Please eat, son!
September 11, 2012 11:00 AM   Subscribe

Thoughts on how to get my three year old to eat.

My three year old has Pervasive Development Disorder Not Otherwise Specified complete with a severe language delay, a couple of fine motor skill delays, sensory issues, and social skills issues.

He can communicate -- has a good number of words and signs, and he is receiving appropriate private and public services (just started preschool!). But, for example, he lacks a lot of expressive language, so he often repeats words we say for something he wants.

For example, if we ask him, "Would you like yogurt?" if he says nothing, then he does not want yogurt. If he says, "Yogurt," then he wants yogurt. So for dinner, we often run down his list of approved dinner foods until we land on something he wants. We go to the effort to make it. And then he won't eat it.

He can't tell us WHY he won't eat it (in the sense that, literally, he can't talk, not just in the sense that he doesn't have the right words). So last night, after settling on spaghetti, he refused to eat it. So my husband made my son sit at the table for some time, which caused a meltdown and my son still didn't eat his spaghetti.

And then this morning, I made him toast (he did not ask for it, I've just been making him breakfast foods I know he eats because he will refuse any and all foods, so I thought just providing a consistent option is a good idea. I leave it where he can reach it and let him know it is there and remind him of it frequently) coupled with two large strawberries and a small slice of cheese. He came running over to me with the strawberries and then the cheese because he didn't want them, and then he picked slightly at the toast with "red jelly." But he didn't really eat.

So he went without dinner last night and then without breakfast this morning and not for lack of trying on our part. Fortunately, he has snack time at school almost first thing so he does have the option of eating again fairly soon after leaving in the morning.

But, again, yesterday, he did not eat breakfast, his teacher reported he did not eat anything at snack time, and then he ate only none-to-some of his food for lunch (everything packed from home with foods we KNOW he loves) and then didn't eat dinner.

We suspect some of this is part of the new routine of going to preschool and then to his still relatively new after-school care. So we're mindfully watching and waiting some. And we suspect with the breakfast thing that he's just one of those people who doesn't eat until he's been up and about for three or four hours (he does eventually eat) since this is nothing new. But overall, we're still concerned he's not eating enough, especially for a long-structured school day with therapies followed by his after-school daycare (who has also had some struggles getting him to eat) and I do think some of his recent acting out is because he is hungry.

So I'm looking for suggestions on what else to try because I hate the thought of him going hungry for most of the day. On weekends, he eats just fine.

What has worked for you in getting your child to eat? Experiences from people with knowledge of autism-spectrum disorders especially appreciated. Comments on just letting him go hungry because he won't eat what we eat are not so helpful or useful in this situation.
posted by zizzle to Food & Drink (27 answers total) 2 users marked this as a favorite
Are you seeing a speech-language pathologist? They are concerned not only with speaking, but also with feeding disorders.
posted by Ery at 11:14 AM on September 11, 2012 [1 favorite]

Just a data point:

My oldest daughter doesn't have any of these delays but was also a bear at meal times when she was the same age, often going a meal or two or three not eating anything. It caused crazy amounts of stress/anger/pleading/etc...

We eventually had to change more about how we worried about it, rather than getting her to eat.

He energy levels and growth were / are fine and we just had to accept it.

We made sure she wasn't filling up on juice / milk but that was about it.
posted by bottlebrushtree at 11:19 AM on September 11, 2012 [2 favorites]

Best answer: I'm not sure that I have any specific help but I would second the advice to see a speech pathologist. They may also be able to help you with means of facilitated communication such as flashcards. Better communication could go someways to making things less frustrating for everybody.

I only mention this because you didn't do so specifically - I don't imagine that the words here could express the depths of difficulty and the lengths you've gone to ameliorate them. Best wishes.
posted by mce at 11:32 AM on September 11, 2012 [1 favorite]

I'll chime in to say that my three year old is a nightmare to feed too. I think it's just the age.

For the communication issue have you tried making flash cards of foods? Maybe the SLP will nix the idea, but it might help keep you guys from exploding in a shower of frustration.
posted by PorcineWithMe at 11:33 AM on September 11, 2012

I'm not familiar with concerns specific to children with special needs, but I am the mom of the Pickiest Eater Alive (TM). Assuming your doctor has ruled out any medical reasons for eating difficulties, I'm gonna recommend the ONLY thing that made my life with The Pickiest Eater Alive (TM) bearable: giving up.

