My daughter won't eat at all

[SadParents]

My daughter is 31 months old and she weighs 23.5 lbs and is 34.5' tall. She has always been in the 1 to 2 percentile on the growth and BMI chart. She has number of problems related to eating. First of all she does not want to eat ever. If we ask her if she wants to eat, she would never say yes. We have been always spoon feeding her because of that. Feeding times are nightmares for us. She does not like to chew foods so she hates solids. All she likes is semi-solid mashed foods. She does not like any kind of fluids, not even milk. She does not like cookies, chocolates or ice cream either. We occassionally give her cyproheptadin (an anti-allergy medicine which has a side effect of improved hunger in young kids) so that she gets hungry but still she would bite a piece of cookie twice and she will run away. In her 2.5 years of age she has done forceful projectile vomits at the avg rate of 2 times per week throughout (i.e. total of 250 times). Some times she vomited even 4 times in a day. No medicines have worked against her vomiting problem. We have consulted so many specialists and have done so many tests on her including barium test and endoscopy but outcome was always normal. Doctors and other family members suggested that if she self-feeds her she will eat exactly how much she needs and will probably stop vomiting. We have started doing that for past 2 weeks. Now we do not ask her if she wants to eat. If we are eating she shows interest in knowing what we are eating but then she doest not show interest in eating with us. Even if she does that, upon giving her the food she eats one or two bites and then starts playing with it or stops swallowing. She used to take 2 hrs in finishing 8 oz of milk when we were spoon-feeding her. But now after we stopped doing that, she does not even finish 4 oz in 3 hrs. In the whole day today she just drank 6 oz of milk and 1/2 bread and 6-7 french fries. She looks skinnier day-by-day and we are worried. Can someone please help us?

[Renee Radenberg]

Mealtimes can be a battlefield when children do not have an interest to eating. It becomes the battle of the wits between the child and the parents. Meals need to be joyous for you and your child. I see you are very worried about your daughter losing weight from not eating, however, I do agree with your MD. She will eventually be hungry and want to eat something. Engage your daughter with preparation of food. Have her help you set the table or do something for the meal. Children love to be a part of making food. Milkshakes would be good nutritional snack or meal for her since she is not eating much of any foods. All it takes is milk or soymilk, ice cream and some banana (any fruit). Whip it up in a blender and you have a drink packed with protein and calories. If she accepts the milkshakes she will be getting more nutrients then she is eating now and hopefully she will enjoy making it too. Hope this helps you. Thank you for your question.

[star queen]

Hmmm quite a quandry.  I wonder if she may have a problem with her jaw.  At her age she should be chattering away. If she is, watch to see if she opens her mouth wide and completely for extended time (singing a whole song), or attempts to talk with her jaw closed or nearly closed or speaks only in short spurts.  Instead of singing a song, she will only hum or sing a few words then stop.   If she isn't talking well or she won't ( or can't) open her mouth really wide and hold it there, she may be having a problem with her jaw. If this is her problem, then difficulty chewing and swallowing may be a result of this. Her Tempromandibular joint (TMJ) could be compromised.  See an orthopedist who specializes in this problem to get her evaluated.  TMJ problems often surface as difficulty swallowing or chewing, or in children, they will attempt to swallow food whole, chew food then spit it out, or vomit because the pieces are too large to complete the swallowing effort.   good luck

[SadParents]

Thanks for your prompt reply. Our daughter is very talkative and speaks very long sentences and can sing many rhymes and alphabet song etc. We have never seen any trouble with her talking and screaming. She was in fact a very early talker. It is just that when it comes to food she just does  not want to use her energy in chewing and she thinks it is too boring to spend time eating. So if we spoon feed her and she has some activity to do in the meantime she is ok with that. There is one example I would like to give you. When she was approx. 8 months of age, she knew how to sit but at the time we could not feed her while she was sitting because she would just open her mouth and let the milk fall out. So we were spoon feeding milk while lying her down. And one day she kept one spoonful of milk in her mouth for over 20 minutes without swallowing. It was amazingly frustrating for her. I hope you can get what I am saying here. Our main problem now is to make her interested in eating and to make her understand that it is required for her well being. So far she has never done that and for her it is us who wanted her to eat for our satisfaction and she never needed that. Can you suggest some ideas about how to do that? As I mentioned yesterday, we are already making her driver about her eating and she still does not ask for food. We wait for couple of hours after the regular mealtime for her to tell us that she is hungry but then she does not do that. So then we tell her that it is time to eat and we will give you some thing to eat and you will have to eat it yourself because now you are a big girl. And then she starts eating, eats 2-3 pieces of cracker (or whatever favorite food we gave her) and then starts playing with it and eventually when after 30-40 minutes when we ask her do you want to eat at all or just play with it then she would say she is not hungry anymore and wants to now play with her toys. Some people say that we should not even ask her if she is hungry for a couple more weeks. We should just behave as if she does not need food and let her worry about it and ask for it. Even if she does not ask for a couple of days, we should not offer it. We should let her realize that it is not for our satisfaction but it is for her physical needs. Do you suggest if we should do something like this? In your experience, do you think it would work? Also considering her overly low weight, will it be ok if we let her go hungry for some days? We will really appreciate your suggestions about this.

