Appetite and ADHD Meds

[isabel]

I'd love to hear advice or input on dealing with low appetite while on ADHD meds.

DS2 is 7. He's honestly not a big eater even when he's not on meds. We took him off for the summer to try to get him to gain some weight and he has gained about two pounds, which is about what he gained between May 2023 and May 2024, so not too bad. But he'll start back on meds this week to get ready for the school year and I'm trying to figure out how to make sure he continues to gain weight.

I'd love input on increasing calories at breakfast and dinner when he's hungry and ways to try to get him to eat at lunch when we're not with him and he's reportedly not hungry. I don't think he's eating much, if any, lunch when he's at school and on meds.

[AdaraMarie]

My kid likes to eat nutella on waffles that seems like it would have a lot of calories, or breakfast shakes.

[loira]

What about avocado toast? You could add a decent amount of olive oil to the mashed avocados and that would probably be a significant calorie boost.

Does he drink milk? Could you switch him to a higher fat milk?

[imimahoney]

My son eats a lot of full fat yogurt with pancakes and milk for breakfast. He's a big fan of cliff protein bars which are fairly caloric and really likes hummus with crackers and veggies for lunch.

[trytobearunner34]

I have a friend who gives her daughter Ensure and other similar calorie/protein rich drinks to get some additional calories for her 8yo.

[expectantsteelerfan]

My ds has been on meds since he was 8, he's 15 now. We went through a lot of trying to get him to eat, but what ended up working for us was letting him skip breakfast as long as he ate SOMETHING for lunch. Hed eat a normal dinner, and then at night, when his meds wore off, we'd let him snack on literally whatever he wanted. Our pantry is full of little Debbie snacks, chips, cereal, pop tarts, etc. He also likes to snack on nuts, fruit, toast, etc in the evening. And then we don't stop meds entirely during the summer, but we drop down a dose, and he does he more in the summer...like he'll still skip breakfast, but he'll eat a normal lunch and sometimes an afternoon snack too and a big, healthy dinner.
Our goal has always been to not loose any weight during the school year and gain a few lbs each summer, and it's worked so far.
Honestly, we tried all the healthy high calorie stuff, protein shakes, etc., but eventually I just gave in to the best food was whatever food he'd actually eat, so I let him make a lot of the decisions. And I'd talk to him honestly about how he might not FEEL hungry from the medicine, but his body still needed food, so please try to eat at lunch, even if it's a piece of bread and an apple (which his lunch often is)

[heygrey]

Does he have an IEP? If so, I would include language that he is allowed to eat whatever he wants at lunch. If not, I would try to get a message to the adult lunch supervisors. I know a lot of schools (mine included) have a push towards healthy lunches and supervisors will [overstep their role and] discourage kids from eating cookies or treats. I always ask for the food inclusion language for kids I support so I have a document I can point to when another staff member wants to police their lunches. Then pack him whatever is his favourite of the day. For a lot of our kids on ADHD meds, any calories are good calories.

[joy]

Our pediatrician pushed filling up her breakfast with calories any way we could. She suggested whipped cream on her waffles, which we laughed at but she was serious. Also recommended were scoops of peanut butter. Basically the idea was small but calorie dense items added to her normal breakfast and dinner.

[Saudade]

From diagnosis in early 2nd grade to just this last late spring of 4th grade, I made DS2 drink an Ensure every day. It took that long for him to finally get sick of them. He has slowed on his growth curve, from 65% for weight to 58%. But to be quite honest, that might have happened regardless because of his body type.

He hasn't been a big eater at school mainly because he doesn't typically like school lunch. But he does a good job of eating at dinner and eats a lot on the weekends despite taking the meds so it's been ok so far.

[mrsann]

We do a lot of the same - get as much as we can at breakfast and push high calorie/protein things. DS is very hungry in the afternoons, and we try to have leftovers (ready quickly) or make a peanut butter + banana + milk “milk shake”. He will also get bedtime snack to try to get calories.

Just to add more because I need actual examples - breakfast things we do are protein waffle with peanut butter, full fat yogurt with granola, eggwhich (brand is Red’s), croissant breakfast sandwich, bagel with full fat cream cheese, baked oatmeal, muffins with butter, peanut butter toast or English muffin, etc.

Bedtime snacks are things like apples and peanut butter, string cheese, full fat yogurt, sweet potato chips, peanut butter filled pretzels, yogurt covered raisins, sandwich meat, etc.

[maudefindlay]

My DS2, 13, has been on ADHD meds since pre-k and they continue to suppress his appetite and his weight remains off the charts underweight. He has med rechecks every 6 months and so far the benefits (good grades, friendships, good behaviors etc) still outweigh this one negative.