We spent five years begging and whining and pleading and wheedling and bribing and yelling and disciplining and coaxing and crying. NOTHING. WORKED. We were ALL miserable. Finally, we decided, "You know, an otherwise-healthy kid is probably not gonna let themself starve to death... and also, what's more important? Winning a battle with someone who still eats their own boogers OR being happy together?"

We eliminated all snacks and all caloric drinks (juice, milk, etc). We made sure that lots of well-liked, nutritious foods were offered throughout the day (yogurt, peanut butter, etc). We gave effusive praise for trying new stuff, but we did NOT force the issue. And we were so, so, SO much happier than before.
posted by julthumbscrew at 11:36 AM on September 11, 2012 [9 favorites]

I had a terribly picky eater who also would eat only a bite or two at time. He just didn't like the sensation of being full so would stop after just a bit. One thing that worked for us was allowing protein shakes (like Boost) on days when he just didn't feel like eating. That might be something you could try for breakfast if he isn't a morning eater. It's easier to sip on something while getting dressed, etc than to sit down to real food. It sounds like your son eats a variety of foods, so this may not be an issue for him, but my son also had lots of texture issues with foods. If that sounds like something that may be happening with your kiddo, I'm sure the therapist could address that.

At the end of the day though, toddlers are just weird eaters. They seem to survive on air and dust for days at a time. It's really hard as a parent not to fret about that, but it seems to be an almost universal issue and kids seem to thrive in spite of that. I've heard some doctors say not to look at the daily food totals, but think of the cumulative weekly totals as a way to help parents keep from worrying so much.
posted by SweetTeaAndABiscuit at 11:40 AM on September 11, 2012 [2 favorites]

Out-there suggestion: any chance he's got a loose tooth? If a loose tooth is making it even a little uncomfortable to eat, he might not understand why, and probably doesn't have the words to verbalize what's going on.
posted by phunniemee at 11:47 AM on September 11, 2012

First of all, relax, when he gets hungry, he'll eat. You're offering lots of different options, some kids just don't have an appetite for a couple of weeks.

Also, if he's on medication, is it possible that loss of appetite is a side effect?

I'd make every meal a bit of a buffet. Lots of options and don't sweat it if nothing particularly appeals. Don't ask about preferences, just present a lot of choices.

Veggies and ranch for dipping, macaroni and cheese, pbj, chicken nuggets, cottage cheese, yogurt, olives, quesadillas, etc. Whatever you've got. Arrange it tapas style on little plates for more appeal.

What doesn't get eaten, wrap it up and present it again at another meal.

I knew a kid who only ate things he could pick up with fingers. Dumplings, fries, Spaghettios, etc. You just never know.

Try different things, keep options open, and don't stress about what he does and doesn't eat unless he starts losing weight.

Sometimes they wait and wait and then they eat the earth.
posted by Ruthless Bunny at 11:49 AM on September 11, 2012 [2 favorites]

My oldest nephew has autism and his total lack of desire to eat anything has driven my family to fits. I cannot even estimate the number of completely untouched plates of food we have cried over. No amount of sobbing or begging or food variety made him eat with any regularity. And then he started taking medication which had a side effect of appetite loss. His pediatrician told my sister to let him eat whatever he wanted, when he wanted. If he wanted ice cream for breakfast, the doctor told her to go for it. She also cooks with butter and olive oil to increase the calories in whatever he might eat. He has pretty consistently enjoyed "chocolate milk" which is Hershey's syrup mixed with half and half. It's totally disgusting, but it keeps calories in him. She continues to make him small portions of regular meals, and if he eats it, great. If not, he'll probably eat something tomorrow.
posted by crankylex at 11:59 AM on September 11, 2012

My 3 year old is not a picky eater and doesn't have verbal problems and is still like this sometimes. It is definitely the age. And honestly, I think he just isn't hungry sometimes. If your kid isn't losing weight and has decent energy, just offer a variety of food and let it go at that. He'll eat when he's hungry. If he is losing weight, then talk with your doctor, or perhaps supplement with yogurt drinks or ensure for kids, something healthy and somewhat filling?
posted by katers890 at 12:01 PM on September 11, 2012

For most kids "don't worry, they'll eat when they're hungry" is the best advice. For autistic kids, maybe, but maybe not. If your child isn't already seeing an occupational therapist, it's worth looking into. They have training and techniques to work with people who have feeding difficulties.
posted by Daily Alice at 12:16 PM on September 11, 2012 [5 favorites]

