Picky eaters can be a real challenge. The most severe picky eaters I have in my clinic actually have to have a tube planted in their stomach, which leads out from the abdomen.
They are fed with a bag during the day and during the night. They receive all their fluids and nutrition through this apparatus. They absolutely refuse anything oral! Then, slightly less severe, there are the boys and girls who will only eat 4 or 5 things. My son Joshua was one of those boys, he would only eat, specifically, Chips Ahoy cookies, French fries, fruit loops, bacon, and close to a gallon of milk each day! Ff you did not give him what he wanted, he would throw a tantrum and, he would not eat (or drink). Sadly, I see children in my clinic who are malnourished and not growing and gaining weight. This is what we call “Failure to Thrive.”
Here are the 5 “tips” of why children will not eat:
1. Severe oral/sensory disruptions
They may have problems with:
- the appearance of the item
- the color of the item
- the consistency of the item
- the temperature of the item
- the smell of the item
- the texture of the item
- the way the item feels in the mouth
- the taste of the item
2. Motor issues with chewing
3. Obsessive/compulsive behaviors: they will ONLY eat a few “safe” things, or they will exclude everything else.
4. They do not respond to the stimuli of hunger and/or thirst in an appropriate manner (these feelings just so not make sense to them)
5. Their tummies just do not feel good:
- Inflammatory bowel disease
- Chronic infection of the bowels: bacteria, yeast, parasites
- Food allergies/sensitivities
Our approach really depends on trying to figure out the sources of the problem. I say “sources,” because it is usually more than one of the above problems contributing to the picky eater.
Here are the 5 “tips” of what I look for:
- Stool culture: looking for infection such as yeast, bacteria, and parasites
- Blood studies looking for inflammation, food intolerances, basic metabolic and liver functions
- X-ray of tummy looking for the severity of constipation or fecal impaction
- Urine studies looking for the presence of casomorphins and gliadorphins (derived from dairy and gluten, can act morphine “like” in the brain)
- Urine studies looking for the presence of metabolites from yeast, bacteria
The treatment plan is put together with the information from the parents, the physical exam of the child, and the results of the laboratory investigations. Here are the 5 “tips” of how I treat my patients:
1. Heal the gut:
- treat underlying infections,
- institute fiber, probiotics, digestive enzymes, and antacids (if indicated)
2. Assure daily bowel movements
3. Remove, albeit slowly, foods the child is sensitive to.
- I usually start with the removal of dairy, then gluten. Make sure we continue to consume enough calories!
4. If the appetite is still very low…
- I consider using an appetite stimulant such as Cyproheptadine as it has done wonders for many of the children I see in my clinic.
- If there is a strong obsessive compulsive component, that totally prevents the child from eating/drinking, I will even consider a 6-8 week course of risperidone (seems to shut down OCD behaviors and also, increase appetite)
5. Engage a feeding therapist to help the child overcome oral and sensory aversions
And that’s my approach to the Picky Eater.