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    Toddler Anorexia
    mjibuwait posted:
    I need some help finding the right treatment for my son who is 28 mos old. Based on several internet sources, I believe he is anorexic. What type of specialist deals with this issue?
    4Watermonkeys responded:
    What does his pediatrician think? As a therapist that has treated patients with eating disorders, I would strongly caution you from basing such a diagnosis on internet sources. To label a child at such a young age with a disorder like that is a bit odd. There is plenty of research in regard to a child's likelihood of developing such disorders later in life due to various experiences, but again, to label a child at that age when the brain is in its strongest developmental stages and experiencing the most functional plasticity sounds out of line.

    I would also question if any treatment facility for eating disorders is accredited to treat a child at the age of 28 months. If any facility you find claims that it is accredited, I strongly urge you to check its credentials as well as those of the therapists and physicians.

    As far as where to start, please start with his pediatrician who is familiar with his medical history, can examine him in person, and can observe his eating habits in order to make a decision.

    Can I ask what symptoms he's exhibiting that lead you to believe it's anorexia?
    mjibuwait responded:
    Your reply makes it seem like you think a toddler is too young for the disorder. There is a disorder called infantile anorexia, maybe I should have used that term. It covers the disorder from 8 months to age 3.

    My son does not eat. I don't mean he is picky, I mean he does not like to eat and if I let him choose when and if to eat, he would choose to not eat at all. Yesterday he ate a handful of grapes over the span of the day. That is it. He is low energy and very underweight - last appointment he was in the 8th percentile and right now, 10 months later he weighs the same but is taller, so he is probably even closer to 0%. He has an appointment with our doctor on march 8th. I want to be prepared to discuss this with him then and suggest a referral. But my concern is that we will go through several different specialist before finally agreeing that it might be anorexia, which I am convinced that it is (unless they find an organic cause for him not wanting food). Reasons for this is because he acts fine, is happy, not whiney or withdrawn. He plays well with other kids. He has a dairy allergy and asthma but other than that and the low weight he is healthy. His food refusal is not absolute, he simply acts like he is not hungry so after one or two bites of food he is done. I suppose his stomach is tiny and he does not realize when he is hungry (body not signaling his brain to eat). This has been an issue since he was about 8 months old. In fact, at birth he did not have the suck reflex and took about a week before he would suckle. The percentiles for weight have gone down from about 50% at 6 mos to probably 0% now. I have been pretty relaxed about it, at the advice of others saying he will eat when he is hungry, but after so many months, and watching him get skinnier and skinnier, I realize he will not get better without help.

    You may ask, what am I feeding him maybe he does not like it. I am not a health food nut, he is offered and encouraged to eat anything except milk, cream, cheese. He can eat processed dairy (like in waffles) but not fresh dairy like in mashed potatoes. So we feed him everything we eat except prepared without the milk and cheese. He is not forced or coerced to eat. But I do coax him and put the fork to his mouth at times when he gets distracted or loses interest (which happens after one bite). The only thing he shows an interest in is fruit like strawberries and grapes. Sometimes he will eat a sausage patty, which is what is keeping him alive at this point. I even have to coax him to drink from a cup - so he is not getting overloaded on liquid either.

    The only time my son ate normally was when he was prescribed prednisone for asthma. It lasted 2 weeks and he gained a pound during that time, eating happily like a regular kid. I wish they had a drug he could take to increase appetite like that, at least for a short time, so he could get back to normal.

    Any suggestions are welcome.
    4Watermonkeys responded:
    It is possible for a toddler to experience an eating disorder; however, it is unlikely due to the reasons I stated in my first post. If you look at the specific definition of infantile anorexia and look at it in context to the fact that the brain is in its highest level of development and functional plasticity from the ages 0-7 years, it then makes the definition of infantile anorexia quite vague. The criteria that has to be met in order for that diagnosis to apply could explain a wide variety of other conditions. As a therapist, I don't think it's sound practice to apply a vague diagnosis to such a serious issue. But, that's a decision that only your son's pediatrician can make since s/he is aware of his complete medical history.

    As far as percentile ratings, those need to be looked at in context to the child's overall health. For example, my children are in the 3% for weight, yet are healthy as can be. Part of that has to do with genetics. It's basically a bell curve, someone has to be at the top and someone has to be at the bottom. Placing at the top or the bottom isn't necessarily a bad thing.

