Episode 82: A case study of a fussy eater with ADHD on medication

In today’s episode, I walk you through a real-life case I’ve recently worked on with a family navigating fussy eating alongside ADHD medication. This little boy’s food intake had been narrowing for years, his appetite was poor, and his parents were feeling stuck in an exhausting cycle of pressure, worry and frustration around mealtimes.

I unpack how ADHD medication can significantly impact appetite, why expecting children to “eat better” during the school day is often unrealistic, and how shifting the focus to when children are naturally hungrier can completely change outcomes. We talk through iron deficiency, constipation, fluid intake, growth concerns and how all of these pieces are deeply connected in children with limited diets.

I also share practical, realistic strategies to boost calories and nutrients without forcing more food, reduce stress around lunchboxes, and help parents feel confident that they are not failing their child. This episode is especially relevant if you’re supporting a picky eater or fussy eater with low appetite, poor weight gain, or nutrient concerns.

Links:
https://nourishwithkarina.com/feedingbabies
https://nourishwithkarina.com/membership

Highlights:

A Case Study on Fussy Eating and ADHD (00:00.074)
The Iron Connection and ADHD Medication Side Effects (02:16.214)
The Weekly Balance vs The Daily Struggle (04:41.046)
Front Loading the Day for ADHD Fussy Eaters (07:00.416)
Maximizing the Rebound Appetite Window (09:13.438)
The Connection Between Fluid and Fussy Eating (11:22.478)
ADHD Medication and the Fussy Eating Cycle (13:40.782)
The Rewarding Path to Managing ADHD Fussy Eating (15:57.706)
ADHD Medication and the Fussy Eating Perfect Storm(18:07.362)

Show notes

READ TRANSCRIPT

Show Notes

If this episode resonates, you’re not alone – and there is a clear, supportive way forward.

Episode highlights

ADHD medication and appetite – Why reduced appetite is common and how to work around it
Timing nutrition strategically – Front-loading and back-ending the day to maximise intake
Iron, constipation and growth – How low iron and bowel health affect appetite and energy
Making foods work harder – Increasing calories and nutrients without increasing volume
Reducing mealtime pressure – Supporting a healthier relationship with food for the whole family

Show notes

Healthy recipes and ideas for children: https://nourishwithkarina.com/healthy-recipes-for-kids

A Case Study on Fussy Eating and ADHD (00:00.074)
You're listening to the Easy Feed Podcast, episode number 82, a case study about a fussy eater with ADHD on medication. Hi there, I'm Karina Savage and with over 20 years experience feeding children, including my own, I've learnt all the secrets that busy mums need to get their children eating better and actually enjoying healthy foods. So a huge welcome to the Easy Feed Podcast.

Hello, hello, welcome back. It's great to have you here. Today I want to talk about a case that I've recently worked with, a little boy who is a very fussy eater, well, quite fussy, concerning enough that the parents reached out to me to get help. So I met with mum online and she was really keen to catch up and have this consultation because she's been worried about his intake now for a while.

It's been narrowing and narrowing and narrowing and she just doesn't know what to do. She's trying really hard to try and get him to eat more food, but not getting anywhere and just going around and around in circles in this, you know, feeding cycle of frustration and overwhelm and, trying to get him to eat more meat, but he doesn't want to eat more meat, trying to get him to eat more plant foods, but he doesn't want to eat more plant foods.

trying her best to manage meal times with the family, but it's really hard. It's really hard when you've got a fasciitis. It's really hard when you've got a child who is very adamant that they don't want to try something and you layer that medication, which impacts appetite. makes it even harder. Concerning enough that the parents reached out to me, booked in a fasciitis consultation and we had a fantastic session earlier in the week.

this little boy has ADHD, he's been diagnosed with ADHD and he's on medication. And this medication is impacting his appetite as well as potentially other factors. He's quite lean and he's quite tall. So mum especially was worried, is worried about his nutrition, about his vitamin intake, about his overall, intake based on the fact that he has a very limited intake and also

The Iron Connection and ADHD Medication Side Effects (02:16.214)
His appetite is quite poor and it's affected by his medication as well, which is very common. So ADHD medication, whilst beneficial from a perspective of perhaps improving symptoms related to the ADHD, it can also have side effects on our children's appetite. And that's a big one. And that's something that I see a lot in my clinic or my online clinic, is mostly, yeah, parents who struggle with their children to get them to eat during the day.

