Question from Ana:
Hi, My son just turned 5yrs. He weighs the same now as he did 9 months ago. Tonight, I noticed that I can see his back ribs and count all of them. This past month and a half, he has the following .. Heightened sense of smell (everything smells yucky), almost everything he used to love to drink and eat tastes yucky, nausea, a few episodes of headache and vomiting, eats maybe 2-3 bites of food if lucky, memory loss. He has lost weight and today he ate 1 or 2 bites of a bagel, vomited his 3 bites of cheeseburger, and could only keep down a slice of bread for dinner (he kept gagging on his favorite pasta). He tells me he is hungry but before I can feed him, he says he’s full even though I purposely make sure he doesn’t drink before eating. The pediatrician did not think neurological, so we saw a psychologist today who recommends therapy for ADHD. I don’t think this is ADHD related and my “healthy” child is dwindling away. I need a second opinion, what should I do next? I even offer him candy and ice cream which he LOVES, and he declines. He has basically been living off cheese sandwiches, grape juice, and chewable vitamins.
Oops, I forgot to mention, he also often says his tummy feels funny. I had him retested for food allergies (because he does have allergies) but this seems not to be the cause. Nothing new found. He went from 98-99 percentile since birth, to about 10 %.
Answer from: Keith-Thomas Ayoob, EdD, RD, FAND, our contributing Nutritionist. If you want to learn more, please follow Keith’s twitter @KeithAyoob
A couple of things concern me here. There may be a few things happening. It may not be ADHD (and I’m not a psychologist but I wouldn’t rule it out just yet — it may be worth a few sessions to see what happens) but I’d suspect at least something behavioral and here’s why: He says he’s hungry and then he denies it when you give him food. He’s been able to hone his diet down to his most favorite foods and may keep doing so until he is allowed to live only on those foods. He’s also getting a lot of attention for his efforts (the gagging, the complaints of an upset tummy, and on) and he may be loathe to give that up. There can be a payoff for him by seeing you get stressed when he turns down food he usually likes. The attention can be alluring to a 5-year-old who now has mommy exactly where he wants her. Stop begging him to eat and set some limits. Also let him know that when he says he’s hungry and then refuses food, he may not get the food he wants the next time because you won’t believe him. As for the cheese sandwiches and grape juice, those are fine but let him know that there’s a way to get them — he needs to taste (and without gagging) the foods prepared for the regular meal. If he gags, he needs to know he will not get the cheese sandwiches or grape juice. As for juice, it only comes after some food is eaten. If his behavior turns into a food tantrum, do not reward it. Also, if he exhibits lots of these food refusals and you don’t pay it much attention, watch what he does. If he acts out, then it may very well be behavioral. By the way, his tummy may feel funny when it’s been too long without food. As for a second opinion, you might consider a gastroenterologist, just to rule out anything organic going on. Hope this helps.
Keith-Thomas Ayoob, EdD, RD, FAND
Associate Clinical Professor
Department of Pediatrics
Albert Einstein College of Medicine
1165 Morris Park Ave. 4th Floor
Bronx, NY 10461
718-430-3970 ext. 6412