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!

[OldDude]

My #4 son is a kid like Spidey's mom is talking about. I believe if he was attending another district there would have been a push for him to take ADHD meds. He is very fidgety and has trouble sitting still. The solution was to allow him to stand at his table instead of sit during elementary school. As he developed and passed through grades he has been able to compensate and sit more but he still stands occasionally during class. He is an AB student. Having athletics as the last period of the day this year is very helpful. He is in 7th grade now. Of course I've laid the groundwork for this classroom intervention with the staff.

[Spidey's mom, ADN, BSN, RN]

Check out NIMH resources. Lots of research info there. And what about a possible link between the increase in broken homes, drug abuse, etc.? Maybe the kids are just shellshocked by their home life.

Clearly context matters. What one parent might consider hyperactivity, another parent might consider healthy exuberance. What physicians once called attention deficit hyperactivity disorder (ADHD), often now elicits a diagnosis of childhood bipolar disorder, leading to a 40-fold increase in prevalence from 1994-1995 to 2002-2003

http://www.nytimes.com/2014/05/17/us/among-experts-scrutiny-of-attention-disorder-diagnoses-in-2-and-3-year-olds.html?_r=0

Dr. Visser said that effective nonpharmacological treatments, such as teaching parents and day care workers to provide more structured environments for such children, were often ignored. Families of toddlers with behavioral problems are coming to the doctor's office for help, and the help they're getting too often is a prescription for a Class II controlled substance, which has not been established as safe for that young of a child,” Dr. Visser said. It puts these children and their developing minds at risk, and their health is at risk.”

[lavenderskies, BSN]

Some kids really are into dipping. So you can have little containers of dipping things (breadsticks, crackers, pretzels, veg sticks, fruit wedges etc) and other containers of things to scoop up (yogurt, nut butters, humus, pate', refried beans etc).

Other kids really like compartmentalized foods....like trays with small cubed foods. Meat cubes, cheeses, fruits, veggies, beans etc. Sometimes it's all about the utensil to pick it up....maybe they like toothpicks or chopsticks or whatever.

One of my kids loved hot food. So he was all about the thermos. Soups, chili, lassagne, Mac n cheese, raveoli, etc.

Just ideas.

[canigraduate]

Not a nutritionist or a school nurse, but I come from a line of odd people with food issues.

I would recommend a nutritionist, for sure. My brother and both are picky about textures, tastes, and touching. (Ha! Look at all that alliteration!) Some of it we were able to get around, but not all of it. There are things that induce instant vomit for both of us.

My ped told my mom to let us eat what we could tolerate and try to work in small amounts of stuff. The rule was we had to try one bite of everything. We puked a lot. We were also poor and learned to hold stuff down 'cause that was all we were gonna get. Hunger is a great motivator.

I don't know if that helps, but I just thought the perspective of a picky eater might throw some light on the situation.

I really like the smoothie idea, if he can tolerate it. I love smoothies, as long as I don't know what's in them.

[Nurse Leigh]

Not a nutritionist or a school nurse, but I come from a line of odd people with food issues.

I would recommend a nutritionist, for sure. My brother and both are picky about textures, tastes, and touching. (Ha! Look at all that alliteration!) Some of it we were able to get around, but not all of it. There are things that induce instant vomit for both of us.

My ped told my mom to let us eat what we could tolerate and try to work in small amounts of stuff. The rule was we had to try one bite of everything. We puked a lot. We were also poor and learned to hold stuff down 'cause that was all we were gonna get. Hunger is a great motivator.

I don't know if that helps, but I just thought the perspective of a picky eater might throw some light on the situation.

I really like the smoothie idea, if he can tolerate it. I love smoothies, as long as I don't know what's in them.

I've actually considered trying hypnosis to "encourage" my taste pallette to expand. The texture thing is a tough one - for many people, a dinner of calamari and other things with tentacles is a delight to be savored. For me? A tortuous meal of rubbery nastiness.

[Farawyn]

Mmm... Tentacles.

[OldDude]

Mmm... Tentacles.

It's an acquired taste...

[explorereb96, ADN, BSN]

Some research shows we are pushing our young kids too much, too soon. If the child was "100X" worse before meds, maybe he had too much expectation on his plate for a young boy; especially a boy. Boys are less able to sit still and do workbook-style classroom activities. Kindergarten used to be the time when kids learned things by play. Now, they sit at desks and are expected not to act normal - fidgety, talkative, etc.

