major food refusal, 16mth old, please help :(

[huntersmummyinoz]

I'm totally stressed out and having a hard time with Kingston refusing food at the moment and am not sure about how to handle it. (My eldest ate pretty much anything so this is all new territory for me!)
 
I think it has started as a result of teething, last month he got 3 molars and the 4th has cut about half way thru now. 4 canines are moving all at once and i expect to see the first in a week or two at most. Also suspect his appetite has lowered as is common at this age, and think some of it is behavioural saying no just because he can too. He also started getting fussier, almost distrusting in food I was offering, when I started to offer more new foods (he is on a very restricted diet due to MSPI, and also salicylates intolerance). I also think part of the problem is that he hasnt been exposed to enuf range of foods due to his intolerances, so whereas you can normally offer a wide range of fruit and let them choose, he can only have 4 types anyway, so if he refuses a couple doesnt leave you with much range). He is also now very aware of what everyone else is eating. I try to make a meal that everyone can eat twice a week, and to make other meals look similar to ours as much as i can but it's not always possible.
 
Around when his molars started he would refuse occasional foods but still ate pretty well. About 4 weeks ago he stopped eating any fruit other than pear puree that he gets at breaky (bananas and pawpaw used to be his favourite foods). About 2 weeks he stopped eating any vegetable other than green beans, and small amount of zucchini and sweet potato pieces that he has with lunch. This week he has now started refusing cereal after about 2 - 4 spoonfuls and then screams and cries for his cup of milk, refusing most meat, which has previously been a favourite too, and all meals are hit and mess as to whether or not he will eat anything and it is becoming quite stressful. If he does attempt a new food I have put on his plate, usual result is he spits it out and then refuses to eat anything else for that meal. If I stick to previously accepted foods, often most of it is left on the plate too.
 
The only foods I can reliably get him to eat everyday at the moment are: pear puree and 1tbs apple puree, rice cakes or water crackers, teddy bear biscuits (but only gets these occasionally like once a week), banana bread, pasta (usually served with a meat and veg sauce, but is starting to get fussy if has 'too much' sauce on it now), and scrambled egg or omelette, yoghurt (tho has only been eating half a tub the last 2 days), 1 tbs equivalent of zucchini and sweet potato pieces, chips (again gets these maybe once a week). 
 
I'm stressed and worried, and don't know what to do. What strategies are best for dealing with this type of behaviour?

Thanks,
Kirry

[charmie]

Katrina started refusing all her favourite foods one by one after she turned 1.  She was a wonderful eater before that.  I think most of it was from the new found power of being able to refuse it.  I was very stressed by it too.  I did the mistake of stopping offering her the foods she was refusing and the choice kept dwindling until I started resorting to chicken nuggets and fish fingers just so she would eat something.  This lasted for a whole year!  The hv said I should stop stocking these foods altogether and start offering her whatever we were eating.  So I went cold turkey.  I started preparing one meal for everyone.  At first she was not impressed to say the least.  But things improved.  She's still very picky and getting her to try something new is like murder to her.  But much better than chicken nuggets and fish fingers.  I still cook the same thing for all and sometimes she still refuses or takes ages playing around with her food.  But I don't offer an alternative.  There's also a set time for meals.  She has x amount of time to eat and then lunch/dinner is over.

Looking back I should have kept offering all the range of food she was eating before this phase started.  And showing them our stress doesn't help.  You need to act a bit business like.  You offer the food, no coaxing (I dont think it helps anyway). You set yourself a time limit.  And you take the food away without offering an alternative.  At some point he'll be hungry and he will eat what you offer. 

That's from my experience, and what I think I should have done.  I hope someone else can give you a solution which they actually tried and worked for them.

Hugs xxxx

[~inbalance~]

(((hugs))) Kirry.  Both of my boys are giving me a hard time right now and I'm really starting to stress as well.  T was a previously good eater so I'm not sure what is going on there.  F has never been a great eater but he is at an all time low.

I do offer what I make for the family all the time.  It feels like they refuse everything these days.  Even most fruits which they both used to eat.  I don't really believe it making special foods just for them, they get what we all get.  I understand the frustration though.  I'm at the point right now where I just want them to eat!

I never used to worry about picky phases, etc.  Figured they would regulate what they needed and overall were getting enough.  I am starting to worry now though simply because they are just so little and don't seem to be getting any bigger.    I plan on taking them to see the ND soon for more ideas.

[Shiv52]

I have done alot of work with LOs who are really picky.  Very often the pickiness starts with a bug or teething so parents alter things to get them to eat and it reinforces to them that they can control meals/food.

