Alarmingly underweight tween

[Anonymous]

Anonymous wrote:Thanks PPs, your posts are incredibly helpful. Even as a baby, DD didn’t recognize when she was full. She spent a week in the NICU due to poor feeding. I nursed her and when she didn’t gain much, I pumped and bottle fed breast milk for the first three months. The most she ate was 3 oz at a time. I threw away a lot of milk.

Since upping the supplements a week ago, something unexpected has happened. I was worried that the supplements would take the place of food and that DD couldn’t manage both. But that hasn’t happened. In fact, she is eating MORE now that we are supplementing. She now gets a hearty breakfast, protein bar for snack, lunch, a supplement and snack after school, dinner, and a supplement before bed. It’s only been a week but so far so good.

I’m also happy to report that we have found an awesome pediatrician. She comes highly recommended by people here, she has helped two friends’ daughters with eating disorders, and she instantly bonded with DD, possibly because she is well under 5’ herself. She didn’t discount the feeding tube approach, but didn’t feel it’s right for DD right now. Given DD’s ability to manage the supplements on her own and her new found enthusiasm for food (or fear of the tube), she recommended reevaluating in one month. Meanwhile, she will study her chart, calculate her nutritional needs based on her activities, and we will discuss a new game plan for weight gain. I couldn’t be more relieved. Not that she said all is well, but that she promised to fix whatever is going on together.

I'm so glad to hear this. (I'm the PP who suggested dialing it down and working with your DD and DH to find something that DD can take ownership of). It's great that you have a doctor who you all can relate to and work with... and that she is taking a measured approach.

[Anonymous]

OP, so happy for you.

I am the poster with the underweight son. He absolutely positively does not have an eating disorder. Like another poster, he just get full fast. I can give him all the whole mike milkshakes he wants, but that just means he doesn’t eat the next meal.

Anyway, your daughter may be the same. Just because she is female doesn’t mean some anorexia situation.

Best of luck! My son is almost 14. You are doing a wonderful job catching this early. Kudos.

[Anonymous]

Someone introduced me to EDPS on Facebook. Good info there. “State not weight,” they teach.

[Anonymous]

Anonymous wrote:OP, so happy for you.

I am the poster with the underweight son. He absolutely positively does not have an eating disorder. Like another poster, he just get full fast. I can give him all the whole mike milkshakes he wants, but that just means he doesn’t eat the next meal.

Anyway, your daughter may be the same. Just because she is female doesn’t mean some anorexia situation.

Best of luck! My son is almost 14. You are doing a wonderful job catching this early. Kudos.

(Just a point of clarification -- anorexia isn't the only eating disorder.)

OP, how is your daughter doing? Is she continuing to eat as well as take all those supplemental drinks? I hope things are going well for you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Thanks PPs, your posts are incredibly helpful. Even as a baby, DD didn’t recognize when she was full. She spent a week in the NICU due to poor feeding. I nursed her and when she didn’t gain much, I pumped and bottle fed breast milk for the first three months. The most she ate was 3 oz at a time. I threw away a lot of milk.

Since upping the supplements a week ago, something unexpected has happened. I was worried that the supplements would take the place of food and that DD couldn’t manage both. But that hasn’t happened. In fact, she is eating MORE now that we are supplementing. She now gets a hearty breakfast, protein bar for snack, lunch, a supplement and snack after school, dinner, and a supplement before bed. It’s only been a week but so far so good.

I’m also happy to report that we have found an awesome pediatrician. She comes highly recommended by people here, she has helped two friends’ daughters with eating disorders, and she instantly bonded with DD, possibly because she is well under 5’ herself. She didn’t discount the feeding tube approach, but didn’t feel it’s right for DD right now. Given DD’s ability to manage the supplements on her own and her new found enthusiasm for food (or fear of the tube), she recommended reevaluating in one month. Meanwhile, she will study her chart, calculate her nutritional needs based on her activities, and we will discuss a new game plan for weight gain. I couldn’t be more relieved. Not that she said all is well, but that she promised to fix whatever is going on together.

I'm so glad to hear this. (I'm the PP who suggested dialing it down and working with your DD and DH to find something that DD can take ownership of). It's great that you have a doctor who you all can relate to and work with... and that she is taking a measured approach.

This makes me very happy to read.

It doesn't surprise me that once she started eating a bit better something resembling appetite came back. That was always true for me during my skinny times.

[Anonymous]

Anonymous wrote:OP, so happy for you.

I am the poster with the underweight son. He absolutely positively does not have an eating disorder. Like another poster, he just get full fast. I can give him all the whole mike milkshakes he wants, but that just means he doesn’t eat the next meal.

Anyway, your daughter may be the same. Just because she is female doesn’t mean some anorexia situation.

Best of luck! My son is almost 14. You are doing a wonderful job catching this early. Kudos.

I am also a poster with an underweight son. Disordered eating is any eating that doesn't lead to enough consumption for health. Anorexia is only one of many disorders. It is the one with the highest profile, but it isn't the only disorder. PP, I suggest your son work on learning to eat on a schedule and to stop using his own body as a guide. This was advice given to us by a colleague whose son had a metabolic disorder, but it sure worked for my underweight son (that and the threat of removing him from his soccer team).

[Anonymous]

OP here and I’m pleased to report that things are going well. We’ve instituted a strict schedule for meals and snacks that seems to be helping. She’s been very good about remembering her supplements (and I remind her when she forgets). Her new doctor is amazing. She bonded with DD immediately, reassured me, reviewed her complicated chart on her own time, called me on a Saturday and spent an hour discussing all the things she didn’t want to address with DD yet. She suspects, given DD’s lifelong history of feeding issues, that the root problem is not anxiety but a signaling issue. But by slowly increasing her calories through the supplements and regulating her meals, we can help her begin to recognize her hunger and satiety cues. She didn’t discount the role of anxiety or the possibility of eating disorders but felt the best approach right now is to focus on her eating. So far so good.