And I think the parents put a lot of pressure on themselves to get more food into the lunchbox. Like this mom I worked with the other day, she was putting so much into the lunchbox and she was trying to put even more into the lunchbox. And I'm like, hang on a minute, you know, and we'll get to this later, but I was like, can't expect them to eat much during the day. So let's take the pressure off you, off them around the lunchbox and the school day, because we have to have a very different approach in children on medication, especially when it has such a significant impact on their appetite.

So this little one's intake had narrowed from about the age of four. And whilst he's not diagnosed as being on the spectrum, has noticed some preferences and some sensory, you know, issues, but he's certainly not autistic. So his intake has narrowed for a variety of reasons. And as I always say, it's really important to get to the bottom of why and understand why they are bussy or picky or limited or restricted or, know,

Why they have preferences for certain foods or types, because once you understand why, that's where the magic is. That's where the magic can start to happen because then you can start to implement very intentional strategies to then help that child or help that family. And it relieves so much pressure and tension and the ripple effect is amazing when meal times start to become happier. So this little one had had a blood test and his iron was low.

So his ferritin was in the twenties and I would consider that to be low. Sometimes on blood request forms, they'll say, or I should say blood results, I'll say a ferritin above 20 is normal, but I prefer it to be above 30. To be honest, the higher above 30, the better for a fussy eater because when it starts to below 30 or definitely below 20, that's when you start to get into the territory of iron deficiency symptoms can be affected, which can be impacting sleep.

The Weekly Balance vs The Daily Struggle (04:41.046)
restless leg syndrome, they can not fall asleep as easily or wake up more often, although that can be impacted also by tonsils and adenoids and, you know, oxygen. The symptoms of iron deficiency might be dark circles under the eyes. It might be lethargy, although often not the case in kids. It might be impacting sleep, getting to sleep or restlessness over the night. It might be restless leg syndrome. It can be achy legs. So there's many symptoms of deficiency, pale skin.

And tiredness is definitely a thing with some kids, but some kids not. But iron deficiency is very common. You 20 % of young children don't get enough iron in their diet and therefore can have lower iron levels. And certainly too much dairy can impact this as well. So this little one has a lower iron level in his blood. And so we needed to be mindful of that. He's also a bit constipated and this could directly be related to what he's eating.

but also his overall fluid intake. As I said, he's lean and he's also quite sporty. And so often he'll go straight from school to sport, which also impacts the opportunity to give him lots of food. Okay. So when we dived into what he eats, and I always encourage parents to email me through a four day food diary prior to our consultation. If not, that's totally fine. We just go through it on the day.

But it gives me a really good indication of what their nutrient spread looks like. And there's absolutely no judgment ever because I've had children, I've had a fussy eater as well. I totally get it. So there's never any judgments, but it's important for me to be able to look at total carbohydrate. Look at the quality of carbohydrates, fast sugars, slow sugars. Look at protein, the types of protein, the nutrients, iron and zinc. Look at fats. Are we getting enough healthy fats? So.

All of those things are factored in into my dietary assessment when I look at a child's daily intake or weekly intake. And I always like to look at it as a nutritionally balanced week rather than a nutritionally balanced day. And that also takes the pressure off parents. So when I looked at this boy's intake, we really discovered that he has a very, very, very limited intake of fruits and vegetables. And in terms of fruit, really it was an average of about one piece of fruit a week.

Front Loading the Day for ADHD Fussy Eaters (07:00.416)
He was quite restrictive with what he did choose to consume, but what he did consume was a good variety of most food groups aside from the fruit and veg. He did consume strawberry yoghurt. He does eat avocado, which is great. And occasionally he'll eat a bit of banana or a bit of apple. He will eat veggies in very, very limited form hidden in like a jelly con can.

But most of his intake was kind of wraps and bread or Weebix. And Weebix was a really good one that he started off the day with a healthy breakfast, which was great. Or toast with avocado. you know, often when I do this with parents, I'm reassuring them, I'm saying, do you know what? He's actually not as bad as a lot of really picky fuzzy eaters that I see. You're actually doing really well. Yes, it's restricted.

