Getting Kids on Stimulant Meds to Eat

[wendyroo]

What are your best tips and tricks for getting adequate calories into kids on stimulant meds.

 

Peter's focus/control/behavior are tremendously improved on Focalin (Immediate release, not XR.  He takes a dose after breakfast and another after lunch.), but he is losing weight that he cannot afford to lose.  His psychiatrist is saying that if Peter doesn't gain weight in the next month that he will have to stop taking the Focalin.  

 

He eats very little, even for breakfast before he has taken any medication.  He just seems unable to ever focus on eating and totally uninterested in food.

 

ETA: Peter's anxiety also makes him a very picky/cautious eater.  We have gotten to the point that he will eat a wide enough variety of single ingredient foods (several meats, cheese, a couple fruits, a couple veggies, a couple whole grains), but he rejects a lot of foods (avocado, hummus, milk, smoothies, anything with butter on it, casseroles, soups, etc).

 

Wendy

Edited February 15, 2017 by wendyroo

[maize]

Will he drink calories? I would look into protein shakes or better yet home made smoothies high in protein and fats.

 

This is a concern for one of mine--we did a short trial of stimulant meds but the appetite suppressant effects are not good for a kid who is already skinny.

[BlsdMama]

What are your best tips and tricks for getting adequate calories into kids on stimulant meds.

 

Peter's focus/control/behavior are tremendously improved on Focalin (Immediate release, not XR.  He takes a dose after breakfast and another after lunch.), but he is losing weight that he cannot afford to lose.  His psychiatrist is saying that if Peter doesn't gain weight in the next month that he will have to stop taking the Focalin.  

 

He eats very little, even for breakfast before he has taken any medication.  He just seems unable to ever focus on eating and totally uninterested in food.

 

Wendy

 

 

We are dealing with this.  

 

DS began Concerta in a low trial dose, did well.

Then they upped the dose to normal levels.  I didn't notice a behavior change but he did drop three pounds.  DS is a super skinny kiddo and didn't really have the three pounds to lose.  We backed down the dose and made sure he ate well before his dose and then ate something at lunch and then he eats normally at supper time as we do not do a second, later dose.  

 

He gained back three pounds this month.  

 

So, I will say the Focalin might not work for him but don't worry, something else might work great.  I was worried this past month because Concerta has worked SO well for him that the idea of going off it made me want to cry.  I think backing down the dosage helped.  We do try to get breakfast in him and get that dosage early in the AM so that he will eat at night.  Pushing snacking - odd but true.  

[BlsdMama]

And have you explained all this to him?  Bringing him on board as an advocate for his own health might help too - he has a vested interest in staying healthy and it's helpful to know he just needs to eat a small snack here and there through the day rather than one bigger meal might help.  

[wendyroo]

Will he drink calories? I would look into protein shakes or better yet home made smoothies high in protein and fats.

 

This is a concern for one of mine--we did a short trial of stimulant meds but the appetite suppressant effects are not good for a kid who is already skinny.

 

I doubt it.  He refuses milk, chocolate milk, any fruit punch like drinks and smoothies.  He will occasionally drink apple juice, but I'm not sure how to leverage that into consuming adequate calories.  He mostly just chooses to drink water.

 

Wendy

[wendyroo]

And have you explained all this to him?  Bringing him on board as an advocate for his own health might help too - he has a vested interest in staying healthy and it's helpful to know he just needs to eat a small snack here and there through the day rather than one bigger meal might help.  

 

I've discussed it with him before, but after this morning's appointment with the psych I need to really sit down with him and stress the importance of eating.  Maybe he and I can brainstorm a list of snacks that he would be more interested in.

 

Of course, just to make life more complicated, the 5 year old is at the very upper end of the BMI scale and very interested in food, and therefore should not be encouraged to eat high calorie snacks.   :willy_nilly:

 

Wendy

[maize]

If he is already choosy about foods this could be really hard.

