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Dear Doctor Olson,

My son is 17 months old and is not interested in solids at all.  For medical reasons, I had to stop nursing for a week when he was 7 months old and though I resumed nursing after the break, I was unable to produce at the level that he preferred but he did exclusively nurse until 12 months of age though it was difficult on us both due to my low production.  (I pumped at work and was able to bring home about 8 ounces a day until 12 months - this was a huge decrease for me as I was bringing home 25 ounces a day prior to the nursing break).

I did offer solids from 8 months on but he did not take an interest in them until age 15 months.  I am down to 1 nursing session a day now and it's really just for comfort so I know he is not getting much nutrition from breast milk.  He drinks about 16 ounces of cows milk per day and then another 8 ounces to 10 ounces in the middle of the night. He wakes up hungry and looks for his bottle.  (We co-sleep)

As for solids, he eats 6 ounces of whole fat yogurt once a day, 2 egg whites and 1/4 up of pasta.  That is all.  He keeps wanting to nurse but given that I am down to one session a day, I am unable to produce enough for him.  I don't know how to get him to eat more.  I do not make meal times a battle.  I offer food whenever he seems to need it and offer variety but he just wants very little.  From age 12 to 15 months he gained 1 pound and did not grow in height. I am worried that he is not getting what he needs and I do not want to resort to pediasure unless it is absolutely necessary. I also worry that if I do give him pediasure then he will be less likely to want solids.  I prefer that he gets his nutrition from food and not shakes but I will do whatever is best for him.

He does have some iron deficiency since age 12 months and I have offered him all kinds of iron rich foods only to have him feed the dog.  Rather than battling with him, I try and give him what he wants to eat - even if it means he eats yogurt for 3 days straight.  

I am not sure how to deal with the night wakings due to hunger - I have tried getting him to consume more calories per day but that is not happening.  I know he wants to just nurse but that is also impossible now.  He is meeting milestones.  I did notice that after the one week break (I was away from him) he stopped saying mama and dada.  Prior to that I was sure he was going to be an early talker.  He is walking, climbing, understands basic commands, enjoys having songs sang to him but he does not speak much - he has 3 words.  I worry that rejection of solids is related to that week long break nearly a year ago.  Is this possible?  Is it possible that maybe he just isn't ready for solids emotionally?  

People say toddlers won't starve themselves but how is he getting by on such little food?  He does not get any juice, hates sweets and hates trying new foods.  He has a limited range of interests food wise and I wonder if this will ever change.  Is it possible for a toddler to basically not grow till age 2?  And eat very little?  

Our pediatrician was not worried about the iron levels and assured us that it will get better over time especially if we offer foods high in iron.  But getting him to eat... that is another story...and getting him to not eat in the middle of the night... that is also tough.  

One last thing, when he gets frustrated he hits his head with his hand or actually tries to hit his head on the floor.  Is this normal?  I try and sooth him and show him alternative ways of venting his frustration if I can't figure out what he needs.

thanks for your help,
sarah

Answer
Hi,

Head banging is normal and occurs in at least 20% of kids.  I tell parents to ignore it, he won't beat himself senseless, and respond loving immediately upon stopping.  

It really sounds like he is developing a feeding aversion, commonly seen in kids this age who have had some early feeding "issues".  I would strongly recommend being evaluated by a pediatric OT person who has specific training in this area.  This is a behavioral problem that has the potential to get worse and develop into a full blown eating disorder.  Generally a pediatric hospital has people with this sort of training.  

I also agree with your pediatrician that his health in general is OK and that he will get over this eventually.  

Good luck, Dr. Olson

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David Olson, MD

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I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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