We make breakfast his big meal as he wakes up hungry. He is not into mixing things with his food, but will eat them separately. So oatmeal with sides of nuts, blueberries and bananas, high fat yogurt, spoonful of peanut butter. Carnation high protein chocolate milk.

He doesn't eat much for lunch, but anything is better than nothing. I have him help pack his lunch to up the chances he eats something.

He really isn't hungry again till 8pm, but we've worded it as a health issue that he needs to not lose weight and needs to stay hydrated, so he will eat a small amount till then if I suggest it. Spoonful peanut butter, a bowl of cheerios, half a sandwich.

[secretagent]

This is a major issue for one of my ADHD kids (who was quite slim to begin with). We basically allow all the food all the time which frequently means second dinner, as they don't eat much during the day. We do med breaks most weekend/non-school days as well (which is not my favorite frankly but their weight/growth is a major concern so it's the best we can balance). We have found Vyvanse to be slightly less of an appetite suppressant than Concerta.

[redheadbaker]

DS actually lost weight on his first ADHD med. We have since switched him to a different one, but when we were dealing with his weight/appetite issues, here's what we did:

Had him eat a big (for him) breakfast -- either whole-grain toaster waffles or microwaveable mini pancakes with syrup, a full-fat cheese stick, some fruit (usually berries), and a cup of milk.

I always packed his lunch, so I could see how much he ate compared to what I sent. I usually sent buttered pasta, more fruit (sliced apple, pear, plum, mango, pineapple, whatever), raw veggies (bell pepper sticks), and a full-fat yogurt.

He was allowed a snack as soon as he got home from school. Usually Goldfish, animal crackers, freeze-dried fruit, fruit leather, whatever.

While we always encouraged him to at least try what we were having for dinner, I'd make him something I knew he'd eat if he didn't like our dinner. Velveeta shells and cheese, quesadilla, grilled cheese, etc. along with raw veggies (carrot sticks or cherry tomatoes).

He would also have an after-dinner snack (similar to after-school snack).

[suzv]

We do a heavy breakfast for my almost 8 year old. Pancakes or waffles with peanut butter on top. He’s been really into peanut butter waffle sandwiches lately. Lunch is tough, especially when he’s at school. He typically does a yogurt and maybe some goldfish. He’s very distracted at school so doesn’t eat a lot. He does pretty well most days eating dinner, and I let him eat snacks after dinner as well.

[khibb]

My son has ADHD and has been on medication since he was six. He has never had a big appetite and has always been underweight. I started pairing Ensure plus (they’re 350 calories a bottle) with every meal he has. They’re expensive ($34+) for a pack of 16 but he’s put on 6 lbs since we started doing this about 8 months ago. He’s very active so we were really struggling to get him to gain weight. For breakfast he’ll have a blueberry muffin (450 calories) and an Ensure so I at least know he’s starting his day with around 1,000 calories and then when he gets home from school he’ll have another Ensure and either a sandwich or a mini pizza and then he’ll have another Ensure with dinner. The bottles are small so he can usually finish it in 2 or 3 gulps.

[isabel]

Aug 7, 2024 15:13:26 GMT -5 khibb said:

My son has ADHD and has been on medication since he was six. He has never had a big appetite and has always been underweight. I started pairing Ensure plus (they’re 350 calories a bottle) with every meal he has. They’re expensive ($34+) for a pack of 16 but he’s put on 6 lbs since we started doing this about 8 months ago. He’s very active so we were really struggling to get him to gain weight. For breakfast he’ll have a blueberry muffin (450 calories) and an Ensure so I at least know he’s starting his day with around 1,000 calories and then when he gets home from school he’ll have another Ensure and either a sandwich or a mini pizza and then he’ll have another Ensure with dinner. The bottles are small so he can usually finish it in 2 or 3 gulps.

Are you making the muffins or is this something pre-made that you're buying? 450 calories is great.

To answer some questions, we're already doing whole milk and full-fat dairy (yogurt, cheese, etc.). He almost always has an after dinner/pre-bedtime snack. He seems to be coming around on peanut butter again, which he used to not like. I'm hoping I can start getting him to eat half a PBJ before bed.

I just bought some Carnation mix to make milk/yogurt shakes in the morning, but I'll check out Ensure too. 

[khibb]

Aug 10, 2024 23:04:04 GMT -5 isabel said:

Aug 7, 2024 15:13:26 GMT -5 khibb said:

My son has ADHD and has been on medication since he was six. He has never had a big appetite and has always been underweight. I started pairing Ensure plus (they’re 350 calories a bottle) with every meal he has. They’re expensive ($34+) for a pack of 16 but he’s put on 6 lbs since we started doing this about 8 months ago. He’s very active so we were really struggling to get him to gain weight. For breakfast he’ll have a blueberry muffin (450 calories) and an Ensure so I at least know he’s starting his day with around 1,000 calories and then when he gets home from school he’ll have another Ensure and either a sandwich or a mini pizza and then he’ll have another Ensure with dinner. The bottles are small so he can usually finish it in 2 or 3 gulps.

