When to be alarmed about underweight child?

[Anonymous]

I have a 10 yo DC who has always been slender. They started taking stimulants 3 years ago and since then have struggled to gain weight but growth is staying on the curve.

They need their stimulant to make it through the day at school - when DC accidentally skips it’s a disaster socially and academically.

Pediatrician tells me not to worry as DC is growing but BMI has dropped from 10% before stimulants to 5% after one year of stimulants to <<1%. BMI is now 12.5.

DC has seen a nutritionist in the past, and has also done feeding therapy (that was when BMI was 2%). DC refuses to do feeding therapy again.

I’m trying to trust my pediatrician, but it’s getting harder as I see DC growing without gaining weight. Any advice from other parents who have BTDT would be appreciated.

[Anonymous]

I'm assuming you mean 10th percentile on the growth charts, not BMI...

My kid was <5% his whole life and we/ped had no concerns - until anxiety spiked in 6th grade and he actually lost a small amount of weight. Ped said then that it wasn't a serious issue yet but that if we couldn't turn it around in 6 months it would be more concerning. TBH that was scary for me. I met with a wonderful nutritionist and we got him back on his growth curve by the fall. (All in concert with therapy/treatment for the anxiety, too, of course.)

Her advice to us in a nutshell - all calories are good calories for this case, don't be afraid of liquid supplements or sugar if that's all he'll eat, add a multivitamin+iron for micronutrients. It is HARD to let go when the only thing your kid will eat is Lucky Charms with whole milk or Reeses cups, but when it came down to that or nothing, we took it. And lots of Ensure Plus / Boost Plus / Protein shakes.

It's still hard, his diet hasn't gotten significantly better / is still a work in progress, but he's gaining weight at a normal pace now and I'm learning to deal with the side eye I get from other parents who don't know the history there.

Good luck <3

[Anonymous]

Anonymous wrote:I'm assuming you mean 10th percentile on the growth charts, not BMI...

My kid was <5% his whole life and we/ped had no concerns - until anxiety spiked in 6th grade and he actually lost a small amount of weight. Ped said then that it wasn't a serious issue yet but that if we couldn't turn it around in 6 months it would be more concerning. TBH that was scary for me. I met with a wonderful nutritionist and we got him back on his growth curve by the fall. (All in concert with therapy/treatment for the anxiety, too, of course.)

Her advice to us in a nutshell - all calories are good calories for this case, don't be afraid of liquid supplements or sugar if that's all he'll eat, add a multivitamin+iron for micronutrients. It is HARD to let go when the only thing your kid will eat is Lucky Charms with whole milk or Reeses cups, but when it came down to that or nothing, we took it. And lots of Ensure Plus / Boost Plus / Protein shakes.

It's still hard, his diet hasn't gotten significantly better / is still a work in progress, but he's gaining weight at a normal pace now and I'm learning to deal with the side eye I get from other parents who don't know the history there.

Good luck <3

I'm not the OP but thank you for this. My son drinks pediasure every single day and I know I get a lot of side eye from other parents but he is literally in the 1% and it's the only way I have some assurance that he's getting nutrients and calories in.

[Anonymous]

Can you do a lower dose or a different medication? The decline in BMI would worry me.
Is there anything he'll eat that's high calorie? Good high calorie ice cream like Haggen Daaz or Ben and Jerry's?

Our psychiatrist told us we needed to step up the calories and suggested ice cream when DS didn't gain weight for 6 months but got taller with weight dropping from a little above 40%th percentile to a little below that for a very tall kid.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm assuming you mean 10th percentile on the growth charts, not BMI...

My kid was <5% his whole life and we/ped had no concerns - until anxiety spiked in 6th grade and he actually lost a small amount of weight. Ped said then that it wasn't a serious issue yet but that if we couldn't turn it around in 6 months it would be more concerning. TBH that was scary for me. I met with a wonderful nutritionist and we got him back on his growth curve by the fall. (All in concert with therapy/treatment for the anxiety, too, of course.)

Her advice to us in a nutshell - all calories are good calories for this case, don't be afraid of liquid supplements or sugar if that's all he'll eat, add a multivitamin+iron for micronutrients. It is HARD to let go when the only thing your kid will eat is Lucky Charms with whole milk or Reeses cups, but when it came down to that or nothing, we took it. And lots of Ensure Plus / Boost Plus / Protein shakes.

It's still hard, his diet hasn't gotten significantly better / is still a work in progress, but he's gaining weight at a normal pace now and I'm learning to deal with the side eye I get from other parents who don't know the history there.

Good luck <3

I'm not the OP but thank you for this. My son drinks pediasure every single day and I know I get a lot of side eye from other parents but he is literally in the 1% and it's the only way I have some assurance that he's getting nutrients and calories in.

We're in the same boat. We always felt alone and frustrated until we found a nutritionist who said don't focus on how you think others are judging focus on getting calories into your son. If he'll eat it, give it.

[Anonymous]

OP, are there ways to add fat to what DC will eat? Mix in protein powder and oil, butter or heavy cream into baked goods, smoothies, etc?

I would add nut butter and frozen avocado to smoothies and DC would drink it all if distracted by tv. Basically the opposite of the conventional advice.

Can you take periodic breaks from the meds and/or add a non-stimulant as a buffer and dial back the stimulant? Who is doing the prescribing? I'd go for a psychiatrist over a ped when there are other issues in the mix.