[star queen]

If the problem is not physical, but either psychological or behavioral, going without meals will not improve your problem.  People of any age who go without food for several days lose the hunger impulse and don't miss eating.  Anorexic people often have problems getting themselves to eat at all, as the thought of eating repulses them.  Your daughter seems to be at the stage where eating holds no interest and actually repulses her.  If this is so, then your daughter will not eat if left to her own interests.  Spoon feeding her isn't going to help, either.  I would suggest  punishment to get her to eat.  I am not speaking of sitting in a corner or spanking or something of that, but rather holding out what she likes to do.  Treat eating like a chore that must be done, like making a bed or putting toys away.  If she doesn't accomplish her task, she has a penalty, like no tv, or whatever activity she likes doing. Sit her down at the table and offer her food.  Tell her it is time to eat and if she doesn't eat she will not be able to do ....(toy, activity, whatever) until she does.  Sit down at the table with her and eat your own food, making it an enjoyble experience for her to see. Say things like Ummm this is wonderful.  Laugh and have fun eating like she is missing something fun to do.  Tell her she better eat because she is really missing out on something yummy and fun.  If she doesn't eat, don't make a big deal of not eating, but rather that she is missing out on something fun to do.  When you are finished tell her she has a set time to finish up, say 3-4 minutes.  If she doesn't eat then she loses her toy.  After the time is up remove the food and let her without the toy.  If she has a fit (that is good) tell her she lost the toy because she didn't eat and will have another chance to get the toy at snack time.  Children in this age group have short attention spans, so don't wait too long.  In about an hour, offer her a snack. Again she must sit at the table and stare at the food. Tell her she must eat before getting the toy.  If necessary, make the punishment a different toy, activtiy, tv program, etc.  If she doesn't eat, continue the routine. Don't show your frustration by raising your voice; her not eating is no big deal to you, but she is the one losing out.  Always let her see you eat or drink something enjoyable and fun that she is losing out by not eating herself.  Whatever amount she actually eats, even one or two bites, make a big deal of the correct behaviour and give her the toy.  By the end of the day you might have a pile of lost toys, but that's okay.  She will push you to the limits to win and push your buttons.  Take away whatever is necessary.  She can't go to the park because she didn't eat.  Remember the prize for eating shouldn't be too big, like don't take her to Disneyland for eating a muffin, but rather let the prise be something small that she will get enjoyment from so that she will relate eating to everyday enjoyment rather than something really big.  But make the punishment hard for her to give up so that the punishment is greater than eating.  If she isn't going to lose something important to her eating won't be worth the prise.  good luck

[star queen]