 

Does he follow a schedule or checklist? If so maybe you could make regular snacks into expectations that need to be checked off, just like chores or school work. If he could eat some cheese cubes and nuts, or toast with extra butter or peanut butter, or, well, whatever calorie dense snacks are acceptable to him every 1-2 hours it might make up for smaller meals.

[wendyroo]

So, I will say the Focalin might not work for him but don't worry, something else might work great. 

 

This is the 13th med we have tried.  He was diagnosed 3 years ago, and we only, finally, found a med that worked 6 months ago.  The first dozen medications were either ineffective or had too many side effects.

 

We have a very vested interest in getting his weight up so that he can continue to take Focalin.

 

Wendy

[eternalsummer]

well, apple juice is calories.  Not like the best calories in the whole world, but calories.  

Does he wake up hungry at night?  Is he able to eat before bed?  Does he like ice cream?

[eternalsummer]

and apple juice would be easy to dilute for the 5 year old.  you could give them both "juice" - just one is a lot juicier.

[Zinnia]

I have a child that is...quirky.  For right now, he's functioning fine, and so he hasn't been tested and I don't have dx, but he's just....quirky.  One of his things is that he never, ever stops moving, is super skinny, and he is super picky about foods.  

 

This child really likes ranch dressing IF it's made from mayo, sour cream, buttermilk, and a package of mix.  No other combos.  :)  He likes salad, and so I pour the ranch a bit heavy at times, and he eats that fine.  He'll eat seconds or thirds of this.  Bonus for us is that his 2 years younger brother that struggles with weight is not nearly as interested in salad.  :)  

 

 

[Ravin]

I'm at a loss. Both DD and my little brother have little appetite because of their meds, but mostly in the middle of the day. They'll eat breakfast and usually an after-school/afternoon snack and dinner, even if they skip or skimp on lunch.

 

My sisters had trouble gaining weight when they were young teens and my mom made them drink Carnation Instant Breakfast in milk in addition to their regular breakfast. Nowadays Pediasure would probably be the better option to that. But if he's not even hungry at breakfast? I don't know.

[Lecka]

I went to a presentation about Food Chaining by Cheri Fraker.

 

The speech therapist who put it on is someone I really like and think is good.

 

But I didn't think any of my kids were picky enough to do the program.

 

But it might be worth looking at the book from the library?

 

Bc he sounds like he was a picky eater even before the Focalin, and it is a picky eater book.

[RebeccaS]

My oldest ds has the same issue.  (and he's always struggled with weight gain-FTT as an infant, feeding tube for years, super picky eater)  His doc put him on an additional med to try to stimulate his appetite.  It mostly works for him.  

[EKS]

My son only took a short acting version in the morning.  That way he was hungry certainly by breakfast the next day and he would also eat at least something at dinner.  He also didn't take any meds on weekends or holidays, so I loaded him up then.

[Katy]

The no milk thing is tricky. I had short term care for a kiddo who would drink milk.  Her doctor had me switch her milk to half and half, which got lots of extra calories into her without depriving her siblings of anything that would be considered a treat.

 

There's also an old nursing trick of making a "chocolate milk shake" out of a scoop of ice cream and a meal replacement shake like Boost.

 

How does this kid feel about non-healthy foods that are higher in fat?  Cheese?  Nuts?  Peanut butter?  Snickers bars?

 

What about highly processed "bad" bliss-point foods like Doritos that are made specifically to override your natural appetite?

 

 

No clue how to go about getting more junk food into a kiddo without letting siblings have it, just thinking about what he might like that's high in calories.

[anmom]

I didn't read the other responses so sorry if this is redundant. Does he get hungry at night when the meds wear off? My son is always very hungry at dinner time. Our pediatrician said to let him eat whatever he wants and to get his calories in then. I have also tried delaying giving it to him in the morning until after he eats breakfast. He has done well and hasn't lost any weight. 

[City Mouse]

If you put off his morning dose for 30-60 minutes would that allow him to eat more?

 

Also, it is fine to let him eat his favored foods at non traditional time. It doesn't matter if he eats meat and cheese for breakfast. My quirky kid like to eat macaroni and cheese for breakfast.

