ADHD And Low Appetite

Don't worry Momma,I have been through this since my kids were in first and second grade. Both of my boys are on Adderall and take about 30 mg per day. The drugs do suppress their appetite quite a bit and were pretty skinny in their elementary school years. My boys are 13 and 11 now. My 11 year old describes it that his stomach feels like he ate Thanksgiving dinner and can't possible eat at all, which I can understand that. I have been giving them a huge breakfast before they take their drugs. They usually don't eat lunch and then they are starving by 4 pm. On weekends or summer I don't always give it to them everyday unless they have activities like baseball, football or basketball. The good news is that once they start puberty, my oldest seems to still be hungry regardless if he takes the drugs or not and has grown 1.5 inches and 8 lbs. I do have snacks for them in the afternoon and I let them eat when they are hungry.

My daughter is on Vyvanse and we have the same issue. We took her to a growth doctor because she is so tiny. He told us to give her milkshakes before bed to get extra calories into her. He said normally he would not suggest such a thing, but she really needs to gain weight because she does not even weigh 60lbs and she is almost 13.

DS (7) and I both take Concerta for ADHD. We BOTH deal with decreased appetite on the medication, even in the evenings when the medication has already warn off (different than on Adderal when DS's appetite would suddenly pick up right after his afternoon crash).

Some ideas/advice:

First...Try not to worry about percentiles. Remember that it's a ranking, so SOMEONE will always be the 1st percentile, and SOMEONE will be 99th. The difference between the 10th and 75th percentile could be 15lbs or 50lbs or 2lbs, as long as the next 65 out of 100 kids fall in that window. As long as he's growing, and learning, and staying healthy, it's no big deal at all. Also note, there is some research that suggests people with true ADHD (on or off of medication) are typically thinner than their neuro-typical peers. Just something to think about.

Now, eating...

Feed him real, high calorie food for BREAKFAST, before he takes his medicine in the morning. Don't limit him to typical "breakfast" type foods. DS usually warms up a plate of leftover dinner first thing in the morning, or makes a sand which, hotdog, or plate of chicken nuggets.

Try to get in a "second breakfast." It takes about an hour for me and 90 minutes for DS before the Concerta really kicks in. I usually pack him another snack to eat at before-care during their breakfast time (about an hour after that first meal at home).

Encourage him to drink milk (assuming he's not dairy free) at every meal.

Replace the empty calorie favorites with slightly heartier versions... pasta with red sauce --> pasta with homemade meat sauce... boxed mac cheese --> mac cheese with tuna and peas, or with diced chicken and broccoli.

Let him have a late night snack just before getting ready for bed (but not so heavy it'll bother his stomach or anything while he sleeps).

Talk to him ABOUT his medication and help him understand that the feeling of not being hungry is just a side-effect of the medicine. Your son is a bit older, so you may be able to come at it more directly, but with DS we talk about his medicine tricking his stomach, so he has to use his brain so he doesn't fall for the trick. When he KNOWS he should eat, then he should eat a little something even if he doesn't FEEL hungry because he actually IS hungry... he just can't tell.

Ultimately, he may just eat like a bird and be thin all his life. DS is 7, 4'3" tall and hasn't broken 50lbs yet. He's skinny... like REALLY skinny, but he's not LOSING weight, he's growing, he's learning, he's physically active and coordinated, and I've always been thin too, and we're not going to make our lives miserable trying to bulk him up while the rest of the country worries about childhood obesity.

HTH
T.

I think you need to get your ped to try a different medication. It can be serious if he doesn't eat because his stomach hurts. It's one thing for him to have a poor appetite. Another totally different one for his stomach to hurt when he tries to eat.

I think maybe that you should also broach the subject of taking him off the medicine for a month and seeing if he can eat again without pain. This way you would know if something is wrong that has nothing to do with the Concerta. Then you would need a ped gastroenterologist to work with him.

Good luck with this.

My son and my husband theory is this. Why would you eat if you are not hungry. They do not pick on anything. You know like grazing at night, stress eating etc. needless to say neither has a weight problem. Tall and thin. Make him ice cream shakes with Pediasure. Is he losing weight or just growing taller?

Keep doing what you're doing. Maybe see if the ped or behaviorist thinks adding Pediasure would be a good plan?

It should only suppress the appetite when he is on the meds. So during the school year I will make them a huge breakfast, whatever the want. Then they eat a huge dinner. Lunch they don't eat at all.

Is he on the short acting or the extended release? Mind you I take adderall but the short acting destroys my appetite where the extended only effects lunch.

Our son has ADHD but also food neophobia (he's afraid of eating most foods), so food is a huge battle. It's been this way long before medication. His therapist recommended adding in Benecalorie. It's a thick supplement you mix in with beverages. It adds something like 300 calories in one little addition.

Unfortunately, with our son's food issues, he detected it right away. However, I think if your son will drink a smoothie or milkshake, it would blend in pretty well. (Our son also has limited drink options, none of which concealed the stuff)

As mentioned already, try to feed him a big breakfast before the hour when the medication kicks in and then feed more at the end of the day when it's out of his system.

I'm with you 100% on not wanting to give up Concerta. When you find what works, don't change things.

When my son was that age he was very, very thin. His doctor was concerned and told me he had to start gaining weight. I bought a product at GNC that was for gaining weight. It was a powder to make into a shake or put it in a smoothie, whatever you can get him to eat. It was not an option, he had to eat it. Of course now as an adult he fights to not gain weight.