An addemdum to above:  Remember to make eating fun.  So far your daughter has seen that eating is stressful, frustrating and worrisome. She has not associated eating, chewing, or swallowing with anything pleasant.  Make the mealtime a fun time.  Make it a game.  You and your family laugh, have fun and love to eat.  Make bets that "you can't eat all that" and when it is eaten, make a fuss.  Clap your hands, high 5 each other and when the meal is all eaten, hug each other and congratulate each other on a job well done and fuss about how yummy the food was and how much fun you all had eating and chewing it.  Put a morsel of food in your mouth and count chewing to 10, then cheer because you made it to 10.  Eyeryone holds their breath until you swallow then cheers, or claps, or otherwise affords you praise.    Take turns cheering each other on that they take a bite, chewed it to 10, and swallowed the food.  As the turns go around the table, your daughter also takes a turn.  If she takes her turn, treat her just like everyone else at the table.  Cheer, clap, high 5, hug, whatever, then continure for another round.  If she doesn't take her turn, tell her she is missing out on all the fun, then continue around the table again and give her another turn at the fun when it comes around to her.  Do this throughout the meal.  If she doesn't eat, remove the food and tell her it's okay, but she sure missed out on some yummy fun.  Continue this at all mealtimes.  When she eats her hourly snacks, make it fun, too, by making the food look like bugs, make whip cream faces on pancakes, gummy bugs on cupcakes, etc.  When she takes a bite, count the chews and if she "makes" it to 5 or 10 clap and hug her then when she swallows the food, cheer again.  If she doesn't eat, don't make a big deal, just tell her she is missing out on the "yummy fun".  If she sees that eating can be pleasant and fun, she will want some fun, too.  Whenever she asks for what you are eating, don't give her a bite off your fork or spoon, but rather scoop some off your plate and put it on her own plate for her to feed herself.  Praise the correct behavior.  If she doesn't chew, show some disappointment, maybe a pouty lip that she didn't chew the 5/10 times, but then cheer up and smile at her and tell her next  bite she can try to "make it" to 10 before swallowing and continue without making a fuss.  Everytime you eat anything and she is nearby, make it into a yummy experience.  Show her by doing, then she will make her own decision to eat.  When she makes her own decision to eat, you are on your way to success.  The punishment I outlined above may be do-able during the day when she is being stubborn and pushing buttons, but making eating fun as I just outlined is a more pleasant method, so you have two methods to try and see what works best for all of you.  good luck

[kitcurious]

Try the milkshakes, even Ensure, they have a kiddie-type version I believe, and let her come around eventually on her own. Putting that much attention on something (even as a "game") is just making it stressful. There's nothing less appetizing than pressure. Listen to the experts completely, let her alone for a while and see how she does.

[mum2beagain]

I have had most of the issues you have described and more I think with my son who is now 3 1/2; now he does have some other medical issues which may or may not have contributed to his feeding problmes, no one could ever give me an answer on that one. He has hydrocephalus and mild cerebral palsy.
He was seriously underweight at 2 years old, showed no interested in food, gaged, vomited, would only eat mashed  or smooth textures or jars of baby food. To get him to eat we had to read books, distract him and spoon feed him, we had to give him milk in a bottle lying down until he was 2 1/2, sometimes waiting until he was asleep and then gently putting the bottle between his lips and then letting him suck the milk down in his sleep. We had him evaluated by a feeding specialist at 2 years old, they found no physical problem and just described him as having a weak chew. We were told to start each meal with a spoonfeed and then allow him to play with some other finger foods afterwards, it did not matter if he didn't eat them as long as they were on his tray and he saw the rest of us eating. Now here is the key to our problems; James was later diagnosed with sensory integration disorder, it began to make sense why he gagged and vomited so much, mixed textures confused him, the signals did not go to his brain to tell him to chew, he needed lots of sensory information from the food in his mouth before he would chew, slowly he began to eat crackers, raisins, raspberries, toast, one thing at a time, one texture at a time after playing with them on his tray many many many times. Our other problem; he just didn't know he was hungry, for most of us we feel our stomachs empty and realise it is hunger, he just didn't, his senory system is so out of whack he didn't know he was hungry, he would go all day and not eat, later when he was able to talk better he began to say he was tired and felt sick, this was hunger, he just didn't realise it and did not know he needed to eat to take those feelings away, many times he asked to go to bed when he was hungry, he tought going to sleep would make him feel better. We had to educate him that this feeling was infact hunger and he needed his dinner!
A year and a half on we still have to feed James with a spoon sometimes, but quite frankly if it's what we have to do it's what we have to do. He is now a healthy weight again. Routine has been key; James has three sit down meals at the same time each day, if he won't feed himself I do it. He also gets two snacks a day with finger foods to feed himself that have slowly over time become acceptable to him, his school must think I am either mad or mean, he gets cheese, crackers and raspberries every day, but he will accept these foods and happily eat them now without fuss. He is getting better with a spoon too but still gets upset if he gets messy (another thing from his senory integration dissorder) and I have to help him finish the meal.