Yes, it's the same foods day in, day out, which is what really bothers some parents, but I'm like, overall, the spread's actually not too bad. You know, you're doing better than you thought. So that's often a conversation that I'll have with parents in our online consultation. But at the same time, it's also really important to troubleshoot, to look for too many fast sugars, to look for too many food additives, to look for low fiber.

inadequate fluid, because when you're factoring in bowel health as well, that's something else that we need to look for. And so when I see a child who's constipated in my head, I'm like, right, fiber, fluid and toileting routine, we go through the list of everything that is important to keep stools healthy. And I've got a whole podcast episode on that you can find out as well. But my assessment of this child was with the mother, obviously I'm not seeing the child, but

My assessment was that we need to find more opportunities during the day to fill him up. Opportunities to fill him up when he's hungrier, not putting more pressure on the lunchbox because really at the end of the day with medication such as Rizal and Vivance, you can't expect children to eat well during the day. It's just not going to happen. And so we really need to front end the day before the medication goes in and we really need to back end the day as well.

Maximizing the Rebound Appetite Window (09:13.438)
Once the medication started to wear off and I often find in kids, it's probably like afternoon, late afternoon, you can start to get more food into them. So it's really trying to maximise their nutrition and their intake, the calorie intake and their nutrient intake when they are going to be hungrier. So, you know, it's really important to try and set up a plan. So for example, we talked about the option of

They were perhaps going to engage with the babysitter to help out with afternoon pick up with another sibling. And so they wondered whether the babysitter could take the son some food for afternoon tea so he could actually eat a bit more afternoon tea before his sport. And then we talked about trying to serve up slightly bigger serve size at meal time. So that goes for breakfast time, that goes for dinner time in terms of the protein serve, the carbohydrates serve. We talked about trying to increase high calorie.

nutrient dense snacks and look, loved peanut butter. So we said, well, can we do more peanut butter on toast or maybe peanut butter and apple, peanut butter and banana, peanut butter and dates? Can we to his pasta add extra oil, extra virgin olive oil? Can we stir in an egg? Can we add calories to the existing foods so that

He doesn't have to eat double the amount to try and gain weight. We just make it more nutrient and calorie dense. If he likes avocado, can we give him guacamole as a snack rather than perhaps just playing crackers? Not that he necessarily just had playing crackers, but it's a good example. Can we give him a really wholesome supper? And this is an opportunity that he really had. And also many patients that I work with in this situation have, they don't get enough supper. And it's something that

I guess the parents, you know, whether their family typically has dessert or supper or not, often families don't. But in this situation, that child needs supper because it's an opportunity when their medication is worn off, when they're hungrier, they're needing more food and it's going to help them with their overall daily intake, meeting their nutrient requirements, meeting the calorie requirements for adequate growth, optimal growth and nutrition. So.

The Connection Between Fluid and Fussy Eating (11:22.478)
Supper is often a really beautiful opportunity for these children to get in more nutrition, to get in more calories. So we talked about great options for supper because it's a really great opportunity for him to get more nutrition. So it might be Weet-Bix, another bowl of Weet-Bix if he likes Weet-Bix. It might be fruit and yoghurt. It might be a smoothie, bite might be mixed nuts and dried fruit. know, anything that he likes that's going to be nutritious is what we want to be giving him. It might be homemade baked goods. He might've made some banana bread or

Black bean brownie and black bean brownie is another thing that we talked about putting into his day because that's another healthy, high protein, high fiber option that he may eat. Maybe it's after school if he's not going to eat much for lunch, but absolutely putting in those higher energy, nutrient rich snacks to try to boost his overall nutrition. And also it's going to increase his iron intake as well, because that's something else that we needed to factor in. in terms of our plan for him.

Aside from high energy, you know, diet and really trying to maximize his hungry time. So breakfast, late afternoon dinner and supper, we also needed to look at his total fluid intake because his total fluid intake was not enough and we really needed to increase it to ensure that he's getting enough fluid, not only for his daily activities, but his kidney health and also his bowel health. Extra fluid will help to soften his stools to keep him regular.

it will reduce the risk of constipation. And sometimes we need to talk about strategies to increase their acceptance of fluids because some kids are just not great drinkers. Earlier in the day, on the same day, I'd seen a little one who was about five or six and she was only drinking an average of about three to 400 mL of fluid per day. And she was constipated as well. And I said, right, we really need to get this fluid intake up to at least a litre of