It's so stressful, I know. Take care of yourself as well!

[Anonymous]

When my kid dropped below the 2nd percentile for BMI was when the doctors became more concerned. Advice was to add more calories to what they already eat rather than trying to add volume. We buy only full fat dairy products, cook all veggies in oil or pour melted butter over them, mix cheese into just about everything, use heavy cream for any recipe calling for milk, ice cream and other desserts are always in the freezer.

We also added a fourth meal in the evening before bed. It's a time when they were usually hungry, probably because the meds had worn off, so we added a small meal then to get more healthy foods in before they can eat whatever they want.

[Anonymous]

If they are healthy and active I wouldn’t worry too much.
I wouldnt resort to lucky charms and Reese’s pieces just to get food in, that’s crazy.

[Anonymous]

I think 10 is an age for stretching out a bit but that said i would trust your parenting inner voice more than the constant pediatrician wave offs.

[Anonymous]

Have you spoken with the pediatrician specifically about this concern - that your kiddo is growing but is not gaining weight, you are concerned, etc.? Those statistics are fairly alarming, and when combined with your kiddo's history of feeding tube, it is weird to me that the pediatrician's approach is as hands off as it sounds.

What is your understanding of the problem for your kid? Is it a sensory issue? Is it a different kind of food restriction? Is it purely stimulant-based appetite suppression? I would be alarmed by the numbers alone, but I might be comforted by more specific context for my kid.

FWIW my kid has always been small, and the first time she dropped below the 5th %ile, we were referred to a pediatric endocrinologist. I thought that was a bit much given the context (she'd just started walking, she had been sick a lot in daycare that fall), but he was concerned and made the referral. Your ped is not doing anything like that, it sounds like.

[Anonymous]

My child was put on cyproheptadine/periactin to stimulate appetite, and it helped her put on some weight. That said, she’s 5’4” and weighs 90 lbs. she’s always been very skinny and is 2nd% for bmi. Our pediatrician recommended all of the things already mentioned.

[Anonymous]

Can kid wake up earlier and do a big breakfast before taking meds? Can they have caloric beverages throughout the day (put it in an IEP or 504 if needed) and a big pre-bedtime snack?

I agree with the PP who suggested med breaks on school breaks.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm assuming you mean 10th percentile on the growth charts, not BMI...

My kid was <5% his whole life and we/ped had no concerns - until anxiety spiked in 6th grade and he actually lost a small amount of weight. Ped said then that it wasn't a serious issue yet but that if we couldn't turn it around in 6 months it would be more concerning. TBH that was scary for me. I met with a wonderful nutritionist and we got him back on his growth curve by the fall. (All in concert with therapy/treatment for the anxiety, too, of course.)

Her advice to us in a nutshell - all calories are good calories for this case, don't be afraid of liquid supplements or sugar if that's all he'll eat, add a multivitamin+iron for micronutrients. It is HARD to let go when the only thing your kid will eat is Lucky Charms with whole milk or Reeses cups, but when it came down to that or nothing, we took it. And lots of Ensure Plus / Boost Plus / Protein shakes.

It's still hard, his diet hasn't gotten significantly better / is still a work in progress, but he's gaining weight at a normal pace now and I'm learning to deal with the side eye I get from other parents who don't know the history there.

Good luck <3

I'm not the OP but thank you for this. My son drinks pediasure every single day and I know I get a lot of side eye from other parents but he is literally in the 1% and it's the only way I have some assurance that he's getting nutrients and calories in.

We're in the same boat. We always felt alone and frustrated until we found a nutritionist who said don't focus on how you think others are judging focus on getting calories into your son. If he'll eat it, give it.

Chiming to express appreciation for 15:00's post. It took me a long time to get over the idea that nutrition had to be chewed - and I completely understand how hard it is to let it go when the only food your kid will eat is something you're judged for!

Don't lose hope! I'm happy to report that my oldest kid (who's now 20 and in K would only eat PBJ) has a more well rounded palette. He continues to have texture issues but he's far more willing to try new things - especially things his peers are eating. I sometimes think his choices are questionable (he'll eat black beans straight out of can but not with any seasonings) but he's actually eating some vegetables and mixed foods (like chili and tacos). But, to keep me humble, I have another kid who pretty much will only eat pasta. It's not as if DH and I haven't tried. We have! We also have a third kid who is NT that eats everything.
It's just the way it goes sometimes. Hugs to all of you going through this.

[Anonymous]

Anonymous wrote:If they are healthy and active I wouldn’t worry too much.
I wouldnt resort to lucky charms and Reese’s pieces just to get food in, that’s crazy.

So says someone who has never experienced kids who refuse to eat. And, no, some kids will NOT eat when they're hungry.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If they are healthy and active I wouldn’t worry too much.
I wouldnt resort to lucky charms and Reese’s pieces just to get food in, that’s crazy.

So says someone who has never experienced kids who refuse to eat. And, no, some kids will NOT eat when they're hungry.

DP. OP's DC is growing taller, which is a good sign. In her shoes, I would try to increases calories and call the pediatrician to ask about the concerns. But I have also done extensive research about when to be alarmed about an underweight child. OP needs to do her own research, not ask DCUM. We can give her advice about increasing calories. Her doctor can say when to be worried.