Annalisa Czeczulin wishes her son wanted pizza and Happy Meals.
When the 8-year-old asks for ice cream — or anything else to drink or eat — she’s thrilled. Alex isn’t a picky eater. He has a feeding disorder.
At one point, he was eating only six macaroni noodles and a cup of juice all day.
“We felt like we were watching our child starve to death,” says Czeczulin, a Russian professor at Goucher College and Johns Hopkins University.
Today, Alex is a success story at Mt. Washington Pediatric Hospital, which has a special program for children ages 1 to 12 with feeding problems. He regularly eats soup, peanut butter, fish sticks, carrots and macaroni and cheese. He’s taken a few bites of hamburger, sampled mangos and tried apples with the skin still on.
“We’re cautiously optimistic that we may have rounded the curve,” Czeczulin says, adding that Alex now weighs 40 pounds.
Most parents worry from time to time about the nutritional needs of their children, whether it’s angst about allergies or balance. Could that bump be a reaction to a peanut? Are they getting enough calcium? Will they ever eat anything green?
Even the most adventuresome eaters have their quirks and levels of cooperation. The old “won’t eat broccoli” is a widespread complaint, according to Dr. Richard Katz, vice president of medical affairs at Mt. Washington Pediatric Hospital.
But as many as 25 percent of children have a feeding disorder, though it’s often mild. Symptoms can range from taking too long to eat and refusal of certain foods and textures to real or imagined difficulty swallowing and total rejection of food and drink. Statistics aren’t available for the number of children with more serious feeding problems like Alex’s.
However, Katz says, “It’s surprisingly more common than you might think.”
Every year, the Baltimore hospital treats about 100 children with severe feeding disorders. Some of the problems are caused when the children have been fed through feeding tubes because of other medical problems. Other times, the problems stem from a behavioral or mental condition. The average age of children in the program is about 3 1/2.
A child who is growing normally can still have a feeding disorder, says Katz. An alarm bell should sound for parents when the child stops eating at least two food groups, he says.
The Kennedy Krieger Institute also has a feeding disorders clinic, which treats about 350 children each year and has a 90 percent success rate, according to the hospital.
Dealing with a child who refuses to eat “can be a very stressful thing for parents,” says Dr. Peter Girolami, assistant director of the Kennedy Krieger feeding clinic.
Parents shouldn’t hesitate to consult with their pediatricians and seek out expert help, Girolami and other experts say. Both hospitals say having a team, which includes social workers, occupational therapists and nutritionists, is the key to success.
For Alex, the trouble seemed to begin after he choked a bit on a corn niblet at the age of 2, his mother says. After those negative gagging experiences, his diet became narrower and narrower.
Because Alex was eating so little, he began having bowel obstructions. They frequently had to rush to the emergency room in the middle of the night. And the GI problems, in turn, made his stomach hurt, which made eating even less appealing.
By March 2007, Alex weighed 28 pounds. He was 5 years old, but he was the size of a 3-year-old, his mother says.
“He looked like a skeleton,” says Czeczulin, who has two other sons, ages 19 and 17. (Both are healthy.)
A first step was getting Alex on a liquid formula to provide some basic nutrients and help resolve his GI issues. But the breakthrough came when Alex entered into Mt. Washington Pediatric Hospital’s six-week day program last summer. There, staff worked with Alex at breakfast and lunch, teaching him to overcome his fears about eating and choking. They broke down the task of eating new foods into smaller steps. For example, the staff had him touch the food, then kiss it, and later lick it, put it in his mouth, chew it and then finally, swallow it.
The staff has “such a good feeling for what they can ask of a child,” Czeczulin says. “They knew what scared him versus what was just him trying to control the situation. They knew when to keep pushing.”
He was rewarded constantly with incentives, including a new pet guinea pig named Gizmo for completing the program.
Carlee Aluise, a 5-year-old from Westminster, is having similar success with Mt. Washington’s program. Her problems stemmed from allergic reactions to certain foods, including oats, eggs and dairy, which inflamed her esophagus. She has gone from eating stage 2 baby food bananas and soy yogurt and being fed by a tube twice a day down to one tube feeding and an ever-expanding diet, which now includes pancakes, chicken nuggets, real bananas and applesauce.
“She’s so much happier,” says her mother Dawn Aluise. “It’s amazing the difference.”
Alex’s improvements in eating have helped resolve a number of physical problems caused by the lack of proper nutrition. He no longer needs to wear glasses every day. And his hair, once missing in patches, has returned. He still suffers from hearing loss, though that, too, seems to be getting better.
And Alex is now sleeping through the night. “You can’t imagine not only the impact that that has on the child, but the whole family,” says Czeczulin, whose husband teaches at a community college and works on the family’s chicken farm on the Eastern Shore, where they spend weekends together. During the week the boys and their mother live in Towson.
Czeczulin is interrupted with a request from her son for ice cream. She is happy to oblige.
“Believe it or not, even ice cream didn’t look good to him a year ago,” the mom says. “It’s not a battlefield at the table anymore.”
But there is still work to be done. Czeczulin is waiting for the day that the family can go to a restaurant and have a meal.
“Not being able to do that makes travel very difficult,” she says. “It sounds horrific to some parents, but I’d be ecstatic if he’d eat some chicken nuggets and French fries.”

If your child needs help:
Mt. Washington Pediatric Hospital Feeding Day Program: 410-578-2608 or www.mwph.org/services/feeding.htm
Kennedy Krieger Institute: www.kennedykrieger.org
American Academy of Pediatrics offers nutritional guidelines, meal suggestions and tips for fewer mealtime hassles: www.aap.org/healthtopics/nutrition.cfm
Spatulatta has step-by-step videos and recipes: www.spatulatta.com/
Penn State Children’s Hospital has information and tips at: http://www.hmc.psu.edu/childrens/healthinfo/f/feeding.htm
Is meal time stressful at your home? Try these tips from medical experts and parents:
• Involve your child. In addition to making the mealtime fun and being educational, a child who helps make the meal may be less likely to reject it.
• Be consistent. It can be hard with hectic schedules, but try to have mealtimes at the same time each day when the child is not overly tired for them.
• Keep at it. You may have to present a food ten or more times before your child accepts it. Don’t give up hope too quickly that your little one will learn to like broccoli. But be careful not to establish a routine of allowing your child to reject foods.
• Give choices. If you want a child to eat a vegetable, give them a choice of what kind. (You may have to prepare both veggies.)
• Keep a food journal. Log what your child eats and rate the overall experience of mealtimes from 1 to 5. That way, you’ll see trends over several weeks and months. You will see if your child is eating less variety of foods or if the child’s behavior at mealtimes is getting worse.
• Use a timer. Don’t let meals end when a child screams or throws food.
• Trust your instincts as a parent. Do you think your child is going through a picky stage? Or do you suspect something else more serious is happening? Don’t hesitate to get a second opinion.
Sources: Dr. Richard Katz of Mt. Washington Pediatric Hospital, Dr. Peter Girolami of the Kennedy Krieger Institute, Annalisa Czeczulin and feeding disorder experts.