I'm truly bothered by the trend to medicate kids for what is most likely normal behavior or behavior that shows the kiddo is being asked to do too much for his/her age.

I'm in the middle of a discussion with a group of parents who are invested in that Baby Wise book by the Ezzo's and trying to rigidly schedule a baby's life so it lessens the impact on the parents lives. I think parents nowadays are unrealistic about what it means to have a child and raise a child. So, let's medicate any behavior that might just make our lives more difficult. But that's another story.

I am not sure if constant rigid scheduling really is the problem. Our Asian counterparts have been doing exactly this for centuries (I am NOT saying I agree with it). Yes, I agree that there ARE many children that are being medicated for behaviors that were considered normal years ago. It's so subjective. I can't tell you what it is physiological or psychological or both. I just see a VERY fundamental change in the way children behave from generation to generation, with it getting worse. I have seen kids that without medication would be literally bouncing off the walls and running around like a schizophrenic cat. Then I have seen parents look at like their at their wits end with relatively placid kids. I don't think anyone has all the answers. Hey, I still don't. I have a 27 year old son with Asperger's that has an Plastics Engineering Degree but has such a social phobia that he is unable to obtain and/or keep a job. He stays isolated in his room playing video games. We ran the gamut of failed attempts of Life Skills....etc. He has been on many meds and has been completely off of them too. What you see is what you get. I have gone through enough, it's time to live life.

[canigraduate]

I've actually considered trying hypnosis to "encourage" my taste pallette to expand. The texture thing is a tough one - for many people, a dinner of calamari and other things with tentacles is a delight to be savored. For me? A tortuous meal of rubbery nastiness.

I did that, actually. It helped a little.

My "no way, Jose" is fried vegetables. Okra, squash, whatever. It's like eating warm, crunchy snot. I vomited in my mouth a little just thinking about it.

Can you imagine being Southern and not being able to eat fried stuff?

Oh, the shame!

[amoLucia]

Back to the supplement idea - maybe kiddo would like to blend his own supplement shakes using his own blender to watch it swirl & mash up things. He can 'earn' all kinds of points if he adds new things, drinks it all, has 2 or more add-ins., makes such & such calories or grams of protein, etc. Make a game out of it. A sweetened vanilla shake with some yogurt and a dash of cinnamon sounds good to me. (And it's all white.) Added protein powder can be good, but can be gritty. Mom can provide a small battery-operated blender that is for his use only in your office.

I do caution one MAJOR warning. DO NOT try to hide anything in his supplements. I remember in psych, we were prohibited from doing that for fear that the pt would discover and lose trust in you fearing you were suspiciously poisoning him.

I try to be creative with my own protein shakes. Makes it worth it to me to counterbalance the need to wash my blender after use (I hate washing my blender.)

[clockwood]

I had a similar situation...a student on the spectrum with "food aversions" who was also on a stimulant medication. Mom was actually blaming school for his weight loss. Ha! The lunches she packed him were not healthy or calorie dense. I emailed mom (so that there was hard evidence of my action) that I too was concerned and recommended a f/u with pediatrician and/or nutritionist and/or behaviorist/psychologist.

[hppygr8ful, ASN, RN, EMT-I]

Your description of the student in question meets almost all the defining criteria of Asperger's or High Functioning Autism as it is now called. It is important to note that many children with HFA go undiagnosed until adolescence and sorely miss out on early intervention services that can improve their over-all outcome and development. I worked with many people on the spectrum who are all almost genius level intelligence including my own husband who is an aerospace engineer even though he dropped out of school in the 7th grade. He was inappropriately diagnosed with ADD as a child and the system as it was back then just gave up on him because his parents would not medicate him. As a school nurse have you thought about referring this child for early intervention services. A good interdisciplinary team can get this child started on the right educational and treatment path to achieve his highest level of success. My son when through a period of very picky eating and my pediatrician told me "You know what solves that?" "What I asked." "Hunger he said." We simply removed all foods from the house that were not acceptable and it took about two weeks but the boy was cleaning his plate" If this child has HFA it may be more difficult but if he prefers certain shapes, textures or colors the food should be prepared that way at least for now. The child will not starve to death and a pediasure two or three times a day will solve the calorie and nutrition deficits.

Hppy