Are you making the muffins or is this something pre-made that you're buying? 450 calories is great.

To answer some questions, we're already doing whole milk and full-fat dairy (yogurt, cheese, etc.). He almost always has an after dinner/pre-bedtime snack. He seems to be coming around on peanut butter again, which he used to not like. I'm hoping I can start getting him to eat half a PBJ before bed.

I just bought some Carnation mix to make milk/yogurt shakes in the morning, but I'll check out Ensure too. 

I buy the bakery muffins from Ralph’s- they come in a package of 4. My son will also eat the chocolate chocolate chip ones which have a few more calories than the blueberry ones. He is so picky I only have a handful of foods he will actually eat so I try to get as many calories as possible into each meal.

[sometimesrunner]

We basically try and make all of DD's food "wet." Eating fries? Use ketchup or ranch. Eating an apple? Dip it in caramel. It's a really easy way to add calories. It's hard, because most of this adds a bunch of extra sugar, but I'd rather her have excess sugar than not enough calories. DD's doctor gave us a list of high calorie foods to eat and nutella was on the list, so now when she eats it she says it's "doctors orders!!"

[macmars45]

We're just starting on our ADHD med journey for autistic DS(8), but he's been eating a bedtime snack for at least 3 years now because he's struggled with food aversions since he was 2/3 years old. His bedtime snack is nuts, a cheese stick, raisins, crackers and a veggie/fruit. He doesn't eat very much breakfast or lunch so we back load his calories with a bigger dinner & a snack before bed plus usually ice cream in the afternoon. And we care more about calories than sugar. With his limited safe foods and food aversions we don't have to luxury of caring about sugar.

[awkwardpenguin]

We’re dealing with this too. Has anyone had to stop meds due to weight issues? DS’s weight for age percentile has fallen from the 75th at 4 to the 30th at 7.5. We started meds a year ago, and he was around the 60th percentile then so some of the fall off is probably picky eating related. The doc said today that if his weight moves down the percentiles anymore, we’ll need to look at alternatives to stimulants.

DS is autistic and a pretty restrictive eater. I’ve posted his food list before. The difference between then and now is now the doctor is concerned about his weight.

pandce.proboards.com/thread/639804/picky-eating-when-get-help

The doctor basically told us to take away his privileges until he eats dinner and that seems counterproductive to me. But she was very clear that he needs to eat more.

[secretagent]

awkwardpenguin, we don't do meds on the weekend for one of my kids whch has helped a bit. We also do protein shakes and second dinner.

[mainelyfoolish]

Sept 9, 2024 17:07:21 GMT -5 awkwardpenguin said:

The doctor basically told us to take away his privileges until he eats dinner and that seems counterproductive to me. But she was very clear that he needs to eat more.

This would work if the non-eating was a behavioral issue. Based on your linked post, it sounds like you have might have a kid with ARFID, which is an eating disorder. You’re not going to parent your way out of a ED.

I have a child with ADHD (who requires stimulant meds) and ARFID. My child is not underweight anymore since I gave up trying to make DOR and balanced meals work for my kid (we still do family dinner, but the ARFID kid eats a separate plate of food). Harkening back to the whole breast milk vs. formula debate (ha! I wish it was that simple)…fed is best. If my kid only eats cheddar cheese, chocolate chip muffins, and salt and vinegar potato chips, then that’s what I buy and let them eat as much as they desire.

I don’t have trouble getting my kid to eat enough food in the evenings when their meds wear off, as long as they have their preferred foods available, but in ARFID groups, a lot of parents with kids who don’t want to eat no matter what find success with getting their kid to eat more while watching videos (the distraction keeps them from focusing on the food). Ideal? Of course not. But whatever it takes, it takes. Do not worry about the ideal because you don’t have a typical kid.

[shauni27]

Sept 9, 2024 17:20:48 GMT -5 secretagent said:

awkwardpenguin , we don't do meds on the weekend for one of my kids whch has helped a bit. We also do protein shakes and second dinner.

our friends who have kids on ADHD meds also take breaks on the weekends. They found that very helpful.

[jene]

Sept 9, 2024 17:07:21 GMT -5 awkwardpenguin said:

We’re dealing with this too. Has anyone had to stop meds due to weight issues? DS’s weight for age percentile has fallen from the 75th at 4 to the 30th at 7.5. We started meds a year ago, and he was around the 60th percentile then so some of the fall off is probably picky eating related. The doc said today that if his weight moves down the percentiles anymore, we’ll need to look at alternatives to stimulants.

