Alarmingly underweight tween

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP, you posted this early on:

As for her general health, her vitals are fine. Her team at NIH concluded that her bone delay is most likely a result of “insufficient caloric intake.” She is active, happy, social, coordinated, bright. Sometimes she says she feels weak, tired, or dizzy. She is anxious, and I can’t say I blame her.

I am astounded that her team and you and your husband are allowing this child to participate in ballet, a high energy sport, when she has poor bone growth and is feeling weak, tired and dizzy most likely due to insufficient caloric intake.

I know that dance makes her happy and gives her self confidence. But your child has poor nutritional status. Through no fault of her own or fault of her parents but it is the truth nevertheless.

Your daughter should not be participating in high energy sports of any kind until she can eat enough food to fuel her own growth.

She does not needs to be diagnosed with an eating disorder for you to take this extremely seriously and to use techniques that are helpful for feeding children with eating disorders. Step one is to reduce all unnecessary physical activities. No more ballet!!! You are shooting yourself in the foot by allowing her to continue to burn calories when she cannot eat enough calories to let her bones grow.

Step two is to focus on high calorie foods -- not the red peppers. Add oil to everything. Count all her calories and make sure she is getting 3000+ calories per day. (Ask about the use of periactin to help her stomach empty faster.)

You seem to think that anorexia is about control but it is not. It is about not eating enough calories to fuel growth. She might not have started with anorexia, but just filling up her stomach fast, plus additional caloric needs of her sport and of trying to grow, may have triggered anorexia.

You need to stop the ballet now.

Thanks but I will follow the advice of her medical team. I think you are overestimating the caloric requirements of a typical dance class or two a week. Especially at this level. She is not rehearsing four hours a day. The emotional and social benefits far outweigh the risks, and dance motivates her to eat. Now if she were playing soccer or long distance running, that would be another story. I’ve spent 45 years in a dance studio and when dancers want to lose weight, they run or do other cardio activities. Dance is an anaerobic activity. If her medical team recommended she quit, we would pull her. But right now all agree that dance is an important balance in her life.

Why are you arguing with strangers about your daughters’ life instead of doing something?

[Anonymous]

Anonymous wrote:OP, what is a typical diet like each day for your DD? For you and your DH?

Here’s a hands-off day:

Whole grain cereal with whole milk
PBJ on whole wheat
Sliced apples or bananas
Toast with butter
Orange juice
Cereal with whole milk
Grilled chicken
Sweet potatoes with butter
Green beans
Ice cream

Here’s a hands-on day:

Soft boiled eggs with butter
Toast with butter
1/3 Avocado
Orange juice
Protein bar
Creamy cheesy mashed potatoes
Handful of nuts
Red peppers
Chocolate power waffle
Ensure Compact
Mango slices
Cinnamon bun
Cheese cubes and buttery crackers
1/3 Avocado
Kalamata olives
Carnation Instant Breakfast with whole milk

As for calories, I really don’t know. DD’s dietician does not recommend counting them but focusing instead on macronutrienrs food groups, with a focus on fats and proteins.

DH and eat pretty well. Oatmeal with fruit and nuts, big salad with protein for lunch or leftover dinner from the night before, nuts and banana or yogurt with granola for snacks, salmon or other protein with rice or potatoes and a vegetable of some sort, dark chocolate sometimes for desert. We eat dinner together as a family, with DD mostly eating what we do. DH drinks coffee, wine and/beer. I drink coffee and tea.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, you posted this early on:

As for her general health, her vitals are fine. Her team at NIH concluded that her bone delay is most likely a result of “insufficient caloric intake.” She is active, happy, social, coordinated, bright. Sometimes she says she feels weak, tired, or dizzy. She is anxious, and I can’t say I blame her.

I am astounded that her team and you and your husband are allowing this child to participate in ballet, a high energy sport, when she has poor bone growth and is feeling weak, tired and dizzy most likely due to insufficient caloric intake.

I know that dance makes her happy and gives her self confidence. But your child has poor nutritional status. Through no fault of her own or fault of her parents but it is the truth nevertheless.

Your daughter should not be participating in high energy sports of any kind until she can eat enough food to fuel her own growth.