My four year old daughter has never been easy to feed and she doesn't have that or any other disorder. It's normal for toddler's to be finicky eaters. If she's hungry enough, she'll eat things she normally hesitates to eat, and not only that but she'll eat big portions. I don't know anything about the disorder you mentioned, but seems like you shouldn't sweat it unless that disorder involves risk of self-starvation (which would seem very unlikely).
posted by Dansaman at 12:16 PM on September 11, 2012

Best answer: A friend with a child who started out as a micropreemie and has had major medical problems (including repeated cardiothoracic surgeries that have made eating very painful) has to go to all sorts of lengths to get her son to eat. Here's her blog post detailing some of her techniques. (Warning, they are totally exhausting and crazy, but they have worked to get calories into her child.)
posted by chickenmagazine at 12:20 PM on September 11, 2012

Best answer: As a parent with a kid with eating issues it's frustrating when people don't understand REAL eating issues. I used to get "Oh, my kid is the same way!". Ugh, my kid hasn't gained a pound in 1 1/2 years. ITS NOT THE SAME!

Make an appointment with a feeding team. I wont tell you it will solve your problems but it's nice to know HOW many more calories he should beeating. For me it hasn't helped. They just tell me he should be eating more and gave me some strategies.
I would also see a Gastroenterologist to try to rule out physical reasons.

When he was younger I used TV. I would pause the show until he took a bite and then play the show a bit more. It worked a tiny bit and when your kid only eats a few bites a day, any little bit helps.

Good luck.
posted by beccaj at 12:32 PM on September 11, 2012 [3 favorites]

I have two ASD sons. Neither is formally diagnosed. The oldest is faceblind, which is generally associated with more severe forms of autism rather than asperger's. He also has a form of cystic fibrosis, which causes serious gut issues. Some kids with CF get tube fed (through a port in their side) and become very avoidant of taking anything orally. Children with CF and children with ASD sometimes wind up in similar therapeutic programs for teaching them to eat. My oldest was very challenging to feed when he was three but later was a lot easier. Here is some of what I did:

I made it a high priority to make it possible for him to choose to eat voluntarily. I did my best to avoid badgering, nagging, power struggles, etc. I let him pick two and only two utter junk food crap at the grocery store (think "chocolate covered sugar bombs" from Calvin and Hobbes). If he found a third he wanted, one of the others had to go back. I generally did not buy junk. I loaded the rest of the cart with healthy stuff. So if he was eating, most if it was mom-approved. I never said anything at all about what I approved or disapproved. I just physically limited his access to crapola.

I placed a much higher priority on getting fluids, nutrition, and calories into him than food per se. So I made sure he had access to fruit juices and the like. You can die from dehydration in as little as two days. It takes a lot longer to starve to death. So I worried more about him drinking and I counted nutrition and calories from drinks as all to the good. I only wants put a limit on that. At one point, he essentially stopped eating and, instead, drank 20 bottles of apple juice a day. He peed his bed and then peed in my bed every night for two weeks. I took his apple juice away. But, other than that one extreme exception, I let him drink if he didn't want to eat. In fact, he routinely had carnation instant breakfast before preschool because, like your child, he just wasn't up for a real meal when he first got up.

When he was three, I routinely made some favorite meal or other for lunch, piled my plate high with it, and picked at it until he came to eat from "my" plate. If I stopped eating, he stopped eating. Years later, I learned he was using me as his royal food taster (the person who tests for poison). Unbeknownst to me, he had eaten soap or something and didn't trust his own judgement. So he was using me as a shield.

Of the limited things he willingly ate, I kept bunches available: cold noodles stored on the bottom shelf of the fridge where he could reach, precut watermelon he could handle himself, parnesan cheese, etc. I tried to respect his unwillingness to eat (once when I forced the issue, he puked all over me which made me more willing to assume maybe he didn't feel well or something) but made every effort to keep food easily available and in a kid-friendly form (precut melons, caprisun juice bags, things on low shelves he could reach) so he could get it himself when he was hungry.

I will add that both my sons get motion sick so were hard to feed during car trips. I mention that to suggest that if your child gets carsick (many ASD kids do), the morning snack at preschool might be poorly timed for his needs.
posted by Michele in California at 12:55 PM on September 11, 2012 [1 favorite]

That should say "I only once put a limit (on the fluids/drinks)". (instead of wants)
posted by Michele in California at 1:03 PM on September 11, 2012

Definitely talk to the OT, it could be the texture in your son's case. Also ask about the Wilbarger Protocol, in particular, the Oral Tactile Technique.