Best thing you can do is not get into offering alternatives.  Just offer as you normally would and if they don't eat, thats fine.  How is he with choices?  You could offer a choice between 2 things at  the start of a meal so at least they have an element of control but its a controlled choice between two things, if they don't choose you just choose one of the two things for him.

We always had an element of choice for breakfast and lunch but dinner was always just set.  I always made sure there was something she would generally always eat so she generally ate something. 

On poor eating days I did sometimes give M a bowl of porridge before bed to make sure she wasn't hungry but because it was a different time of the day it wouldn't have made her think it was an alternative to whatever she refused earlier IYKWIM? 

We did cut our PM snack at 18 months so she was hungrier for dinner but couldn't cut the AM snack as she ended up grumpy by lunch.  She always ate most in the first half of the day and still does.  Dinner can still be hit and miss even now at 3.

{{{hugs}}}  It is tough when they aren't eating well xx

[*Ali*]

I have heard of people leaving a plate of finger foods on the coffee table with no pressure to eat it so their LO could eat it as snacks when they wanted and would often try new things in their own time. Not a great habit to get into though I admit.
Would K be interested in helping you make the food? Of course he won't be much help in reality but if he felt he had been involved in the making and been allowed to "play" with the foods he might be more interested in eating them. I am thinking things like homemade pizza, pasta sauces etc. So he could just pour stuff in/on for you.
Otherwise I agree with pps that I would just keep offering foods and giving him the opportunities to eat even if he doesn't. It must be so hard when K has to eat different meals to the rest of the family. I know Cadan just wants what everyone else has which is why I rarely order him a meal in a restaurant I just get a small plate and put some of my food on his plate. Would K eat if he thought it was yours or H's?

[hrk]

Hi Kirry.  Teething made H severely reduce the amt of food he would eat.  If that is it, it is probably a waiting game.  But the reflux/food allergies can also be an underlying issue for kids with tactile defensivenss.  We have had tactile defensiveness lasting for quite some time stemming from food intollerance and reflux.  

I did read an article from our ot on the link between food allergies.  It is a pretty small study, though.  I will post it.  http://www.allergysa.org/journals/march2004/tactile%20defensive%20children.pdf  I think you have already tested for Ige allergies, right?

The other thought is that I was looking at some books that talk about chaining foods together.  Slowly starting with what he likes and then slightly building on those to get to other textures/consistencies in foods.  I don't know the correct language for it, but I can look to see if I can find some of the titles I was looking at.  I was going to look at them for some ideas for H.  Any chance you can see an occupational therapist?  Sensory issues like tactile defensiveness are their "specialty".  They could help, if you feel it is at that level.  

[bug_blues70]

Following along. Also want to say Kirry, my LO eats almost nothing at all when teething. I don't have to worry about weight gain tho, as she's always in the upper percentiles (is K?) but I do worry about her waking at night due to hunger. Which brings me to my question for the pps:

when you say you give no alternatives and you give a certain time limit... what do you do if/when they wake for hunger during the night? I don't mind doing that for breakfast or lunch, but I'm always afraid that if she doesn't eat dinner she'll have really long NW due to hunger...

[EloysH]

((hugs))  its awful, I know.  With Jarrah he went through phases like that but i never worred too much because he was a good weight, he slept well, he had gown out of food intolerances so I knew he as able to offer enough calcium and protein. I never was tempted to cook many meal,force feed etc.  But its the opposite for Kai,  I don't have those luxuries.    So the stress seems acute.

Kai is also refusing alot of foods with the teething.  I started limiting what I would offer, then realised things were falling off the menu quick. So I have started offering everything again.  That is helping alot.    I was getting really stressed throwing out food and having to have 3-4 options I knew he would eat, it was also alot of extra work - you and know how hard it is already with the cooking for these two boys and their diets. And also stressful trying to think of 3 mealoptions, it is hard enoug getting one meal into a plate.

Another thing that is helping is that I have modifed our family meals a bit so that they are similar to what he can eat. That is helping alot.   For example last night, I cooked a chicken casserole in hmoe made chicken stock, garlic, leek, with allowed vegetables for Kai and some grains thrown in.  When finished, I took out his portion, and made 3 meal options with it:
1. finely chopped "as is"
2. All pureed
3. The pureed mixed into some cooked brown rice.
  So he thought he had 3 choices when really  all I cooked was one meal. He probably ate 100G of those foods in the meal.  He was calling for banannas the whole time, I just kept saying "bannanas all gone" That was so much less work!!