She does not needs to be diagnosed with an eating disorder for you to take this extremely seriously and to use techniques that are helpful for feeding children with eating disorders. Step one is to reduce all unnecessary physical activities. No more ballet!!! You are shooting yourself in the foot by allowing her to continue to burn calories when she cannot eat enough calories to let her bones grow.

Step two is to focus on high calorie foods -- not the red peppers. Add oil to everything. Count all her calories and make sure she is getting 3000+ calories per day. (Ask about the use of periactin to help her stomach empty faster.)

You seem to think that anorexia is about control but it is not. It is about not eating enough calories to fuel growth. She might not have started with anorexia, but just filling up her stomach fast, plus additional caloric needs of her sport and of trying to grow, may have triggered anorexia.

You need to stop the ballet now.

Thanks but I will follow the advice of her medical team. I think you are overestimating the caloric requirements of a typical dance class or two a week. Especially at this level. She is not rehearsing four hours a day. The emotional and social benefits far outweigh the risks, and dance motivates her to eat. Now if she were playing soccer or long distance running, that would be another story. I’ve spent 45 years in a dance studio and when dancers want to lose weight, they run or do other cardio activities. Dance is an anaerobic activity. If her medical team recommended she quit, we would pull her. But right now all agree that dance is an important balance in her life.

Why are you arguing with strangers about your daughters’ life instead of doing something?

If you’ve read any of my posts you will see that we are doing a lot. I’m not arguing, but processing different viewpoints. Some I’ve considered carefully already and formed opinions based on our unique experience and expert medical advice, some I haven’t considered yet. The feeding tube discussion was very useful as my experience is limited. There is value in weighing experiences from those who have been in similar situations, even if advice varies. And there is value in expressing my doubts and fears to anonymous strangers because I want to protect DD’s privacy in real life.

[Anonymous]

Anonymous wrote:Sorry OP. This must be hard. Are you sure she's not celiac? (it doesn't always show up in the blood test). I was like her, maybe to a lesser extent. Skinny and no appetite. Meals were a torture. Many years later I found out I have celiac disease and dairy intolerance. I didn't have the typical symptoms but I was falling sick a lot, canker sores, anxiety). Just throwing this out there. Good luck.

DD’s pediatric GI fully expected celiac or allergic enteropathy, but her endoscopy and biopsies were clean. After ruling out all probable gastric causes for her issues, and knowing the endocrinologists has ruled out hormonal and chromosomal causes, we were then referred to the dietician, who works as part of the team. I’m sorry for your issues but glad you know what’s going on. I am allergic to milk and lactose intolerant, which went undiagnosed for 20 years.

[Anonymous]

OP, is your DH supportive of your views? That helps a lot, if you are on the same page. Do you have the support you need, for the most part? I respect that you are doing what is best for your child, and I think that PPs have really stepped it up for this thread. Thankful the crazies have not chimed in yet.

[Anonymous]

Anonymous wrote:OP here. Thanks for the gentle advice. I’m feeling fragile right now.

To answer some questions, the nutritionist is a dietician who works with DD’s medical team at Children’s. I am very opposed to the feeding tube for lots of reasons - most importantly because it feels like a total invasion and I’m not convinced it’s necessary anyway. But it did drive home the point that we need to take this seriously.

As for her general health, her vitals are fine. Her team at NIH concluded that her bone delay is most likely a result of “insufficient caloric intake.” She is active, happy, social, coordinated, bright. Sometimes she says she feels weak, tired, or dizzy. She is anxious, and I can’t say I blame her.

Regarding feeling weak, does she need more electrolytes? My child really likes Nuun drinks. (It's a healthier version of Gatorade, available at Whole Foods, sold in fizzy tablets.)

[Anonymous]

PS- My child, who at one point really needed to gain weight, loves the food at Chipotle. Everything there (except the salads) is extremely caloric! I also recommend homemade milkshakes with heavy cream added.

[Anonymous]

Anonymous wrote:OP, is your DH supportive of your views? That helps a lot, if you are on the same page. Do you have the support you need, for the most part? I respect that you are doing what is best for your child, and I think that PPs have really stepped it up for this thread. Thankful the crazies have not chimed in yet.