    A few things come to mind that could explain your son's weight issues. The first is that he had been prescribed prednisone at one time. Prednisone can affect weight and throw the digestive system off for quite some time, especially if the patient isn't tapered off of it properly. Attention-span can also play a huge role in weight issues. And thirdly, is your son on any other medications for asthma? Some asthma medications can cause a jittery feeling, lack of attention, and loss of appetite. You may want to check out research that ties asthma, lack of attention, and loss of appetite together - this can be explained by so many things, take the autism spectrum for example.

    As far as medications for anorexia - anorexia isn't typically treated from a pharmaceutical standpoint. And, unfortunately, psychiatric medications aren't well researched for use in children. That's part of why child psychiatrists are so hard to come by. Their field has such a huge liability risk because there just isn't enough research out there yet.

    It sounds like, given the asthma and attention issues, it would be a good idea for your son to have a thorough work-up to rule out additional allergies. One thing to remember is that children with asthma tend to be at higher risk for allergies and even auto-immune effects due to the allergies.
    FCL responded:
    Has he been tested for Celiac's disease? Given that he already has food intolerance/allergy issues, I wonder if perhaps he may not have others...
    mjibuwait responded:
    He has not been tested for celiac disease but he has had a full work up for allergies. He does not take regular meds for asthma. He is not taking any meds for the allergies - he is allergic to dairy and that is it. We just avoid. He took prednisone over a year ago so I don't think it has anything to do with his eating now. As far as celiac disease, that would have to do with gluten which he does not have a sensitivity to. His digestion is normal - bagels dont bother him. The only thing he might experience maybe reflux, but then he does not complain after eating, and is not fussy. He does not have trouble chewing or swallowing. The only behavior that would be out of the norm is the fact that he is relatively low energy for his age - I have 3 other sons, 20, 20, and 14 and they were not hyper either - this little one is sedate in comparison and will tire easily and needs a lot more sleep (but he is a light sleeper). He is cheerful, happily follows instructions, communicates and interacts normally with adults and other kids and I would have no reason to suspect ASD. As far as the weight percentiles, I use those here only to describe how skinny he is. He is so skinny, I can see all his pelvic bones when I change him. I can feel all his bones when I pick him up. People even comment on how skinny he is. When I look at him I want to cry.

    Back to my original question - what type of specialist deals with early childhood anorexia? Is it a pediatric psychiatrist or a nutritionist or some other doctor?
    4Watermonkeys responded:
    As previously stated, a child psychiatrist is the specialist that would diagnose and treat anorexia. However, please be aware that what you are describing does not meet the criteria according to the DSM for anorexia. I did a quick internet search of infantile anorexia to see what sources you are basing your thoughts on and, quite frankly, was disappointed with many of the sites. Many of them used the term anorexia quite loosely to the point that they were twisting the term and its definition to meet their own hypotheses. The DSM is quite specific about what criteria has to be met for a child under the age of three to be diagnosed with an eating disorder and from what you describe, your child does not meet the criteria in any of the three subdivisions.

    Does that mean your child doesn't have an eating disorder? No. You're the parent, and you, as well as your son's pediatrician know best. I just get the feeling that you are pushing for this diagnosis and potentially overlooking other issues.

    One serious thing I'd like you to keep in mind is that, by definition, infantile anorexia is "secondary" to other causes. Meaning, there is an underlying issue that needs to be dealt with first. Again, I get the feeling that you are pushing for this diagnosis and potentially overlooking what the underlying issue is.

    There aren't many child psychiatrists out there as previously mentioned, partially due to the liability - there just hasn't been much research in terms of psychiatric disorders or pharmaceutical treatments. So, I strongly caution you to find an excellent doctor for your son, if needed, that is well-versed in such issues.
    4Watermonkeys responded:
    I was just thinking, is there a university in your area with a psych program? If there is, you may want to check with their psychology department. Most graduate programs offer services where they will do an evaluation for either free or a nominal fee - there may be a waiting list, but it would be worth it. There, you get the best of the best since all work is overseen by professors that are active in current research and have a great deal of experience in child-psychology and eating disorders. This might be a good option in conjunction with a medical work-up to rule out or determine underlying issues.
    our_family replied to mjibuwait's response:
    Mjibuwait, I'm not sure if you are still here but if you are please email me at My 2-year-old daughter has symptoms very similar to your son's and we actually just got out of the hospital after going through feeding therapy and then having a g-tube placed. I'd be happy to compare notes with you if that would help.

