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!

[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

[Roy Hanson]

get the kid to help mom make his meals. The kid has to be trained that sugar means are not good for him, and because of your condition, of ADD,,etc, etc, Sugar kept to minimum.

Thats a nice way of slowing him down. Get the kid involved. The mom is probably uneducated about this, and the kid is doing what most kids do..go for the sweets.

[DeeninNurse]

I was just going to write the same thing! You summed it up! My wife was a behavioral therapist and she worked with many autistic kids. One of the kids was a 5 year old boy who had issues with eating. He would only eat poptarts and cheetos. She started off by first playing with fruits and veggies. He had a phobio even touching them. Slowly but surely he started playing with them and picking them up. Then she moved onto picking it up and moving it close to his mouth. Finally he tasted. Eventually he ate fruits and veggies but not all of them. He had a preference for some over others. Keep up it up, it's worth the hard work!

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

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.

That's great advice. Kids are not going to starve. Let them miss a meal or two.

[wooten3955]

I have been a special education teacher for 10 years, but am in nursing school now because I need a change of pace. In my professional opinion, everything you have described about this kid screams Asperger's or autism (specific obsessions, ex. stickers; very science-minded; likes to be right; sensitive to sensory stimulation). Problems with sensory integration are common in children with Asperger's/autism. This would explain why he is so picky about the temperature and texture of his foods. If he was a typical kid, I would agree with the above posters who have said that kids today have too many choices, and they should just eat whatever mom or dad makes for dinner. However, kids with Asperger's or autism really can't help it. My friend's son has Asperger's, and he is extremely sensitive to textures. For example, if he feels a bit of gristle on a piece of meat, his whole dinner will come up. Unfortunately, it's just part of the condition. It's very likely that as he gets older, he will outgrow this and the variety of foods he will eat will expand.

You have done your part by attempting to educate this young man and give tips to his mom. But it is time for them to do their part. You are experiencing some of the frustration I often feel as a special ed teacher. You can teach your heart out, but in the end, HE has to want to change.

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

For example, if he feels a bit of gristle on a piece of meat, his whole dinner will come up.

Blech . . . that makes me sick as well. That and that blob of fat on prime rib that people eat too.

We really have to make sure we look at the whole picture and get a medical/psychological screening from a reputable source for kids.

I've been in 504's and IEP's with our local psychologist and his favorite diagnosis is Tourette Syndrome. We are a small school district and the odds of having as many kids with TS here is astronomical. I've also worked with him as a consultant in our local ER. I don't trust him at all.

Just be careful.

[yogastudentRN]

I would refer to counselor. This definitely sounds like a behavioral /sensory issue and I think the counselor would be in a better position to address it, or if he gets speech or OT that might also be a better way to approach.

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

http://well.blogs.nytimes.com/2016/03/11/is-it-really-a-d-h-d-or-just-immaturity/

New research shows that the youngest students in a classroom are more likely to be given a diagnosis of attention deficit hyperactivity disorder than the oldest. The findings raise questions about how we regard those wiggly children who just can't seem to sit still – and who also happen to be the youngest in their class.....

[JerseyTomatoMDCrab, BSN]

Update!

Little man has eaten his entire lunch for the past 4 days. I am thrilled. Mom started packing him chicken or tuna salad with little crackers so he can make tiny sandwiches. He seems to really like that plus it eliminates the "soggy" aspect of bread. I also suggested mom start packing him Greek yogurt or something to get a little protein in him and he has been enjoying that as well.

The last day he didn't eat his lunch he told me "it looked disgusting so I threw it away" and if there is one thing I cannot tolerate it's wastefulness, especially with food. I closed my door, sat him down and gave him the old "there are kids who don't ever get to eat lunch who would be so happy to have the food you just threw in the trash" speech. I didn't mention starving kids in Africa like my parents did. Didn't seem relevant. But this child is very compassionate so he was able to really connect with the notion that he is lucky to have food at all.

We will see what today brings! Have a great day, friends.

[BeckyESRN]

I have a girl that's been eating in my office conference room because she gets too distracted in the cafeteria to be able to eat. This has been an issue for months now and she loosing weight. Mom called yesterday, little girl's weight is up 5lbs! I was so excited! I love these little victories! Congrats on this victory Jersey!

[MrNurse(x2), ADN]

Thanks for the update.