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[quote=Anonymous]My rising 5th grader with multiple issues has failed to gain more than 2-3 pounds in the past two years or so. At his last med check, his height had also dropped off his growth curve, prompting concern and a suggestion to see a nutritionist. He has always been very thin, and genetically he is likely to always be thin, but his weight is now &lt;1% on the charts. He is an extremely picky eater and if anything, his eating habits have worsened over the years. I have read so many books and tried so many approaches, with no real improvement. He mostly eats bread/carb-based foods, very little meat or dairy although he will eat a few forms of cheese, a handful of fruits and vegetables in small portions, definitely does not get enough protein, healthy fats, or fiber. He is severely allergic to tree nuts and has mild allergies to peanuts, several types of seeds included sesame, and a few legumes. He does not like &quot;cold&quot; foods, so no ice cream, milkshakes, yogurt, etc. He is resistant to smoothies as well but I continue to try.

We saw a new psychiatrist a few months ago who came highly recommended. This was after a couple years of medication management by the pediatrician after reaching stable meds/doses with a previous psychiatrist (he takes Adderall and Zoloft). Of note - the Adderall does not seem to have much of an effect on his appetite, as the slow down in weight gain did not coincide with starting medication and we do not notice an uptick in appetite when not medicated. This psychiatrist recommended an integrative nutrition and psychology practice specializing in the interaction of nutrition and physical as well as mental health. It sounded great, but we went for an initial consultation last week and I&quot;m suspicious. It's expensive, and seems a bit alternative/&quot;woo.&quot; I was expecting a more mainstream or at least balanced approach. They want to do a bunch of lab work (urine/stool samples, maybe blood work) that gets sent off to distant labs. My research tells me this will probably turn up with a bunch of food sensitivities/intolerances and the need for lot of supplements. Basically, seems like snake oil. Am I right to be so suspicious? Or is this actually worth a shot? I have often wondered if he could possibly have celiac disease, since he eats mostly bread and isn't gaining any weight - is he not absorbing it? He has had occasional issues with constipation/diarrhea. But his allergist has seemed reluctant to test for that.

The dietician we met with at this practice did notice my son's hypermobility, which seems to have become more pronounced over time. He has trouble sitting upright in a chair and tends to curl up in a ball and &quot;perch&quot; in his seat. He twists his legs around and has terrible handwriting. He has low tone, particularly in the trunk, and struggles with endurance and anything athletic. She hinted at the idea that we might want to have genetic testing done, and that these physical symptoms might be related to his other issues, especially the anxiety. Is this an avenue I should pursue?

I realize this post is all over the place. I don't know where to start with helping to get his nutrition/weight gain on track, and whether his physical issues are connected to, or exacerbating, his mental health/behavioral issues. Do I need to see a more mainstream dietician? A gastrointestinal specialist? A geneticist? Do we need to get him back to OT or PT (we did OT from ages 3-5)? Or would CBT help with the eating issues? I feel extremely overwhelmed and don't know where to start. It seems like no doctor can really help me figure out the best course of action. [/quote]

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