Maybe try and present  the same food differently with different textures to trick him into thinking he is eating something different. After all, textures are just as important as the different flavours right?: - stir fried, fine chop, puree, cubed, fried in gee, veg  mixed with egg yolk, made into little egg quiches (your recipe you told me) etc

HTH hun    xx

[hrk]

I pureed and put the food in a format that H liked most.  We typically eat the same food.  I blended any sauces to make them a texture he would eat.  Cut veggies very small.  He gags and dislikes lumpy foods. Soups are a no, so I make the soup (homemade broth; veggies cut small), and then strain out the veggies and noodles for him. 

A side note is that it takes some sustained muscle strength to chew meats (and other foods for a whole meal), but you said he used to like meat (so I am not sure that it is an issue). With H's low tone, he was chewing the same piece of chicken for a half hour.  Can he use a straw, yet?  That help lo's strengthen a lot of the muscles in the mouth.  I think H wa 2.5 before he could use a straw.

I also keep putting new foods on his plate; it takes a while before kids may even try a food.  So, I usually do at least two things I know he will eat well, and then add one or new two things (even if I know he will not touch it).  If I have made a new menu item, then I will likely put a peanut butter and jelly on the side as an option.  But sometimes he literally has six options on his plate.  I actually find that having three options works better than six; I think he finds it overwhelming and all the food is getting mixed and scrunched together. 

Because I don't eat meat, I tend to make the same meal in a few formats (like Eloys).  I just cook meat separate (add it to the boys), and make sure Heath's is in a fashion that will work best for him. 

Here are some titles I was browsing; going to see if some are at the library.  I probably won't get to reading much because we are busy with other things right now.
http://www.amazon.com/Food-Chaining-Feeding-Problems-Child%C2%92s/dp/1600940161/ref=sr_1_2?ie=UTF8&qid=1307672021&sr=8-2
http://www.amazon.com/How-Get-Your-Kid-Eat/dp/0915950839
http://www.amazon.com/Secrets-Feeding-Healthy-Family-Orchestrating/dp/0967118921/ref=pd_sim_b_1
http://www.amazon.com/Child-Mine-Feeding-Love-Sense/dp/0923521518/ref=pd_sim_b_2

I do know that there is an oral brushing routine that ot's may use to help with oral sensitivity.  But my thought is this really could be his teeth.  Has his reflux increased as well?

[hrk]

Kirry, I did have a couple of thoughts.  While most moms in bc were doing a morning snack, I didn't with H.  There were two reasons.  First, I was doing "lunch" around 10:15/10:30 for a while to give his tummy an hour to empty before lying down for nap.  He was always ready for nap pretty early.  Second, if he was eating snack prior to meals, he didn't eat much for meals.  I keep afternoon snack to milk and something light.

Just tonight, I was reminded of a third scenario that arises.  Dinner can't be too early.  If he skips dinner, I often bring out the same meal later, and he will eat it.  Tonight, I tried to do dinner time a little early (5:00 instead of 5:30), and he had one bite of everything and a half a glass of milk.  I brought him in at 7:45 pm to get ready for bed.  I asked if he wanted his dinner, and he nearly cleared his plate.  Hunger plays a big factor for him.  And he said he liked it all, too.  (He rarely eats rice, and he had all of it.)  :-)  He usually says "I no never eat it".     Of course the full tummy before bed is making me cringe.  Fingers crossed we don't hear a peep.

You have probably already tried most of those things, but I thought I would mention them.

[bug_blues70]

hi!  i just want to second what pp said... ellen eats a snack when she wakes (which i wish would be breakfast but she never eats much), lunch at 11 (nap at 12) and then a light snack a little after she wakes, so around 2:30, and dinner at 6. If I give her her snack too late (if I forget ) or if I let her eat too much, she won't eat dinner. She won't eat any more than that... two snacks and two meals. I've tried and tried for three meals, but I guess she just won't eat if she's not hungry, kwim?

[charmie]

I didn't do snacks either.  K wouldnt be hungry enough for her meals when I gave snacks.