    My understanding is that you need to see a feeding specialist and also a GI. The first can help you teach your child to eat and the second can start to unravel if there is an underlying cause.

    This not wanting to eat thing can be called infantile anorexia but is more commonly called a feeding disorder (probably because the reasons that little ones refuse to eat are different from the cause of anorexia which occures at a later stage in life). But, at least two different specialists have used the term as we've tried to unravel our daughter's eating issues.
    silvercup2 replied to mjibuwait's response:
    You are the only person i have found who is going through exactly the same experience as son is exactly like that - he is 25 months old and i don't know what to do...the peadiatrician just says he is supposed to eat this this and this and says he can't give any more help in this matter and we ( parents) are the only ones who can make him eat
    our_family replied to silvercup2's response:

    Very few pediatricians have an understanding of feeding issues. They are relatively rare and for the majority of "picky eaters", what your pediatrician suggests might work. But, this isn't being picky - it's either a medical or emotional problem or possibly a lack of skills such as knowing how to swallow properly, how to chew or how to move the food around in the mouth. You really need to talk to a feeding specialist. Ask for a referral to a speech therapist who is trained in oral-motor therapy and oral-sensory issues and get an evaluation done.

    Hope that helps. Feel free to email me (my email is in the post above) if you want to.
    JLinsky responded:
    Is there a medical school or large university near you? If so, call and see if you can find someone with expertise in feeding issues in infants and toddlers. I think silvercup is right to advise calling it a feeding issue rather than anorexia. I'm not sure what area of speciality is best - its falls somewhere between gastroenterology, nutrition, development, maybe even ear/nose/throat.

    In the meantime, you might try having food and drinks available to your child at all times. Maybe a "monkey plate" would be helpful - this is a large plate with small amounts of different types of food, both familiar and unfamiliar. So for your son, it could have some cut up grapes, strawberries and sausage, plus some new things - bananas, tofu, crackers, cheerios. I heard about it as a strategy for getting kids to try new things, but in your son's case maybe it would also help increase the amount he's eating.

    Will your son drink pediasure?

    Good luck and best wishes. I can imagine how frustrating and frightening the situation is for you.
    ikshu replied to JLinsky's response:
    My 19 month old daughter has very similr eating disorder as described by many here for their kids. Since my LO is also FTT and her weight is WAY below 1% (she is now 16 lbs; was born full term at 5 lb 13 oz), we had her gone through a complete medical workout---that included numerous tests and specialist visits (GI, OT, ST, PT, ENT, Cardiologist, geneticist, endocrinologist etc).....every evaluation and test came out unremarkable.....she can swallow and chew and has no sensory issues or developmental delays. The only specialist she hasn't seen yet is a pediiatric-feeding behavior analyst or a pediatric psychologist. I myself is a biomedical researcher working on national projects on health issues, so I know that there is NOT much research out their on child psychology or eating behavior.

    But my child does need approrpiate professional help. She has gone through so much of clinic experience and yet we do not know why she is SO underweight and doesn't eat enough calories. We are giving her all kinds of calorie-dense medical food, but still she is calorie deficient.

    My Q to ALL who suggested a evaluation by a graduate program in a University.....HOW should I approach them for an evaluation. We are within 5h-driving distance from University of NEbraska Medical Center that runs Munroe Meyer Institute for feeding behavior and also University of Minnesota. Both the schools has Psychology departments and graduate programs. Can I just directly call them and ask for an evaluation appointment?

    PLEASE HELP....WE NEED AN ANSWER/SOLUTION TO WHY MY OTHERWISE HEALTHY TODDLER IS SO SEVERLY UNDERTWEIGHT? I am unsure about any long-term consequences of this in her later life.....if she will survive this and grow up well.....
    a123b456 replied to ikshu's response:
    We have the same problem with our 28-month old daughter - asthma, food allergies and complete lack of appetite. Please, if you are reading this, let me know if you have any updates.
    seeit2 replied to a123b456's response:
    ikshu - there is food allergy exchange on webmd:

    I don't know if we can offer a lot of insight with the feeding issues but many of us are living with children with milk allergies and asthma. Please come join us! (For the record, we have all noticed that our children refused their allergic foods long before the allergy was diagnosed - as if they somehow knew they should not be eating it...I think that's really interesting and perhaps relevant to this thread)


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