If they determine he doesn't have texture/taste issues, the follow up with the doctor to get a baseline weight. Some kids will go through what seems like forever without eating and then eat a ton when they go through a growth spurt, yes, but you want to make sure it's not part of his disorder first!
posted by Marie Mon Dieu at 1:25 PM on September 11, 2012

When my son -- who has autism -- was that age or a bit older it was difficult to get him to eat because he was so hyper he couldn't sit still long enough to get the food in. What worked for us, like beccaj, was TV. When he was doing his daily screen time I would put good food in front of him, sometimes even in his hand, and he would distractedly eat it. I mostly was giving him smoothies then, as it was a way to get vegetables in him.

At another period when he wasn't eating enough, he started drinking Ensure and loved it.

I think liquids are good for people who don't want to eat; I know when I'm feeling ill I'd rather have a drink than chew anything.

Now he's pretty much a normal picky eater, not unusual for his age.

Good luck! It'll (probably) get better!
posted by The corpse in the library at 2:00 PM on September 11, 2012 [1 favorite]

I read an interview quite a while back with a well-known kids-n-food writer; the details are lost to history but one line stuck: 'There is no good feeding advice that doesn't involve giving control back to the child.'

Which is great advice, and which doesn't mean Cheetos on demand, just: no power struggles, period. Making him sit somewhere, engaging in any punishment/reward scenario, will backfire.

Ellyn Satter's site has some useful stuff ("division of responsibility" in particular), but if his health is demonstrably at risk, this is too much for internet strangers to sort out, and if not at risk, every grandparent's "he'll eat when he's hungry" is good advice. The odds of causing feeding problems instead of solving them by trying to force (coax, cadge, bribe, anything) things are high but if there are children, even profoundly autistic ones, who have starved in spite of regular access to food they must be quite unique specimens.

None of what he's doing is...weird, in any way that should worry you. So normal to skip meals... The fussy-because-hungry thing is a drag -- and normal; look how often adults can't sort that one out for themselves, even.

(The "royal taster" phase where they'll eat off a parent's plate is common and theorised to be an evolutionary thing that protected cave-toddlers from eating dangerous non-food whatnot -- not much seen in stationary babies, widespread among mobile tots. A fine thing to take advantage of if possible)
posted by kmennie at 2:04 PM on September 11, 2012 [5 favorites]

I can recall treating an older sibling as my "royal taster" when under duress. My sibling and parents were all very tolerant of it (in restaurants, dad would pull the waitress aside and instruct them to pretend to take my order but disregard it and bring my sibling two orders of whatever they asked for). So I felt confident it was just a phase, my son would outgrow it and it would be best to be tolerant.
posted by Michele in California at 3:37 PM on September 11, 2012

Lots of good things to try here. Seconding the idea of NOT making this a battle of wills or showing that you are stressed about it. Most kids will make up enough calories over the week to thrive, not just survive. Instead of cataloging for the day, why don't you tote up what he eats over a period of a week, and see how that works.

You're probably going to have to put up with offering and being rejected, but perhaps you can save whatever you think he'll eat for later and set it out again. Keep things out so he can see them and pick, and try to vary what is there.

Since he's three, why don't you see if you can involve him in the prep? He can fill a pot with water and drop an egg in for hardboiled eggs. Have him feed you--ask him to make you a couple peanut butter crackers and eat them--If he's allowed to, he might decide to eat what he can make. He can spread jelly or butter. He can put things in the microwave and push the buttons. (Of course, with your help/supervision.) Have him help you add ingredients and stir up cookie dough. Most 3 yo will plop cookies on the cookie sheet. Have him use a cookie cutter to make shapes with bread or cheese. It might occasionally motivate him to eat something he had hands on experience with.
posted by BlueHorse at 4:03 PM on September 11, 2012

My sister has a doctorate in occupational therapy, with a focus on feeding issues in children. Emailed your question to her, but second the recommendation that this would be a great issue to address with an early intervention OT if you have one available.
posted by purenitrous at 8:08 PM on September 11, 2012 [1 favorite]

Comments on just letting him go hungry because he won't eat what we eat are not so helpful or useful in this situation.
I don't fully understand why these types of comments aren't helpful, based on what you've written and a lot of people are responding with this type of suggestion. I'm sure that this is super frustrating for you (both the responses and the actual situation) but I really think that you have a control issue going on here.