[huntersmummyinoz]

right, this is the 3rd time i have attempted to reply. i normally bw during nap times but ds1 is in the midst of dropping his atm.

first of all, thankyou so so much for all of your replies.

ok, so on advice from you lovely ladies, i have changed strategy a little and things are a little better. for snacks i have been sitting him near the kitchen bench, putting a few items on his tray or on the bench where he can ask for them (eg. yoghurt) and keeping myself busy doing dishes, preparing dinner, etc. i used to sit with him for all meals. and dinner time, i have been more conscious of making our dinner appear to be the same even if it's not quite (due to food intolerances) and putting only one or two of each item on his tray and having a big 'sharing plate' on the table so he can ask for more. so he feels he has some control over it i guess by asking for more. and having some mashed veg that he can see and ask for too. snacks were pretty small before but i am sticking to fruit, yoghurt or rice cakes mostly for now.

as a result, he is now accepting some of his usual foods again (ie. eating meat again, eating beans and potato again - so long as it looks like a chip , eating yoghurt again, etc).

main problems i have now are:
breaky - he will still eat only a couple of spoons and then cry for his milk. i resorted to putting the tv on for breaky the last 2 mornings (we rarely use tv for meals except lunch time as they sit on their own for that meal) and he has eaten all of his cereal. only looked to the kitchen for his milk once.
i'm a bit torn on this one, i dont like having him infront of the tv, but the only other option i am thinking is to drop the morning milk which would be pretty horrid for a couple of days, but then hopefully he would eat his breaky as no other option he is about to cut a canine which is why i have stalled with the tv for now. what do you think, do i just need to be brave and ditch it?

fruit and veggies
- this is the other problem, the only fruit he will eat is pear and apple puree, or a pear and banana puree. and veggies, he will eat beans, potato (but only mashed or chips), sweet potato and zucchini. i can get other veggies into him in omelettes, mini quiches, on pasta, but can get him to self feed other veggies. he wont pick it up or try it. he will pick it up and feed it to me, but that's as close as he'll get to touching it.
- i keep putting a few pieces of diff fruit or veg on his tray, but apart from that, any other strategies? eg. do i need to put just cut up fruit on his tray for snack and nothing else? or keep offering alongside one or two familiar foods?

wont self feed with spoon or fork
- he used to eat from a loaded spoon. does occasionally now but rarely and tbh i havent bothered with breaky the last few weeks as it's been a rush to try and get him to eat as much as possible before crying for milk. he has zero interest in eating with spoon from a bowl and i think if he could he may eat better (as he would be in control). once or twice a week i do offer the bowl and spoon  but he usually just gets peeved and cries for milk

i dont think it is a sensory issue as he's never gagged on food. handles chunks of meat, lumpy food, and harder foods like biscuits, even eats his rusks now. i think it's more lack of exposure due to food restrictions as to why he wont try new foods. (jean, does that sounds right in thinking it's not sensory related?)

i gave our dietician a 4 day food diary that she'll assess for us too so will see what she has to say. not sure she can help so much on getting him to eat tho.

hv thinks drop back on is milk, and no milk til eaten cereal. neocate is a lot higher in kilojoules than cows milk. BUT if he eats a good meal he will only drink 100mL milk. if he doesnt eat well, then he drinks 150 to 180mL. any thoughts?

snacks - i've def reduced them more over the last month or so. morning snack is really small eg. a couple of rice cakes, or water crackers, or a tiny muffin, any more and then he wont be interested in much lunch, but he cant last til lunch without tantrums without it. afternoon snack is now usually yoghurt, plus one or two other things (used to be just fruit and a cracker but wont touch the fruit now). i find he often eats a better dinner when he's had a good snack here, of course making sure it's not too big tho.

right, now to find time to look at some of those links jean posted! and will read thru your posts again as some great ideas in there to try.
thanks again ladies, welcome any more thoughts or suggestions you have

[Sam-n-Max's Mommy]

If it's ok, I'm going to follow along here.  Have many of the same problems and have been scared to take the plunge and not offer alternatives.  Finding these comments/suggestions really useful.

(((Hugs))) huntersmommy -- I know how stressful meal times can be.  Feel like I am losing my mind most days.

[bug_blues70]

kirry- i had the same issue with breakfast and her bottle. i dropped it cold turkey several months ago (7?) and immediately saw more solids intake, tho she still won't eat much for breakfast (she makes up for it later in the day). she now only has 2 bottles of FF - 6oz before nap which is right after lunch and 6-7 before bed which is (obviously) after dinner.

how much FF or milk is he taking per day? if its more than 16oz, i personally would start dropping that so he'll have more appetite for solids. he may *prefer* his milk, but he can't stay on liquids much longer, and I think if you take it away he'll start eating more solids, even if he's still picky with them. but that's just my opinion and I know there are lots of people with more experience with this stuff than me... maybe I'm just oversimplifying the problem. If so, I apologize!