One of the most common parent concerns with a selective eating child is the lack of protein in their diet. Protein, as a macronutrient, is relatively easy to come by. It’s in almost everything – grains, dairy and of course meat and alternatives. Usually, when a parent says “I’m concerned about the lack of protein in my child’s diet”, they are referring to the absence of meat options. Parents have good reason to be concerned. Meat is an excellent source of iron, and iron is required to help oxygen rich blood circulate around the body.
When meat and vegetables aren’t part of the dietary rotation, iron can become a concern, as it is for us. TJ’s recent bloodwork shows levels of ferritin (stored iron) are slowly on the rise. Hemoglobin, hematocrit and red blood cell counts, however are all ‘abnormal’ (low) and have peaked my interest in learning more about anemia.
Anemia has some interesting symptoms, all of which are concerns that have been brought up at one time by teachers, psychologists and myself; the ‘ignoring instructions’, the ‘not listening’, the behaviour that looks like ‘defiance and aggression’.
The most common symptoms of iron deficiency anemia are:
- lack of energy, or tiring easily (fatigue)
- difficulty concentrating
Fatigue, difficulty concentrating and irritability would explain the ‘ignoring instructions’, the ‘not listening’, the ‘defiant and aggressive’ behaviour. Of note, the days when TJ has been described as being the most challenging at school are also the same days he falls asleep on the (very short) car ride home.
While I can appreciate how challenging it is for a teacher to have a child who isn’t mentally and/or physically up to the task of learning, it concerns me how often I’ve been approached by educators with their diagnostic opinion. “Is he on medication for his behaviour?” “My son has ADHD too.” “Oh, he’s a very picky eater, he’s probably on the spectrum.” Those in the know, the educated mental health professionals, have not been able to explain TJ’s behaviour with a diagnosis, (a) because he doesn’t neatly fit any specific diagnostic criteria, and (b) he’s a child using behaviour as a communication tool. The question everyone needs to be asking is what is creating the behaviour.
The new school is making sure that TJ’s psychological, sensory and learning needs are in competent hands, while I search for medical answers. One possibility could be that TJ doesn’t have enough red blood cells to carry sufficient oxygen for his growing body’s needs. Most of the literature on iron deficiency anemia states that iron stores correct within a few months with supplementation. Ferritin levels are within the range of normal, but after a year of supplementation, ferritin remains on the low end of this scale. Is that what is meant by ‘corrected’? Are low iron stores normal or just not a medical emergency?
Hemoglobin, hematocrit and RBC are all lower than last year’s measurements despite the daily iron supplement. These are the three (according to what I’ve read) that determine anemia, and indicate how well the blood transports oxygen. Are these numbers lower because iron stores are rising? Do we need to know why all of these numbers are decreasing? Is this a chronic problem, indicative of an underlying condition? Is my son okay!?!? Google is far to vague and scary for me to learn about anemia so I booked an appointment with our family physician to discuss the results and get some answers.
The doctor says he doesn’t see anything that concerns him. He is evasive with my questions, only telling me that we need to continue with the iron supplement.
Me: “Doctor, we’ve been giving TJ the iron supplement for a year now, but his numbers are still low. Now that you’ve seen two comparative readings, do you recommend increasing the dosage?”
I thought it was a very reasonable question, and I thought I could expect an equally sensible answer.
Doctor: “He needs to get his iron from solid food sources. Beef, broccoli and other green vegetables.”
Me: “But he doesn’t eat any meat or vegetables.”
Doctor: “Oh, he is a selective eater?” He uses the lingo. Maybe our doctor knows what he’s talking about?
Me: (hopeful) “Yes, he is a selective eater.”
Doctor: “You have to make him eat his food.” Did you hear a ‘pop’? I distinctly heard the ‘knows-what-he’s-talking-about’ bubble pop.
Me: “How… um… exactly do you propose I ‘make’ him eat?”
Doctor: “You take his privileges away. No TV until he eats what you tell him to. And he gets nothing else until he learns to eat the food you serve him.”
Me: “And how long am I supposed to do this for? ‘Selective’ … remember? He will not eat meat and vegetables, and if I offer nothing else, he will not eat. At all.”
Now, blogging as I do, and through chatting with other parents, I’ve heard of doctors saying some pretty stupid stuff. Like off-the-scale-of-ridiculous stupid. Are you ready?
Doctor: “He can go for two weeks without solid food. Then he will learn to eat properly.”
I’m not a doctor, but wouldn’t a physician want to be reasonably certain that what he says is based in fact, or at the very least, true? As a parent, and one who is very familiar with selective eating, I can tell you confidently, there are no facts or truth to support starving a child into dietary compliance.
Imagine for a moment, that I believed this irresponsible hogwash, because the doctor says ‘eventually, the child will get hungry.’ This would not only backfire spectacularly, it would put the health of my child in jeopardy. Most important, I would lose something absolutely essential to feeding a child who is cautious about food. His trust in me to feed him.
I refuse to be as abusive as our physician suggests, and I don’t hide my ‘wtf’ well. In the public hallway, the doctor ducks into another exam room, calling after me to, “Just keep giving him the supplement” as he closes the door between us.
But when? And how much? Why can’t you just answer my damn question!!??! Or admit that you don’t know! Aaaarrgh!
That’s when I realize that TJ has overheard this entire exchange. He turns to me, horrified and clearly frightened by the doctor’s advice. I assure him there is no way this is going to happen. “Oh, thank you, Mommy!” he says, squeezing my torso in grateful relief…
… and then takes the edge off the tension with, “That doctor is dumb.”
Everybody has a talent, right?
I did let TJ know that, yes, there are foods that would help give his body the iron he needs, but he can try these foods when he’s ready. Together, we’ll figure this out, meaning I will continue to provide the opportunity and the atmosphere for him to decide if he wants to eat meat and veg and how much. Regardless, there will ALWAYS be food he can eat.
Even though our family doctor carefully avoided answering all of my questions, he was absolutely clear on one point. It’s time to find a new family physician.