Child is an Extremely Picky Eater

amother

Mon, Jan 09 2023, 2:04 pm

My 8 year-old son has been diagnosed with ARFID (avoidant/restrictive food intake disorder) secondary to a severe sensory processing disorder. We've tried a couple of different feeding therapy approaches/feeding therapists over the past few years but did not see much improvement (we tried each approach for at least a year).

If your child is/was an extremely picky eater did you address the feeding directly? If so, what approach did you use? Did you see improvement over time?

mha3484

Mon, Jan 09 2023, 2:12 pm

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).

#BestBubby

Mon, Jan 09 2023, 2:20 pm

The ABA Method is to do things in tiny increments.

Introduce a new food that you think he might accept, similar to a food he already eats.

1. Put small piece on child's plate. He doesn't have to eat it.

2. Give reward if child will hold food and play with it.

3. Give reward if child will kiss food with lips.

4. Give reward if child will lick food.

5. Give reward if child will put a bite of food in mouth for 5 seconds then spit it out.

6. Give reward if child will eat one bite of food

No pressure.

Just ask child if he wants to try and he will get a reward.

If child resists,

Just keep putting a bit of new food on his plate and don't say anything or comment. Don't offer reward.

amother

Mon, Jan 09 2023, 2:36 pm

mha3484 wrote:

It's great to know that he might grow out of it. I've been taking the "wait and see" approach overall. I try not to stress about it and I don't push him at all to eat/taste non-preferred foods. My main concern is that he often gets "hangry" and then his behavior is extremely difficult to manage.

amother

Raspberry

Mon, Jan 09 2023, 2:37 pm

Hi

Thanks for starting this!

My son is 8 and has Asd and severe sensory difficulties esp with foods and smells.

He is very very picky and its a constant battle.

We have been to a nutritionist but havent been helped so much.

It a lot depends on the preparation and the mood with my son.

An idea she had was to do smoothies.
So far all we have is the smoothie maker.

amother

Mon, Jan 09 2023, 2:40 pm

#BestBubby wrote:

I'm a proponent of ABA in general but I just can't see this approach working for him. As an example, he won't even eat dinner at the same table as people who are eating non-preferred foods.

amother

Raspberry

Mon, Jan 09 2023, 2:44 pm

amother OP wrote:

I'm a proponent of ABA in general but I just can't see this approach working for him. As an example, he won't even eat dinner at the same table as people who are eating non-preferred foods.

I get you.

My child will either not come to the table or he will 'block' himself with tissue boxes or cereal boxed so he cannot see/smell the food.

Shabbos is very sad.
He has minimal food.
My husband sits at the top and my son sits at the other end.

His diet is really not very healthy.
Hes skinny.

Anyone who says hes nice and slim, I see red.
Our family is not nice and slim by default and I wish he was bigger!

amother

Fern

Mon, Jan 09 2023, 2:59 pm

ARFID is really tough and there are no easy solutions. My brother had it, he's still pretty picky as an adult though he has expanded his pallette enough by now that he can attend a business lunch and eat enough of what's available that he doesn't look childish. Just make sure any professionals you work with are well versed in ARFID. The usual tips and tricks don't work for this issue.

#BestBubby

Mon, Jan 09 2023, 3:02 pm

amother OP wrote:

I'm a proponent of ABA in general but I just can't see this approach working for him. As an example, he won't even eat dinner at the same table as people who are eating non-preferred foods.

Probably because of strong smells.

Are you working with OT to De-Sensitize DS?

You can still do aba method without other people around.

What foods is DS willing to eat?

amother

Almond

Mon, Jan 09 2023, 3:13 pm

amother OP wrote:

That sounds like just what we need! Can you tell me more?

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.

amother

Eggshell

Mon, Jan 09 2023, 3:35 pm

2 of my kids are very picky eaters but they are already teens. Unfortunately it got progressively worse over time. When they were little I would feed them almost anything.
My son struggles emotionally. He’s not as bad as my daughter who struggles academically. My son will eat a piece of schnitzel or meat but it the texture and flavor is not exactly what he was expecting he would rather starve. He won’t touch pasta or rice…I sent him to a dorm and I know many times he skips meals including shabbos.
My daughter was always a little picky but over the years she became very bad. No fish, chicken, meat or eggs. She will eat pasta or pizza and not much else. She is lactose intolerant so I try to keep her away from dairy but she does like dairy products. A few years ago she would get excited about a bbq and hot dogs… now a bbq just means no food for her.
I feel like if I make a big deal, things could get even worse so I just let it go.
It’s not really normal that when we come home from a wedding and my kids are starving because they didn’t touch anything there.
I’m really hoping that as they mature they will slowly incorporate different foods into their diets. It’s possible that they might need therapy to get over the hurdles.

amother

Tue, Jan 10 2023, 8:21 am

amother Almond 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!

amother

Ebony

Tue, Jan 10 2023, 8:25 am

amother OP wrote:

My son has ARFID also. He was diagnosed at 8, and started seeing an eating specialist (not a feeding therapist, but a doctor in the adolescent eating disorder department in a local children’s hospital.) He’s almost 11 now, and I’ve seen slight improvement. Occasionally he will try something new. Although he usually doesn’t like it, even being willing to occasionally try is an improvement. What really gets to me is when he discards a safe food. I have to speak with his doctor about that. She does virtual visits, so if you want her info I can give it to you. Just let Yael know.

amother

Tue, Jan 10 2023, 8:26 am

#BestBubby wrote:

Probably because of strong smells.

Are you working with OT to De-Sensitize DS?

You can still do aba method without other people around.

What foods is DS willing to eat?

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.