Refusing to eat and throwing up because of crying

[nmosur]

A little history first - DD is 5 and just started kindy. She has always been a poor and slow eater. She will eat a variety of foods but just very little in quantity. She is in the 5 to 10 percentile weight range. She primarily ate home cooked food - Indian food with once a week Chik-Fila thrown in for lunch. She was in pre-school for four years and never ate lunch at school. I fed her lunch after getting her back to school even though they did have a lunch break (9:30 to 1:30 with lunch around 12:30 or so). She was fine - no constipation or stomach aches or any kind of nutrition issues.

Fastforward to last month. School starts at 8:00 am which means that she wakes up at 6:00 am and is ready by 6:30 ish. She has an hour to eat breakfast (which is why I wake her up early). Lunch is at 10:30 for 30 to 40 minutes. I cannot send lunch or snack, the school provides both. The lunch menu is exhaustive and has very healthy choices - I rarely see anything that I can say in unhealthy. Dessert is a cookie or graham crackers. Lot of vegetable choices and atleast a couple of main courses.

Our food struggles start in the morning with breakfast - she does not want to eat anything. It takes a lot of cajoling and begging on my part and crying and threatening to throw up on her part. Probably eats half peanut butter jelly sandwich, if that. I look up the menu and tell her what her lunch choices are so that she can decide what she wants to eat for lunch. The minute I put her in the car she starts whining about not wanting to eat lunch at school. And she hardly eats anything at school. Most of the time she can't seem to find what she decided on - they have a vast selection. A couple of spoons of food and time is up. I suspect that she spends a lot of time looking at the food available and the rest of the time talking or getting settled in the eat. Snack is either an apple or banana. Again, she cannot finish it because she is slow and doesn't ever eat the bananas because they are unripe and green. We come back home around 2:15 and she gets milk and nuts or fruit. I offer a snack at 4:30 which she may not eat - cheese/yogurt/apple - something healthy. Dinner is a nightmare again. I cannot push is back later than 6:30 but there have been times when it is 8:30 by the time she is done and that makes the next morning really bad. Last week she missed school because she developed very bad stomach pain - mostly because she is not eating at home or school and the food in school is not agreeing with her system.

I talked to the school counselor hoping that she would offer suggestions. Her suggestion was to not force her to eat or for that matter show any kind of stress when it comes to eating. But make sure that she eats something for breakfast. How to I do this??? How can I let a child not eat anything if she doesn't want to knowing that she is going to have bad stomach aches. The stomach aches were so bad that she sobbed whenever she had them. Plus was constipated from eating nothing. And throwing up from a combination of being afraid to eat because of the stomachache and acidity.

I am at my wits end and extremely stressed out. Our family life has been hijacked by this issue and it seems like every minute of our life revolves around her eating. I know this is not good for her but then how else do I make sure she is getting what she needs? Until the stomach ache episode, I just let her be if she didn't want to eat. I provided the food and she decided if she wanted to eat. Yes, sometimes I cheated and provided food that I knew she would eat or offered an incentive to eat but most of the time I let it go. This worked very well and she moved up higher on the scale in summer but has lost atleast 3 to 4 pounds in the last one month (she weighed 36 lbs when school started).

Please weigh in with suggestions on what to do. Should I let her go to school without eating anything even though I cannot bear the thought. How do I deal with the stomach issues and throwing up which I am afraid will end up as a regular issue. Any BTDT advice??? Please help.

TIA

[Cuckoomamma]

It sounds like food sensitivities to me. I grew up very similar to your dd with breakfast and eating very little at school. I started having migraine headaches when I was 6. They became increasingly worse over time so that I was missing school all the time. I only discovered it was because of food allergies after I had my two girls and needed to do an elimination diet because I was nursing them and they have food allergies.

My whole family remembers how every single night after we finished eating dinner I'd end by saying, "I feel sick".

Food may very well be making her ill and taking away her appetite. Are you open to doing an elimination diet?

[misshollygolightly]

No BTDT, but have you talked with her pediatrician? Is her ped. concerned about her weight or eating habits? If not, then that might be reassuring. Some other thoughts off the top of my head:
If she doesn't like to eat breakfast, would she try drinking a smoothie?
How about serving some non-breakfast foods for breakfast (think brown rice, leftovers from dinner, sandwich, etc.)?
Can you involve her in more of the grocery shopping and cooking so she's more invested in the food?
Can you eat lunch with her one day at school to help model some skills for navigating the lunchroom?
Would she eat a lunch from home? That might take out some of the guesswork involved in choosing and eating from the school menu.

[nmosur]

I am willing to do an elimination diet - anything to make her healthy. But I don't think it is food sensitivities. Its more of a control issue which goes away when I don't play into it. Weekends she has a great breakfast because we eat late - around 9-ish. The same breakfast that she gets everyday - nothing new. There have been days in the past when I let her go with nibbling a few bites and she makes it up the next meal, next day, etc. The issue this time around is stomach aches and acidity - which is why she needs to eat and not walk out of the house on an empty stomach.

As for her ped., he doesn't really seem to care much about the non-eating issue other than yes, she has to eat more and gain weight. And to not make it a control issue. And he is ready to medicate her for the stomach issues which I don't want to.

