well, like chewable or flavored liquids. Or maybe hide stuff in fruit smoothies or ice cream?

Airway stuff in NJ: Dr Barry Raphael is an orthodontist who is tops in this area but very pricey. There is also dr campi in wall who is airway informed. Shira Kirsch is an slp who is trained in OMT and super informed. She's located in Howell.

amother

Banana

Wed, Jan 11 2023, 3:44 pm

amother Beige wrote:

Are you in therapy?

✔️

amother

Tue, Jan 17 2023, 10:40 am

amother Whitesmoke wrote:

Just curious if you became less picky on your own or if you went to therapy specifically to target the feeding?

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