[wendyroo]

I didn't read the other responses so sorry if this is redundant. Does he get hungry at night when the meds wear off? My son is always very hungry at dinner time. Our pediatrician said to let him eat whatever he wants and to get his calories in then. I have also tried delaying giving it to him in the morning until after he eats breakfast. He has done well and hasn't lost any weight. 

 

No, he does not get hungry at night.

 

Based on his behavior, we think his meds are wearing off after about 4 hours.  He takes his first dose at 7am after breakfast (I offer/encourage a snack mid morning) and we see a lot of challenging behaviors resurfacing at 11am.  Then he takes his second dose around noon after lunch (I offer/encourage a snack mid-afternoon) and things start to fall apart again by 4pm.  We eat dinner at 5 or 5:30 and I try to push a snack on him right before bed at 7 or 7:30.

 

His best meal of the day is dinner.  Not great, but 1/4 cup of chicken, 1/4 cup of peas, maybe a stray bite of mashed potatoes.  I wonder sometimes if that is because his meds are just the perfect amount worn off by then - not suppressing his appetite too, too much, but still giving him just enough focus to sit and eat for more than 5 minutes.

 

Wendy

[maize]

Can you load up the chicken and peas with butter?

[Jenn in FL]

:grouphug:  :grouphug: BTDT(with Vyvanse.)  Ditto the ensuing and completely predictable lack of appetite.  More  :grouphug:  :grouphug: . So frustrating!

 

Disclaimer: this was a college aged kiddo, rather than an elementary aged child, so definitely a different dynamic.

 

Would he try/sample a "popsicle?"  What if you tried freezing a meal replacement drink such as Ensure Plus, frozen in a gallon freezer zip loc bag folded in a such a way as to create a long thin push up pop? It might appear less intimidating to consume and perhaps it could be tied to one of his current interests.  "Eat this and you may do this..."  During especially desperate times, I was not opposed to resorting to bribery.  :lol:  :lol:

 

Edit: autocorrect!

Edited February 15, 2017 by Jenn in FL

[anmom]

Maybe. We are actually on the extended release dose so only take it in the morning. That might be something to look into. He tried the twice a day and we had too much struggle between the morning one wearing off and the next picking up. Once a day has been great, although it does wear off around dinner and things start to get a little hairy sometimes :) Although, he does eat well. We do have a late dinner compared to some though, so that might make a difference too. 

 

 

No, he does not get hungry at night.

 

Based on his behavior, we think his meds are wearing off after about 4 hours.  He takes his first dose at 7am after breakfast (I offer/encourage a snack mid morning) and we see a lot of challenging behaviors resurfacing at 11am.  Then he takes his second dose around noon after lunch (I offer/encourage a snack mid-afternoon) and things start to fall apart again by 4pm.  We eat dinner at 5 or 5:30 and I try to push a snack on him right before bed at 7 or 7:30.

 

His best meal of the day is dinner.  Not great, but 1/4 cup of chicken, 1/4 cup of peas, maybe a stray bite of mashed potatoes.  I wonder sometimes if that is because his meds are just the perfect amount worn off by then - not suppressing his appetite too, too much, but still giving him just enough focus to sit and eat for more than 5 minutes.

 

Wendy

 

[historically accurate]

What are your best tips and tricks for getting adequate calories into kids on stimulant meds.

 

Peter's focus/control/behavior are tremendously improved on Focalin (Immediate release, not XR.  He takes a dose after breakfast and another after lunch.), but he is losing weight that he cannot afford to lose.  His psychiatrist is saying that if Peter doesn't gain weight in the next month that he will have to stop taking the Focalin.  

 

He eats very little, even for breakfast before he has taken any medication.  He just seems unable to ever focus on eating and totally uninterested in food.

 

ETA: Peter's anxiety also makes him a very picky/cautious eater.  We have gotten to the point that he will eat a wide enough variety of single ingredient foods (several meats, cheese, a couple fruits, a couple veggies, a couple whole grains), but he rejects a lot of foods (avocado, hummus, milk, smoothies, anything with butter on it, casseroles, soups, etc).