Is it at all possible that your son is using meal-time as a controllable situation since it sounds like the many other things are so out of his control? Communication is really challenging for him but the ONE thing he can clearly do to communicate with you is refuse. Going through a long list of potential meals might be too much for him and it just sounds like you're putting way too much pressure on him when he's already stressed and frustrated. If I were you, I'd totally back off, read Child of Mine (maybe even give her a call and see about a consult) and then present him with food that you're fairly certain he likes as a cohesive meal that he eats (or doesn't eat) at your regular meal time. he's old enough to be able to decide if he doesn't want to eat and if he's hungry and isn't in a power struggle with you, he'll eat.

But I also want to say that I'm sure this is a really difficult situation and I hope you make some progress soon.
posted by otherwordlyglow at 9:22 AM on September 12, 2012

Best answer: Speaking only from my experience as an autistic person with an autistic kid, there's a lot of things that are involved when it comes to eating. My son sometimes eats dinner alone (we sit with him and chat, but he's the only one who has food at the moment) because we discovered some of the things we ate had a smell that was putting him off his food. He doesn't eat much at school because things can be too chaotic and we have told his school not to put a lot of stress on him to eat all his lunch. Noise, textures, smells, it all gets mixed together.

Could you maybe make a food card for him, such as pictures of some of his favorite foods that he could point to (to avoid communication anxiety)? Sometimes ASD kids will be fine with dry bread but hate toast, you kind of experiment with what works and what doesn't. Grazing between meals can also be a way to fill in the gaps, if he's too antsy to sit with the rest of the family. I've found my kid changes his favorite foods about every 2-3 years and some of those past favorite foods he now refuses to eat. Kids on the spectrum also feel comfort in knowing what something is going to taste like, the familiarity of knowing what looks good and what tastes good.
posted by Wuggie Norple at 6:37 PM on September 12, 2012

> I don't fully understand why these types of comments aren't helpful, based on what you've written and a lot of people are responding with this type of suggestion.

For most kids "they'll eat when they're hungry" is true. Some kids -- especially ones on the autistic spectrum, I suspect -- just don't get hungry, or don't have the instinct to eat, or are so freaking stubborn you wouldn't believe it, and while they might not starve to death they won't eat enough to thrive.
posted by The corpse in the library at 9:25 AM on September 13, 2012

Best answer: From my sister-I'll memail you, too:

Feeding issues are incredibly complex, and typically involve a myriad of reasons.  The number one reason kids don’t eat is because they don’t feel well, so I always think you should rule this out first.  Given that your son eats well on the weekends, however, makes me think that is probably not the case.  Many children with autism spectrum disorders have issues with food; their bodies often are not good at giving physiological cues for hunger and satiation, they have issues with the sensory properties of food, they have issues with mealtime behaviors, and they have difficulty with generalization (e.g. they might know that a chicken nugget is a nugget at school on a certain plate, but you take it home and they no longer recognize it as a nugget.) Feeding disorders are too complex and individualized to probably get too much useful help over the internet, so I definitely suggest you work with an OT and/or SLP who has experience in feeding issues. 

Some strategies that I’ve found helpful are using a visual schedule, working on exploring the sensory properties of food, completing self-regulation tasks before mealtimes (e.g. swinging), and building on existing, accepted foods.  Visual schedules can be really helpful so he knows what is expected of him and what comes next.  I often find that children might have issues with a certain sensory property (e.g. a wet texture) when they are stressed (e.g. on a school day) that they don’t have issues with when they are calm.  Keeping food extremely small can be helpful – you can always give them more later – but imagine if someone put a huge pile of something that grossed you out on your plate.  If they put a crumb of the same food on your plate and asked you to touch it, kiss it, lick it, and/or eat it, however, that wouldn’t be so upsetting.  Counting can also be incredibly helpful because it’s always the same and builds trust (e.g. we are going to touch it 5 times, or smell it 5 times.)  Again, an OT with experience in feeding issues should be able to help you.

Helpful resources – Ellyn Satter’s book “Child of Mine”

OT – Marsha Dunn Klein – the ‘get permission’ approach – she has some great DVDs you can watch and also does classes around the country – A fantastic parent run group that supports families of children with eating issues.  They have great resources and also can partner you with other parents that have lived through the same experience.

Good luck!
posted by purenitrous at 12:09 PM on September 14, 2012 [1 favorite]

Best answer: I've looked after several autistic kids who use flashcards and picture schedules and they work really well. If you are worried that you might be feeding him food he doesn't want, perhaps having him pick from a stack of cards with food options on it might eliminate that feeling. Some of the autistic kids I've had were extremely schedule/routine oriented and you literally could have put "mealtime: 10 bites of food " on their schedules and they would have done that exactly.
posted by Foam Pants at 3:50 PM on September 14, 2012

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