Student doesn't eat and I'm the person to fix it!

[JerseyTomatoMDCrab]

Here's some background on the student in question:

He started back here at school in December in the 2nd grade. Prior to that, he was home schooled by his mother who wanted him at home so she could get a handle on his myriad of conditions: severe anxiety, ADHD, OCD. Once she felt his issues were under control, she re-enrolled him back at school. He is a daily med taker with several allergies so I know him pretty well. Mom is a nice woman, a little overbearing but I can't say I blame her with this child who has so much going on. She's very good about keeping me informed with what's going on with the student.

So, mom comes to me last week and says she is concerned about little darling's eating habits. He is a skinny guy and the stimulant meds certainly don't help with weight gain. She informs me that he has serious "food aversions" and she has a hard time getting caloric and nutrient dense foods into him. He's allergic to peanuts and shellfish and very picky about textures, temperatures, etc. She asked me if, when Darling comes to get his medication every afternoon, I could help educate him on nutrition, the importance of adequate diet, etc. He's very honest about what he ate that day so that afternoon I started asking him about what he packed vs. what he actually ate. I started trying to educate him on the importance of good nutrition. He's got a very scientific mind so I started comparing his body to a machine, explaining that the body needs fuel to run and function, things like that. He also is OBSESSED with stickers so I told him we could keep a card in the office and for every day that he eats his entire lunch, he gets a sticker and we can display his sticker card on the wall. He was totally into the idea but... he has yet to earn a sticker! He has an excuse for not eating his lunch every day. I've sent home some suggestions to mom regarding preparing the food so it's desirable at lunchtime (how to keep bread from getting soggy, yogurts that aren't too runny, keeping cold things cold) but nothing has worked so far.

Mom tells me what this kid will eat and it's horrifying. Cinnamon buns for breakfast every day? I get they are high in calories but that's just scary.

Does anyone have any advice? I can't think of anything else to do but you know, my magic wand is supposed to repair everything.

I've never even heard of a well child having "food aversions" I just always called them picky. Any information would be great!

[RainMom]

I have a young family member with this. Now that he's a teen, it is better, but as a little guy, he only ate white food. He is diagnosed Asperger's and ADHD. His mom was at wit's end, too. Finally she just gave in and let him eat white food. He grew out of it.

This was my thought too; perhaps he's mildly ASD. My older sons were picky, but not compared to my youngest; he won't eat the foods picky kids eat.

[SaltineQueen]

She told me she "studied nutrition" but I don't believe she is certified or anything. I told her to speak to the pediatrician and see if he can recommend anyone.

Probably Google U

[Been there,done that, ASN, RN]

He's definitely not zombie like.I don't think over medication is the problem although this makes me wonder about some other students.

" He's, well, squirrelly. Fidgets, interrupts people while they are talking, likes to be right. "

This describes normal behavior at that age. Now he has brain changing chemicals shoved down him every day. Stop trying to manage the side effects, manage the drug .

No wonder he can't or won't eat. I've lost my appetite just reading this thread.

[Lev, MSN, RN, NP]

I think meds is part of the problem.

[JerseyTomatoMDCrab, BSN]

To OP - since he takes meds with you, will he drink a supplement with you and "earn" one of those stars to be posted?

That's a great idea! He drinks a Pediasure shake or something at lunchtime but maybe I can provide something similar with meds. I suggested mom try smoothies in the morning. You can hide a ton of healthy things in them if you add sweet fruits to mask the taste. Spinach and flax seeds would be a great addition to bananas and berries and if she puts it in an opaque container he won't be able to see the green color. Maybe she can pack a smoothie for him to drink with his medications. I will ask her if she's down, thank you for the suggestion!

[Flare, ASN, BSN]

I have a few older kids on medications that "don't eat" due to their meds. But will then come down to me periodically c/o stomach aches. I've tried explaining that the morning dose of Ritalin taken at 7 am has surely worn off by now and it's probably hunger, not a raging stomach virus they're feeling, but it falls on deaf ears every time. One student in particular, the parent and I are on the same page and she admins and when the kid gets home he devours every dorito and piece of junk food in sight - i've told him this isn't the best idea - but again, this child is 13 and knows everything.

I have a little one who is 5 and is failure to thrive. She just got a g tube. I don't give her any feedings at school and she's encouraged to eat throughout the day, but i don't stress if she doesn't. She does take a med with me, that i started giving with juice, as i have in overabundance and i figure every calorie counts in this peanut.

I agree with the poster that suggested that maybe is the child participates in cooking / prepping his meals. Just like when my own daughter declared she hated all vegetables but then found that she loved green beans, beets, carrots, squash, (everything but the tomatoes we grew that summer) - similar - she has a deeper appreciation for the food she cooks.

Finally - yes, pink food on Wednesdays! (or at least we all cap off the night with a nice glass of chablis wine)

[JerseyTomatoMDCrab, BSN]

This describes normal behavior at that age. Now he has brain changing chemicals shoved down him every day. Stop trying to manage the side effects, manage the drug .