 

Wendy

 

That's a tough one. Have you looked at Seinfeld's cookbook, Deceptively Delicious? Maybe you could sneak in some extra calories (not necessarily veggies as the cookbook is trying to use) in sauces. Feel free to ignore me if he won't eat any of these.

 

Waffles or pancakes with maple syrup or peanut butter. You could load up the pancakes and waffles with some high calorie ingredients like Pediasure as the milk. IIRC, one person in my mom's club years ago who had a child who was severely underweight mixed the syrup with sour cream. 

 

Apples or celery slathered in peanut butter.

 

Muffins?

 

I did find this webpage that might be useful: http://feeding-underweight-children.com/highcalorierecipes.html

Edited February 15, 2017 by beckyjo

[ondreeuh]

We are in a similar mess of trying to find a balance with ADHD and anxiety. The ADHD is a huge trigger for his anxiety, so having the ADHD controlled is super important to keep him functional.

 

Mine takes Vyvanse and eats well. For some reason he is still a bit underweight, but he eats three meals and snacks and isn't a picky eater (though he has preferences and will refuse some things). Loading more calories at the end of the day works a bit (he often eats a huge dinner). We let him have dessert after dinner if there's anything in the house. I encourage him to have calorie dense food during the day - toast or crackers with peanut butter, high protein pancakes with syrup, eggs, tuna salad, etc.Sometimes I put sprinkles on his food to make it more appealing, lol. And I'm not above getting fattening frozen convenience food - corn dogs, fish sticks, chicken patties, hot dogs, pot pies, etc. He gets those pretty often, so he can have something he likes very quickly instead of waiting for a boring sandwich that he's not interested in.

 

His doc offered to prescribe an appetite stimulant. Totally forgot what it was called, but you might look into that.

 

My older son had more of an issue with losing weight, and he had a lot of Instant Breakfast lunches when he wasn't hungry for food. He had to eat something, or else he would get cranky. Now as a teen he eats plenty and has filled out. Being a skinny kid didn't hurt him.

[Lady Florida.]

Ds has gone through this much of his life. We've done meds since he was diagnosed (with a brief break when he wanted to try and control the ADHD on his own). I always had him eat breakfast before taking his dose or before it would take effect. He rarely ate lunch, and would eat a small amount for dinner. I never worried about night time eating. If that's when the medicine wore off and made him hungry, that's when he would eat. To this day he often eats after 8pm (he still takes ADHD meds). He spent much of his life being thin, but we always kept abreast of where he was on the charts. If the doctor wasn't concerned then we weren't concerned. 

 

At Peter's age it's not surprising he's a picky eater, then the anxiety only adds to that. Ds was picky and it was tough trying to get him to eat enough calorie-wise. I will say he got less picky as he got older and now as an adult isn't a picky eater at all. Protein rich foods and high fat (though good fat) foods are your best bet if you can get him to eat them. If he will snack and eat small amounts throughout the day rather than eat meals, let him. It does balance out eventually. If he stays on medication, then as he matures he'll figure out his own way to work around the appetite issues.

[blondeviolin]

Can you try letting him focus on something else at breakfast so he's almost mindlessly eating or would it be too distracting to eat and listen to an audiobook or something?

[Anne in CA]

That he won't eat smoothies is discouraging. It sounds like he also has no sweet tooth. That was how I got my picky eater, super skinny son to eat enough calories was smoothies and desert. I would see about keeping a plate of something in front of him while he does school work to see if he'll take a stray bite here and there. 

[trulycrabby]

DS13 takes a low dose of focalin xr in the morning, then 5mg focalin in the afternoon before soccer practice. He typically runs off the afternoon dose at practice then eats well at night. We skip the afternnon dose when he does not have practice.

 

We have found exercise to be a key component in getting the med out of the system so that he eats and sleeps well. I know it sounds counterintuitive since you are trying to get him to eat and gain weight, but afternoon exercise might help reduce the side effects of the focalin. Might is the key word; I think these things are highly individual.