Alarmingly underweight tween

[Anonymous]

DD is 11, her height is in the 5th percentile, and her BMI is in the .1 percentile. Her bone growth is 3 years delayed. DH and I are both tall (5’9” and 6’2”) but also thin (BMIs around 5th percentile).

DD has been tested at NIH for growth delays, tested at Children’s for celiac and allergies, evaluated by a nutritionist and psychologist for eating disorders. She has been cleared of all probable causes except anxiety, which is no surprise given all the testing the poor kid has been through.

She eats a balanced diet but very little at a time before she feels full. We have tried supplementing with protein shakes, adding fats and dense calories, adding a fourth full meal plus snacks. She is somewhat resistant to all this and it’s been a battle to get her to take it seriously - she just wants to feel like a “normal” kid.

Her psychologist warned us to back off on the food pushing because while she doesn’t have an eating disorder now, our anxiety could trigger one. So today her nutritionist suggested we consider a feeding tube. We are all freaked at this suggestion and DD has promised to be more cooperative about the supplements. How on earth can we back off on the control when our daughter is starving before our eyes?

Has anyone been through this?

[Anonymous]

No I haven't. Your post might trigger a lot of people projecting their shit and being judgemental. I sincerely hope not and hope you get good advice. Sorry op

[Anonymous]

I was that kid. Leave her alone. My mom always had to get into power struggles about food and it was one of several things that destroyed our relationship.

[Anonymous]

Her weight is obviously problematic but what does her medical team say about her overall health? Are all of her vitals stable? Are her electrolytes and bloodwork all stable? Has she experienced any signs of malnourishment?

Is there any area of concern other than her weight?

[Anonymous]

Has she dropped below her normal percentile for weight? My son was at 0.03 percentile so I understand your concern.

I would never consider a feeding tube on the recommendation of a nutritionist.

[Anonymous]

Anonymous wrote:Has she dropped below her normal percentile for weight? My son was at 0.03 percentile so I understand your concern.

I would never consider a feeding tube on the recommendation of a nutritionist.

I would, if the nutritionist is a real dietitian. There is a difference.

[Anonymous]

Has she always been very small? Is she experiencing any issues aside from slow growth? Have you tried meds (appetite stimulants, gastric emptying)? If she's really struggling, maybe the tube can help stabilize, I'd just be worried about cascading problems if the tube reduces her hunger cues further and she eats even less.

[Anonymous]

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.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Has she dropped below her normal percentile for weight? My son was at 0.03 percentile so I understand your concern.

I would never consider a feeding tube on the recommendation of a nutritionist.

I would, if the nutritionist is a real dietitian. There is a difference.

First PP here. There are so many options before you go that route. There are serious negative consequences of a tube. If you are inclined, I’d check out KKI feeding program or some of the other specialists - we live in a great area for feeding services.

[Anonymous]

Anonymous wrote:Her weight is obviously problematic but what does her medical team say about her overall health? Are all of her vitals stable? Are her electrolytes and bloodwork all stable? Has she experienced any signs of malnourishment?

Is there any area of concern other than her weight?

I echo this PP. Is there anything else actually wrong?
As a kid I was always very small and skinny, always a concern to relatives, but thank goodness didn’t pressure me too much. Same with my sister. Today as adults we are petite but completely normal and don’t really stand out physically. It only changed after our 20’s, until then we always looked at least 5 years younger than what we actually were.

Listen to her doctors and educate yourself on how to read blood work. Ask questions. Do not derail with a food tube - that’s extreme.

[Anonymous]

Teen boy with constitutional growth delay. Biggest thing to focus on is not the numbers but the overall health of the child. How is she? Is she active? Is she happy? Does she have friends? Once we backed off we realized he was fine just small. He is now 17 and 5’11” but still not 11 lbs and not a lick of hair on his body. But happy and healthy kid. So look at the overall picture rather than the numbers.

As PP said, stop listening to a nutritionist about a feeding tube.

[Anonymous]

Should say not 100 lbs.

[Anonymous]

Everybody says to lay off except a nutritionist. I say get a new nutritionist.

I have 2 very healthy friends like your daughter.

I have always said it's harder to eat when you need to than stop when you need to.

I don't really have advice ... I had an underweight boy who would eat tons and not gain weight.

You say she eats healthy but healthy for an underweight person is everything we think is unhealthy ... high fat high calorie foods.

[Anonymous]

Re the feeding tube: If it is medically necessary I think the medical team will suggest it. That said, feeding tubes can be SUPER beneficial to some kiddos and if it comes down to that don't be afraid to do what is necessary for her.

[Anonymous]

How much is she actually eating in a day? How many calories would she be taking in? How much protein and fat?