No wonder he can't or won't eat. I've lost my appetite just reading this thread.

Mom has no interest in taking him off medications. He was a student here before being taken out for homeschooling. I didn't work here but according to his first grade teacher, the principal and the documentation from the previous nurse, his conditions were 100x worse before he was on medications. Like, he was so anxious about a math test that he ran out of the room and was hiding in a closet, school was put on lock down for 45 minutes and he had to go home. He's functioning very well at present (other than his appetite) and doing excellent in school. Now, i'm not saying that medications are the answer to his issues but these were the examples cited when I asked why he was medicated and if reducing his dosages would be an option.

Trust me, if I could choose not to medicate some of my students I absolutely would. Unfortunately that's not my call to make.

[JerseyTomatoMDCrab, BSN]

Some of the meds for ADHD decrease appetite. Perhaps timing the food for BEFORE his meds would help. I know a child on Ritalin who could eat if it was timed.

He eats lunch at 11:30 and gets his meds at 2:00. Mom also told me he takes his AM dose at 7:45. He actually was originally taking his midday dose at 1:10 but mom had the order changed because they were wearing off too quickly after school and he wasn't getting his homework done.

[pistolchick]

I know I'm not the first to mention that it almost sounds like a possible "spectrum" issue. For the students I know who are on the spectrum and struggle with food aversions, no amount of "letting them go hungry" will solve the issue - they will simply refuse to eat the things they find aversive. A lot of people on the spectrum with food aversions prefer "white" carbs (like cinnamon rolls?) to fruits/vegetables and other healthy things because they can't cope with the strong textures/flavors of those other foods.

What Is It about Autism and Food? | Blog | Autism Speaks

[DEgalRN]

That sounds like a really rough situation for you, mom, and the student. I have a few students on ADHD medications that often complain that they're not hungry during the school day, but then I see the headaches and stomachaches that come along with not eating. I've been encouraging them to eat peanut butter or a small snack despite their non-appetite.

I really hope your student's mom brings this up with the pediatrician and gets a nutritionist on boards. Unfortunately, I'm not sure that this is something a school nurse can fix. I work with high schoolers, and sometimes they're impossible to reason with, so I can imagine that it's even harder with a 2nd grader.

It does sounds like there are some really knowledgeable people here who've given you some awesome advice though!

[OyWithThePoodles, RN]

My nephew has a sensory processing disorder and he could not do textures. He ate pureed foods until he was 3, not because he was stubborn or picky, but because he had an actual problem.

Not saying that's what is going on with this kiddo...but maybe.

I like the supplement idea. Smoothie is a good idea as well as long as it is in a texture he will eat.

I myself cannot do textures. I LOVE the taste of oranges, grapes, strawberries, yogurt. But the feel of them in my mouth makes me gag.

[nekozuki, LPN]

Pediasure, pediasure, pediasure! It's a great supplement.

Also, I have a patient on the spectrum (also showing signs of anxiety/OCD although doc says she is too young for a formal diagnosis on those particular fronts) who hates pediasure and many textures/flavors to the point of forcing themselves to vomit afterward (and also has violent episodes when anyone tries to open her mouth), so I blend up yogurt, fruit-flavored babyfood, oatmeal powder and whole milk. Other times I will blend up whole-wheat pasta, chicken or beef, vegetable baby food, and spaghetti sauce to create something tastes like spaghetti sauce but goes down like tomato soup. Often I'll add a bit of oil or melted butter to add additional calories and fat (as well as sneak in liquid vitamins). I don't permit her to eat sweets/sugar/too much white stuff, because that can cause unhealthy food addiction and worsen her behavior (since when has sugaring a kid up ever helped their ADHD, aspergers or other conditions?).

We also worked extensively with PT, OT, and speech to stimulate, exercise, and reduce sensitivity orally. Sometimes it was rubbing textured objects over the gums to help acclimate to new sensations, other times it was just stretching the jaw muscles. Our ultimate goal was to acclimate her to new textures/sensations without attaching food to it to prevent oral aversion and future feeding problems.

As time moves on, we have been able to slowly introduce new flavors by pureeing them into her usual meals without adding strange or new textures. Success has slow and incremental, but consistent.

Of course, all this is done ONLY in conjunction with a GI/nutritionist, and I perform these functions as a private duty nurse, not as a school nurse (I needed orders to give her pureed food). You perform a different role, so it may not be helpful to you. But if I were in your shoes, I would be referring Mom out to someone with the training and expertise to help her make informed decisions. Let her know you are willing to help her abide by the treatment of a GI/nutritionist/dietician/OT/ST, but it is her responsibility to do so.

Some hospitals have "feeding clinics" where kids with difficulty eating can attend daily over the course of weeks or months to help them transition to new food, so you might be able to point Mom in that direction, especially since your patient is pretty high-functioning.

None of this may be helpful to you, OP, but I thought I'd share my experiences and the remedies nonetheless! Good luck to you, and I'm so happy to see a school nurse so invested in the welfare of her patient when she doesn't have to be.