DS is autistic and a pretty restrictive eater. I’ve posted his food list before. The difference between then and now is now the doctor is concerned about his weight.

pandce.proboards.com/thread/639804/picky-eating-when-get-help

The doctor basically told us to take away his privileges until he eats dinner and that seems counterproductive to me. But she was very clear that he needs to eat more.

Is he in any kind of eating/food therapy? I’m sorry, but taking away privileges to make him eat sounds like a terrible idea.

[awkwardpenguin]

Sept 10, 2024 8:22:26 GMT -5 jene said:

I totally agree, it's against everything we've been trying for.  He's not in any eating/food therapy.  It seems like that might be a next step.

[awkwardpenguin]

Sept 10, 2024 6:13:19 GMT -5 mainelyfoolish said:

Sept 9, 2024 17:07:21 GMT -5 awkwardpenguin said:

The doctor basically told us to take away his privileges until he eats dinner and that seems counterproductive to me. But she was very clear that he needs to eat more.

This would work if the non-eating was a behavioral issue. Based on your linked post, it sounds like you have might have a kid with ARFID, which is an eating disorder. You’re not going to parent your way out of a ED.

I have a child with ADHD (who requires stimulant meds) and ARFID. My child is not underweight anymore since I gave up trying to make DOR and balanced meals work for my kid (we still do family dinner, but the ARFID kid eats a separate plate of food). Harkening back to the whole breast milk vs. formula debate (ha! I wish it was that simple)…fed is best. If my kid only eats cheddar cheese, chocolate chip muffins, and salt and vinegar potato chips, then that’s what I buy and let them eat as much as they desire.

I don’t have trouble getting my kid to eat enough food in the evenings when their meds wear off, as long as they have their preferred foods available, but in ARFID groups, a lot of parents with kids who don’t want to eat no matter what find success with getting their kid to eat more while watching videos (the distraction keeps them from focusing on the food). Ideal? Of course not. But whatever it takes, it takes. Do not worry about the ideal because you don’t have a typical kid.

Thank you SO MUCH for this. I was really frustrated after yesterday's appointment because it's not like we haven't tried everything under the sun to try and get him to eat more. I was second guessing myself, because I haven't actually TRIED taking away privileges but we've tried so many other things and nothing has worked.

I think it's quite possible we're dealing with something more than picky eating + appetite suppression.  His best friend actually has a ARFID and I was like "well he eats more foods than L" so maybe that's not what we're dealing with.  It seems worth getting more evaluation and support at this point.

In the meantime, DW and I discussed dropping DOR and letting him eat as much as he wants of preferred foods.  I think that's a reasonable approach since he really just needs to maintain and gain weight.

[genet313]

My ADHD kiddo is on a non stimulant but same issues re appetite and being underweight.

We find success with textures that she will
tolerate and things she can lick or suck slowly, most of which tend to be high calorie - hummus, avocado (either actual guacamole or just smashed with lime and salt, spoonfuls of PB or Nutella, yogurt tubes (both refrigerated and frozen she loves), fudge bars (not the low cal options), etc.

We also don’t limit quantity on anything other than ice cream and that’s only bc her NT sisters would be jealous

[robot]

Sept 9, 2024 17:07:21 GMT -5 awkwardpenguin said:

The doctor basically told us to take away his privileges until he eats dinner and that seems counterproductive to me. But she was very clear that he needs to eat more.

This feels like such bad advice to me, even for a neuro-typical child, which makes me question the doctor's judgement a bit. That foods list does not seem terrible to me.  Yes, it's a bit limited, but there are items on there from the major food groups. And as another poster said, it is okay to eat really similar meals every day, if basic nutrition is being covered.  I have a child who isn't on any meds, and eats just fine, but her BMI has changed from like 75% to 30% just over time (maybe over 5 ish yrs, so a little longer, but still) and her doctor has never mentioned it as a concern.  Obviously I don't know the whole situation, AND I'm not a doctor, so take my advice with that big grain of salt, but I wonder if the doctor is overly focused on the idea of picky eating..

[Jalapeñomel]

D eats protein bowls (Kodiak brand) for breakfast and then has protein shake when he gets home from school. It seems to help prevent him from losing weight.

[jg183]

my kid has bad adhd (big dose) and has arfid and is currently in a partial hospitalization at an eating disorder clinic. they have us giving him calorie dense breakfast and dinners and a milkshake at night before bed (he wont drink boost/ensure so he does McDonalds) and he still barely gains but its enough.
They say dont worry about lunch because its out of your control, let them eat what they will. Obviously we want them to but if you push it too much a lot of kids throw it away