This is normal for this med. My son also takes a stimulant and is a thin little bugger.

I suggest that you use the timeframe that the medication is actively in his system as a guide. So you feed him a big breakfast in the morning right before he takes his pill, so his appetite is not suppressed. Normal meals, whatever he'll eat while the meds are in his system, and then start eating dinner late...after the meds have worn off. Also, good snack, like peanutbutter toast, or a sugar free "Carnation Instant Breakfast" right before bed will help to put some weight on.

Basically you want to get the extra calories in him while he's not actively on his meds. He'll be hungry and eat then.

To address some of your issues: DON'T let him gorge. Give him a normal sized meal and a normal sized snack. Something that is calorie rich. Pancakes in the morning (check the freezer section in the grocery for premade pancakes) with peanut butter and sugar free syrup. Sausage. Whole milk. Try making the eggs differently. Boiled, or fried. My boys don't like scrambled eggs, but I taught them to make fried eggs and they scarf them up. They also love grilled tilapia. baked pork chops, and roasted chicken...healthy, easy recipes. Let me know if you want my recipes and I'll share them :-)

Be consistent with mealtimes. Make sure they line up to the time that he is completely off his meds. Sit and eat meals at the table, and make sure he's taking his time. Eating too fast causes us to not recognize when we are full....until we're TOO full. Teach him.

Best of luck!
C. Lee

My 12 year old takes this. It's amazing because it's been an absolute life saver for her. When she first started taking it and then when her dosage increased due to outgrowing the first dosage, she did have the decrease in appetite. That ended within two weeks as the dosage stabilized, though.

We also make sure that she takes it first thing in the morning and she's supposed to take it with a tall glass of water. Then she's supposed to eat a full breakfast right away. Eating before the meds take effect seems to help a lot. The girl eats like she's eating for two (or three) but she's very naturally lean.

If a person is not hungry, they can't eat.
If there is something else wrong with him, then get that investigated. Maybe his stomach pains, are a separate issue?

Stomach pain.... versus appetite, is and can be 2 separate issues.
So look into that.
Or is stomach pain, ALSO a side effect of his medication????

If a person is not hungry or has no appetite, they cannot eat.
It would be force feeding.
Even if that is not what you are doing.
Meanwhile, he will be getting malnourished?
Look into that, too.
He is now, in the 10th percentile for weight.

Its easy for the Doc to just say "he just needs to eat more...."
Well how can he, when he has no appetite and his stomach hurts????

I know, that if I am sick and have no appetite, I can't be forced to eat, I cannot eat.... and don't eat. Eating when one is not hungry, will just be thrown up or whatnot.

His body is not feeling hungry. He has no appetite. Therefore he cannot, eat.
And, per the medication he is taking, how.... can his appetite be increased? Especially since one of the side effects of it, is decreased appetite?
Maybe, another medication can be used.
Until the right fit, is found.
Re-evaluate that and tell the Doctor.
And, if his lack of appetite does not improve, because of the medication... then, what would the Doctor prefer???- ie: him just continuing to take that medication.... or, him continuing to lose weight/becoming even less than 10% in the percentiles... or him being healthy and finding the right fit, per medication?

This is not just a matter, of him eating more.
There are compounding circumstances in this. ie: his medication.
And his lack of appetite.
But you said he's been on this medication for the past 2 years. And.... in the "past few months...." his decrease in appetite has "gotten worse."
So, is this a separate problem/health problem, or is it due to his medication?

This isn't a direct answer, but, I have a friend who's child was on medication (it was for ADHD, but I don't know what the actual prescription he was taking was) and also had no appetite and was thin.
She let him go summers without the meds, so he would eat.

May not be the most healthy approach, and I don't know if Concerta is something you can let him go off of during time out of school or not. That is something you might want to check with his doctor about. Find out if there are downsides and what they might be, if you go without meds during the summer and start them back up just before school starts.

Again, this isn't my personal first hand solution. Just something a friend chose to do as an alternative one year to fighting with the lack of appetite over the summer when her son didn't HAVE to be medicated for school reasons. He graduated last year, by the way... and is very tall! Still lean. And into track-- ran in a couple of marathons his senior year of high school.

Just wondering if you tried taking him off dairy milk? There has been a lot of connection between having a sensitivity to dairy milk and ADHD plus stomach upset. You can do a trial milk elimination or go to www.enterolab.com and order a dairy sensitivity test. You can google.. dairy milk, casein and ADHD and see what comes up.

My son was on concerta, had to stop yesterday after only 3 weeks, that's another story though. He has lost a total of 20 pounds since stopping his mood stabilizer so I was super concerned with concerta. What I did was a sneak in as much proteins and extras to every meal. Like sprinkle protein powder in his cereal and breakfast smoothie. If you make Mac and cheese put purred veggies in it. I also take ground chicken and make chicken nuggets, also a great way to get some veggies in. I'm not sure about ways to increase appetite sorry, only a few suggestions to get a little extra in what he will eat good luck :)

My husband is on Dexadrine for ADD and he has the same issue. He lost 40 lbs right away when he started. Sometimes makes me wish I was ADD. I would love to loose the weight without even trying. ;)

A friend only did instant release meds for this reason, so that could be an option to discuss with your doc.