Pre-teen boy with eating disorder?

My nephew is 11 years old and will not eat anything other than (and this is quite literal) pizza (pepperoni only and only certain brands), grilled cheese (white bread only), mac n cheese, chicken fingers, pop tarts (one flavor only) and french fries (they cannot have any skin on them or look different from mcdonald's fries).  He will eat certain kinds of cookies and ice cream, candy and donuts but they are also limited.  The list of what he eats is getting shorter as the years go on and the amount of food he eats is getting smaller as well.  Three years ago he was eating more than he is eating now in terms of volume and variety of food.  

Not only will he not eat any new food, he will actually start to get very nervous and cry if he thinks he's going to have to eat something new (even in a public place).  He will not eat anything that doesn't look right to him and absolutely no vegetables or fruits or healthy breads or cereals or meats.  On that note he won't eat hamburgers, hot dogs...other things kids usually love.  If someone manages to get him to try a tiny bite of something new he will gag and cough it back up no matter how tiny the bite or how tasty the food.  He seems literally afraid of food.

He is (according to things I've read) about 15-20 pounds underweight.  He weighs under 65 pounds.  He looks so frail and skinny that it frightens me when I see him; but he isn't very tall he is probably about 4 feet tall.

His parents are apparently resigned to letting him eat however he wants to eat and hope that he will "grow out of it" but we've been hoping that for years now.  It seems to be getting worse instead of better.

Thanks in advance for your advice.  

[Kevin Kennedy, Ph.D.]

It is generally true that such 'fussy' eaters do fine and that Mother Nature, if you will, handles things just fine. However, a key point in deciding whether to intervene (and how to intervene) is the child's physical/medical status. Your description indicates that he is not in a sound position from a nutritional standpoint. And it may be that he is displaying an anxiety disorder; I say this in light of your observations about his reaction to food. I would recommend a medical workup to investigate the metabolic/nutritional aspects of his situation, and a mental health evaluation to investigate the possibility of anxiety disorder (e.g., obsessive-compulsive disorder). Based on the results of such evaluations it can be detrmined if any intervention is required or if his parents can continue with their current approach.

[RockRose]

mary - I know so many boys like that!  Even foods they like,  and you think you're going to be able to feed them,  something has gone wrong and they won't eat it because it's got this weird thing on it or this lumpy thing or whatever.  

I think it's texture and taste,  and I think they really can't help it,  the boys I know.  They are frail and pale and difficult to take places because the food could turn out not right.  A boy who would usually eat McNuggets suddenly gets served some where the chicken is stringy,  not firm,  and the meals over!  

My nephew,  and my 16 year old son's best friend sound just like your nephew,  but both boys I know are 16 years old.  They aren't making this up,  or trying to get attention - just the opposite,  they're trying to fit in and are embarrassed to be so picky so it makes it even HARDER,  because they won't just tell you something they will eat so I can go out and get it.

How about Yoohoo chocolate soft drink?  Or Slimfast drinks (they are pretty nutriciious,  and get the calories in easily).  

Best wishes.  I don't think your nephew will grow out of it,  he'll just get older and more independent where he can buy and prepare his own food that he can stomach.

[maryashley]

Dr. Kennedy, thank you for your response.  I do worry about his nutritional needs not being met and interestingly one of his parents was diagnosed with OCD and the other has anxiety problems.  Both parents are on medication as far as I know.  I will mention this to his mom and see about getting him a physical at least.

RockRose, thanks for your response.  I hope that he manages to break this pattern before he is 16 but I know that may not be the case.  I don't think he is trying to get attention either and like you said I think it is embarrassing to him.  Perhaps this is also a reflection of society's eating habits as well...I wasn't allowed regular sodas or fast food until I was 13 years old but things are more about convenience now and many of the foods kids eat are simply addictive.  I'm not sure I would ever have been motivated to try broccoli or oranges if I had been raised on fast food and sugar.  Hopefully this will pass and if not I hope he takes a good multivitamin.  I do remember him drinking ensure at a young age per doctor's request...maybe it would be a good idea to start that again.