She gets to pick what I make for breakfast/lunch/dinner. She doesn't care much for liquids so smoothies are out - it can come back up easily so she really seems to prefer solids. I will give non-breakfast items a shot in the morning and see if that works.

[Clarity]

Originally Posted by nmosur

I am willing to do an elimination diet - anything to make her healthy. But I don't think it is food sensitivities. Its more of a control issue which goes away when I don't play into it. Weekends she has a great breakfast because we eat late - around 9-ish. The same breakfast that she gets everyday - nothing new. There have been days in the past when I let her go with nibbling a few bites and she makes it up the next meal, next day, etc. The issue this time around is stomach aches and acidity - which is why she needs to eat and not walk out of the house on an empty stomach.

If this is the case and it's not that there is something physically wrong with her, I'd do exactly what the school guidance counselor suggested. Meals have become a battle ground for you both and you need to be the one to step back from it.

Ellyn Satter is a pretty well regarded nutritionist by mama's here, pick up one of her books. Here's her division of responsibility in feeding that is found on her website: http://www.ellynsatter.com/ellyn-sat...ding-i-80.html

[fivi2]

I have a question - you said in your post: "Yes, sometimes I cheated and provided food that I knew she would eat or offered an incentive to eat but most of the time I let it go. This worked very well and she moved up higher on the scale in summer but has lost atleast 3 to 4 pounds in the last one month (she weighed 36 lbs when school started). "

Out of curiosity - what kinds of foods were those? What is wrong with continuing to offer foods you know she will like? I pretty much always offer at least one thing I know my kids will eat.

It sounds like you had a system that worked for a while?

I am sorry, I am sure this must be frustrating! Perhaps a nutritionist could help?

eta: I agree with pp - I would either look for a therapist or a nutritionist. Someone with experience in the area.

[nmosur]

Originally Posted by fivi2

I have a question - you said in your post: "Yes, sometimes I cheated and provided food that I knew she would eat or offered an incentive to eat but most of the time I let it go. This worked very well and she moved up higher on the scale in summer but has lost atleast 3 to 4 pounds in the last one month (she weighed 36 lbs when school started). "

Out of curiosity - what kinds of foods were those? What is wrong with continuing to offer foods you know she will like? I pretty much always offer at least one thing I know my kids will eat.

It sounds like you had a system that worked for a while?

I am sorry, I am sure this must be frustrating! Perhaps a nutritionist could help?

eta: I agree with pp - I would either look for a therapist or a nutritionist. Someone with experience in the area.

She likes chicken fingers with fries, steamed broccoli, chicken noodle soup from Panera. I would give her those but for the stomach problems she developed last week. Deep fried food and a gassy vegetable wouldn't help her. I did give the soup but she ate just half a bowl of that last week.

I do not offer her things that are not healthy on a daily basis.

[egoldber]

But I don't think it is food sensitivities. Its more of a control issue which goes away when I don't play into it.

This dynamic would really concern me and not just because of the lack of food/weight. The things you say about the food rituals, taking forever to choose and eat her meal....these are all things that people with eating disorders do with food. There is more and more recognition that eating disorders start much earlier than was previously realized.

Obviously, no one can know what is going on from here, but if it were me, I would see someone who can help you and your DD work on her relationship with food. Right now she is using food as a means of control. I would want an expert to help me with this before it becomes a behavior/control mechanism that becomes any more ingrained.

[nmosur]

Originally Posted by egoldber

This dynamic would really concern me and not just because of the lack of food/weight. The things you say about the food rituals, taking forever to choose and eat her meal....these are all things that people with eating disorders do with food. There is more and more recognition that eating disorders start much earlier than was previously realized.

Obviously, no one can know what is going on from here, but if it were me, I would see someone who can help you and your DD work on her relationship with food. Right now she is using food as a means of control. I would want an expert to help me with this before it becomes a behavior/control mechanism that becomes any more ingrained.

What kind of expert do I go to?? Or take her to??

I did go to a counselor myself to deal with how to behave with her when it comes to food and it helped she suggested that I let go and I did that. What I didn't agree with or couldn't do was offer anything that she would eat. The counsellor suggested that I give her whatever she wanted even if it was something that was zero nutritionally.

[Trigglet]

I want to say this gently because it's clearly a very upsetting time, but I think PPs are onto the right track - it sounds like you both have an unhealthy dynamic around food, not just your daughter. And if it were me, I would be more concerned that she was not getting any nutrition than that she was getting an 'unhealthy' kind. You can make chicken fingers and fries healthier, and chicken noodle soup and steamed broccoli sound perfect. I'm really not sure what your concern is about those foods. She won't get really sick from eating some 'unhealthy' things for a while, but she sure as heck will if she's basically starving herself.

Kids are immensely resilient(gastrically speaking!), and whilst I'm not advocating a cr@ppy diet of fast food all the time, I think that it's more important that she eats regularly and without drama (yours included). Creating stress and tension around food (either what she's eating or how much) will not help the problem.

I think you need to see a counsellor that specialises in childhood eating issues, and also get a paediatric GI referral to rule out any physical problems (though given your description, I'd be surprised if it was physical).

Good luck and I really hope you and DD can find a happy and healthy balance.