My sons pediatrician agreed that with a child as underweight as James was (below the 5th percentile) getting food into him was the most important thing, we sometimes used the pediaure supplemets (childs version of ensure) if he had a particullary bad day and the feeding clinic gave us recipes for protein shakes. Once his weight was within the normal range for his age and height we began the strategies I mentioned above, putting things on his tray. We gave him spoons, bowls and cups to play with, we pretended we were hungry, talked about what we would like to eat if we were hungry (for James it was usually crackers!)

Slowly and surely things are getting better; he still gags and vomits ocassionally and I have to be very careful with soft moist food, any large lumps and he can be sick. His food range is expanding after lots and lots of exploration with texture (not just with food but with toys, sand,  playdough etc)
We still have to take our own food for him if we go out, god forbid if we ordered pasta and it was slightly firm, he'd be sick everywhere!

I do understand where folks are coming from when they say leave her be, she will come round, she won't starve. But if she genuinly has some kind of problem with textures this won't go away on it's own. Personally I would go back to your doctor and ask for a consultaion with a feeding specialist and an occupational therapy assesment (the OT will help identify any sensory issues that may be going on).

I wish you the best of luck, I know what you are going through, I have been there (and still am to a certain extent).

Jo

[mum2beagain]

For the things you can get her to eat some sneaky ways of getting more nutrients and good fats in her diet;

Add a couple of teaspoons of good quality olive oils to the hot mashed dinners you can feed her (pasta, meat, veggies etc).

Use cheese sauces (made with butter, a little flour, mild and good cheddar cheese) with flaked fish or meats and mashed veggies to get extra calcium, protien and fat into her.

Add wheatgerm and ground almonds to yoghurts.

Use iron fortified infant cereals for breakfast, they are easy to eat and full of iron and vitamins.

Try the toddler puffs as snacks, they dissolve so shouldn't make her gag and they come in loads of flavours.

And also always have a plate with three or four of the things she will have out and a cup of diluted juice, milk or water so she can help herself whenever she wants to and doesn't have to ask, just make sure they are removed an hour before your set meal time.

Hope this helps.

[mum2beagain]

Sorry, I forgot to add you need milk for the cheese sauce!

[SadParents]

First of all, we would like to thank a lot to you for such a wonderful response to our problem. Upon reading it, we really thought that we must try it and we have already started doing it. She lost a couple of toys by now and hopefully she will realize her loss sooner than later. We would let you know the outcome of these new experiments. Thanks again.

[SadParents]

Thanks for your suggestions. We have complete sympathy with you and know exactly what you have gone through and how hard it must have been for you. We are planning to take our daughter to a feeding consultant pretty soon. It seems the problem with our daughter is more of a behavioral than physical. She just thinks it is a boring task and she must be playing all the time. Anything that interferes with her playing/exploring/watching TV is not to be done. So, we have decided to try suggestions given by star queen in the meantime. We will share the  outcomes of our experiments with you. Wish you and James good luck.

[mum2beagain]

I am glad you are planning to see the feeding specialists, I was told many times over the course of a year that with James it was 'just behavioural' then that he had a 'weak chew' and that things would sort themselves out in time. It was only when my son was almost categorised as failure to thrive and I insisted on an OT assesment to look at things further that we found that sensory problems where the isssue. I just related to your experiences with her gagging and refusing liquids and thats why I wondered if there may be some sensory problems with texture for your little girl.

How are the suggestions from star queen working out?? I know we still have to use rewards to get James to eat; it helps us get him to try new things, something that was always difficult in the past.

Best wishes.

[Danale]

those toddler puffs are great, and they are pretty nutritious as well.  What about trying applesauce or yogurts in a squeezable bag, then the child just squirts it into her mouth and there isn't much chewing or swallowing (and maybe your daughter will not throw it up).  Also, I would try to get a multi vitamin in her - you can get the liquid baby vitamin drops so she doesn't have to do a chewable vitamin.  Milkshakes are a great suggestion and I also think trying to take the pressure out of the situation might help.  You might try for a while giving your daughter a nibble tray, an ice cube tray with little nutritious snacks (I used to put cheerios, raspberries, blocks of cheese, pretzels toddler puffs in.  I would set it on a table in our family room (or whereever she spends most of her time), say absolutely nothing to her about eating and see if after it turns to a non issue if she won't on her own try to take a few things from the tray.  This worked really well with my daughter, who eats well, but isn't a "meal" person.  This helped me to get nutrition in her and helped eating not to become a battle ground.

Best of luck to you!