[Anonymous]

Anonymous wrote:OP here and I’m pleased to report that things are going well. We’ve instituted a strict schedule for meals and snacks that seems to be helping. She’s been very good about remembering her supplements (and I remind her when she forgets). Her new doctor is amazing. She bonded with DD immediately, reassured me, reviewed her complicated chart on her own time, called me on a Saturday and spent an hour discussing all the things she didn’t want to address with DD yet. She suspects, given DD’s lifelong history of feeding issues, that the root problem is not anxiety but a signaling issue. But by slowly increasing her calories through the supplements and regulating her meals, we can help her begin to recognize her hunger and satiety cues. She didn’t discount the role of anxiety or the possibility of eating disorders but felt the best approach right now is to focus on her eating. So far so good.

HI, this is PP who went with the feeding tube. I am very interested to hear in any follow up and progress around the signaling issue as time goes on. I believe that is at least part of our issue here. So glad you found a doctor you can connect with. Good luck.

[Anonymous]

Thank you, I will report back with updates periodically. We have a check up in 3 weeks to see if what we are doing is enough.

[Anonymous]

So glad to hear a positive update OP!

[Anonymous]

Anonymous wrote:OP here and I’m pleased to report that things are going well. We’ve instituted a strict schedule for meals and snacks that seems to be helping. She’s been very good about remembering her supplements (and I remind her when she forgets). Her new doctor is amazing. She bonded with DD immediately, reassured me, reviewed her complicated chart on her own time, called me on a Saturday and spent an hour discussing all the things she didn’t want to address with DD yet. She suspects, given DD’s lifelong history of feeding issues, that the root problem is not anxiety but a signaling issue. But by slowly increasing her calories through the supplements and regulating her meals, we can help her begin to recognize her hunger and satiety cues. She didn’t discount the role of anxiety or the possibility of eating disorders but felt the best approach right now is to focus on her eating. So far so good.

This is fascinating OP. My DS is very similar to your DD, and I suspect something similar is going on with him as it relates to a "signaling issue" - I just never knew that this was an actual thing! I really appreciate your willingness to share your story as you have helped me quite a bit.

[Anonymous]

Anonymous wrote:Has she always been this small or was she previously following a different curve on her growth charts?

If her bone age is 3 years delayed she should essentially be the same size as the average 8 year old. However, the BMI is still problematic.

Bone age and size are not really related. It means that the spaces between the bones in her wrist, that should close as she matures, are the same size as a younger child, not that her bones themselves are the same size.

It can be a sign of a problem, but isn't necessarily a problem.

I'll also say that while I wouldn't jump to a feeding tube on the suggestion of just one professional, a feeding tube was super helpful for my child, and far less challenging than I imagined. He wasn't a tween, and the reason he had it was different, so maybe take that with a grain of salt, but it really one of the best things we did.

[Anonymous]

That's fantastic OP! Do you mind sharing who her new ped is?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Has she always been this small or was she previously following a different curve on her growth charts?

If her bone age is 3 years delayed she should essentially be the same size as the average 8 year old. However, the BMI is still problematic.

Bone age and size are not really related. It means that the spaces between the bones in her wrist, that should close as she matures, are the same size as a younger child, not that her bones themselves are the same size.

It can be a sign of a problem, but isn't necessarily a problem.

I'll also say that while I wouldn't jump to a feeding tube on the suggestion of just one professional, a feeding tube was super helpful for my child, and far less challenging than I imagined. He wasn't a tween, and the reason he had it was different, so maybe take that with a grain of salt, but it really one of the best things we did.

No. Bone age has nothing to do with "the spaces between the bones." It is about assessing the level of ossification and calcification at the growth plates.

The level of skeletal maturity can essentially be determined based on two characteristics: The level of growth in areas undergoing the ossification and the level of calcium accumulation in those areas. From infancy to adulthood, these two characteristics follow a certain and specific pattern and timeline.

Hand X-ray in pediatric endocrinology: Skeletal age assessment and beyond
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266871/

Yes, bone age does correlate with bone size. This is because the long bones continue to grow until the growth plates have ossified and calcified secondary to the hormonal changes of growing through puberty. A young-for-age bone age indicates "constitutional growth delay," a common cause of (temporary) short stature in children. The short stature relative to others in the age group starts to resolve as they continue to grow after their peers' bones have matured and stopped growth at the growth plates.

Children with constitutional growth delay (CGD), the most common cause of short stature and pubertal delay, typically have retarded linear growth within the first 3 years of life.
...
At the expected time of puberty, the height of children with constitutional growth delay begins to drift further from the growth curve because of delay in the onset of the pubertal growth spurt. Catch-up growth, onset of puberty, and pubertal growth spurt occur later than average, resulting in normal adult stature and sexual development.
...
A radiographic study of the left hand and wrist to assess skeletal maturation is critical in diagnosing constitutional growth delay. Typically, the bone age begins to lag behind chronologic age during early childhood and is delayed in adolescence by an average of 2-4 years. Because the timing of puberty, the pubertal growth spurt, and epiphyseal fusion are dependent on biologic age (skeletal maturation) rather than chronologic age, all of these events are delayed in accordance with bone age.

https://emedicine.medscape.com/article/919677-overview

[Anonymous]

Great news OP!!!