And we talked through ways to try and increase her acceptance because she just wasn't a big water drinker. So we talked about perhaps using a nice straw or a funky cup or perhaps putting a bit of strawberry or a bit of lemon in there, perhaps squeezing a little bit of something in there, maybe even popping a little bit of juice in there to increase the acceptance of fluid so that changes the taste slightly. Like I wouldn't use cordial with

ADHD Medication and the Fussy Eating Cycle (13:40.782)
colors and artificial sweeteners or whatever in there, but I would, a little bit of a hundred percent juice is great. But if you can use just like a strawberry or squeeze a bit of lemon in or just throw a wedge of lemon in there, that could be a great, and it's fun and it's different and kids love fun and different. So it could just be a great way to try and increase acceptance of fluid. Otherwise you could try a bit of carbonated water, like soda water. Otherwise you could try it as ice blocks, like diluted water, melon juice into an ice block or

You know, diluted orange juice is a nice block. So there's ways that we can increase a child's fluid intake and that can be important from a constipation bowel health perspective. Because a kid who's constipated is less likely to want to eat as well. Because when you're full of food, you're less hungry. You know, the system is not working effectively. And so if you can clear them out, then that can also help to improve appetite. Okay. So our plan was maximising his hungry times, increasing the calories.

Increasing the total fluid. I did talk to her about a healthy toileting routine for him just to optimize his bowel health. And I gave her plenty of ways that we can increase his calorie intake because that's my job. talked about lots of ideas from breakfast through to supper.

I gave her some other healthy ideas for snacks and other tips for increasing his overall fluid intake. And we talked about managing him at meal times as well, because sometimes he was a bit fussy with what he would or wouldn't eat, especially the plant foods. And so I gave her plenty of ideas about how we can increase his intake of colour and increase his acceptance of colour and enjoyment of food. And that's a really important thing because we really want children to engage in the meal time.

and to have fun at meal times and enjoy connecting with the family. And when that happens, then they're much more likely to explore and to become a more adventurous eater. And so we talked a lot about strategies there as well. Finally, we talked about supplements and in his situation, he did need some iron supplementation. So actually he just started, should say, iron supplementation, the doctor had put him on it, but we did increase the dose slightly just to meet his requirements, given his borderline deficiency.

The Rewarding Path to Managing ADHD Fussy Eating (15:57.706)
And we also discussed other nutrients such as vitamin C and zinc, especially vitamin C, which could be compromised in a child who basically eats zero fruits and vegetables. So we covered lots of grammar, but it was a very rewarding session and mum was really pleased with our plan because it really addressed all of those potential areas for concern. His limited variety, his resistance to try new foods.

His bowel health, his iron levels, his need to gain a little bit of weight. And just reassuring mum that she was on the right path, that he certainly didn't have the worst intake of, of child I've seen before. Absolutely not. Like she was doing really well. And as I said before, often I am saying that to parents because they feel like they're doing a lot worse than their child's.

doing a lot worse than they actually are. So it was really wonderful to catch up with this mum today. I provided her with all of our information that we discussed. So I emailed that to parents at the end of the session together with the receipts, they can claim with private health insurance or Medicare. And that information she'll now be able to action and have as a reference over the coming months.

She also, as part of the Fassida Consult, has access to my program, the Feeding Kids Reset, which has a ton of resources, which will also be super helpful for her and little video tutorials, which will support what we discussed in our session. So if any of this resonates with you, please reach out to me. As I said, most of my consultations are online and I love helping parents all around Australia and offshore. I had a parent from LA the other day.

And I have a parent in Singapore that I'm chatting to on Monday. So yeah, it's wonderful to be able to help people globally with their children's nutrition. And look, you can also find more information out by heading to my website, nourishwithkarina.com. Click on the consult page and then you'll be able to grab all of the information about how I can help you. And there'll be a link there that you can go to, to directly book an online consultation with me, with kids.

ADHD Medication and the Fussy Eating Perfect Storm(18:07.362)
who are on medication, who are fussy, who may have ADHD, who may be constipated. There are often many layers that we need to consider and look at in terms of their overall nutrition plan. And having a clear plan is so reassuring for parents because then they know exactly what to do. They know that they're on the right track and that reassurance that they are already giving their children a better variety of nutrition than they thought.

is also super helpful for parents. It just gives them that confidence. And we all need that, right? Well, most of us do. So I hope that was helpful for you. Please reach out to me if you've got any questions or concerns about your child's nutrition. I look forward to chatting with you again soon. Bye for now.