Thank you. Mostly DH is supportive of my views but he’s not as close to this as I am. That’s another reason I posted here - so he could read responses and become more aware. We talk a lot but he hears these things through my perspective. He travels a ton for work and can’t go to all the appointments so I interpret. Family members are sympathetic but because most were underweight as kids, I am seen as an alarmist and anxious mom. And I am, but I don’t think my anxiety is misplaced. Also, DD is extremely private about this so I don’t like to talk too much to friends and family. I’m grateful for the support I’ve found here.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here. Thanks for the gentle advice. I’m feeling fragile right now.

To answer some questions, the nutritionist is a dietician who works with DD’s medical team at Children’s. I am very opposed to the feeding tube for lots of reasons - most importantly because it feels like a total invasion and I’m not convinced it’s necessary anyway. But it did drive home the point that we need to take this seriously.

As for her general health, her vitals are fine. Her team at NIH concluded that her bone delay is most likely a result of “insufficient caloric intake.” She is active, happy, social, coordinated, bright. Sometimes she says she feels weak, tired, or dizzy. She is anxious, and I can’t say I blame her.

Regarding feeling weak, does she need more electrolytes? My child really likes Nuun drinks. (It's a healthier version of Gatorade, available at Whole Foods, sold in fizzy tablets.)

Thanks we will try those. She does drink Gatorade sometimes or Vitamin Water before class.

[Anonymous]

Anonymous wrote:PS- My child, who at one point really needed to gain weight, loves the food at Chipotle. Everything there (except the salads) is extremely caloric! I also recommend homemade milkshakes with heavy cream added.

Thanks, she likes burritos and quesadillas with lots of sour cream. I make smoothies sometimes with ice cream, frozen berries, and flax.

[Anonymous]

PP with DS who was below 1%. Your menu looks great, but not for underweight tween. Meat is missing. Sure you have milk and such, why is there no more meat on hands on days? Please add meat to her diet. More carbs too. Is she against eating meat? Apart from cinna bun, nothing there is full of calories. That is not going to make her gain weight. It is good you have ensure and carnation there, apart from few calorie heavy items, which you say are on days you can be hands on, the first hands off is what dieting looks for older women. She isn't eating enough. Her menu looks like what light snacking is for most teens.

[Anonymous]

Honestly, I would incorporate more junk food. What about potato chips? Milk shakes? Cookies? Doritos? Nachos? Mac and cheese? Ramen?

Get the calories in DD first, and then you can slowly start incorporating veggies and fruits.

The note you had posted earlier about packing red peppers in her lunch hinted that calorie consumption could be prioritized a lot more.

[Anonymous]

Overnight feeding tube sounds like a godsend.

[Anonymous]

It sounds like a lot to deal with, OP. I hope all the responses in this thread aren't overwhelming. It sounds like you are already doing what you need to do: getting specialized advice from a medical team, taking the issues seriously, considering all recommendations.

I have a thin but stable kid (<5% for weight, 10% BMI). I have some conflict with my child's other parent who stresses a kind of "healthy eating" that is great for most people, but not our child. My kid gravitates to foods like fruit, egg whites, black beans-and that's great, but I also offer her the highest fat ice cream I can get, give her after school chips or cookies (she still eats the same amount at meals after these foods). Honestly, that's challenging socially because none of my parent peers operate that way, but she is maintaining her BMI.

I was a similarly thin kid who went on to have an eating disorder. So I went from 10%BMI at 10 years to <1 at 14. The fact that I was already a very thin kid and that I didn't express any body dysmorphia really masked my eating disorder. As an outside observer I would say your child has several significant risk factors for disordered eating-possible genetic risk, social contagion of knowing another young person with an eating disorder, and being in an activity that favors slim bodies (and even if the studio is very careful about what they say, kids are not stupid they can see what professional dancers look like and what they most successful older girls at the studio look like).

[Anonymous]

Are you in the DMV? Are you seeing a pediatric nutritionist at Georgetown Pediatrics? I only ask because they used to have a great one years ago and who knows if they have a new one now, but some 5 years ago they changed and got one that is absolutely useless. I don't want to name names, but useless.