I just have to add to this discussion. I think there is too much emphasis on the psychological. OP describes a child who needs more food. She probably also needs a diagnosis.
Our story: My DD has always been VERY interested in food. In 8th grade she bought a nutrition book and we tried it all out. Some weird stuff. I thought this was a phase so I went along with it. I didn’t know what she was suffering through. We tested for allergies. No allergies.
Then she started having stomach aches and we tried elimination diet. Oh we tried everything, including therapy because she was depressed & anxious. And her stomach hurt. And it was a family joke she had a small bladder.
Things came to a head when she was a star in track and field. She strangely fell down in the middle of a race. But really she fainted. While running full speed.
Then she started breaking bones in her legs and ankles. Stress fractures. We thought, geez no need to be THAT competitive.
We were in and out of doctors offices all the time. She started to mention she was in pain a lot of the time from constipation and diarrhea. As a female teen she didn’t want to tell us all the details of her “bathroom issues “. We were STILL treating her for psychological issues.
Finally we found out she has IBS, and not mildly either.
It took 10 YEARS. Doctors missed it. We missed it. I feel bad that we treated her bones (IBS robs bones of nutrients) and her anxiety while missing her REAL problem. And the daily pain she suffered from alternating constipation and diarrhea. At one point she wasn’t allowed to leave the classroom during a test. She HAD to relieve herself and took a zero on the test. Other similar incidents.
We are not uninvolved parents at all. But somehow despite visiting doctor after doctor not one diagnosed this. It was Dr Google in the end. We finally found a specialist and some support and things are much better now.
To get back to the “not eating “. Starving yourself is not normal. A child who steadfastly refuses to eat to the point of wasting/ starving probably has a physical problem, somewhere somehow. The body rejects food that it can’t digest in many subtle ways.
I hope all of you who are struggling find answers and solutions. It’s terrible to watch your child suffer and waste away.
Sorry so long.

This is one of the most interesting threads on DCUM.

20:47, THANK you! I'm so happy to hear your child is doing well and truly appreciate the suggestions.

Anonymous wrote:

Anonymous wrote:NP here- for the 14:56 poster, you sound like my daughter. She gets nauseas when her stomach is empty. She is petite, 65 lbs, 13 years old, 4'7". She struggles to put on weight. She grows and gains weight very slowly. Been this was her entire life. Would you mind Sharing what you eat to get to 2000 calories a day? Looking for small, Calorie dense snacks. Thank you!

I'm not that poster, but I've been following this thread as I am the parent of a child recovering from anorexia. I had a great number of small "footprint" high calorie snacks and meals in my repertoire when we were "refeeding" my kid.

- nuts
- sunflower seeds
- Clif bars
- scrambled egg w/ cream and lots of butter mixed in
- full fat yogurt (trader joe's Greek, e.g. honey flavor, is quite high in calories)
- premium ice cream (Haagen Daaz, Ben & Jerry's, trader joe's)
- smoothies/milkshakes made with fruit, heavy cream, full fat yogurt or ice cream, plus a few tablespoons of canola oil blended well
- avocado (as guacamole with tortilla chips, or on avocado toast with butter spread underneath the avocado, or just on its own)
- rice, with canola oil drizzled on top after cooking.
- dried fruit (many more calories per serving than fresh fruit)
- trader joe's meatalls (beef, not turkey) have a lot of calories-- we microwave a few and serve with ketchup as a snack
- trader joe's belgian chocolate pudding (near the yogurts)-- decadent and high fat/cal
- mashed potatoes with lots of cream and butter mixed in

There is also an amazing product called "Benecalorie" that can be purchased on Amazon; it comes in little tubs of a few ounces each, and can be stirred into many foods (e.g. yogurt, soup, smoothie) for a caloric punch with little or no change in flavor or texture.

Good luck to all of you struggling to get weight on your children, whatever the cause. My anorexic child is now thriving 3.5 years after initial diagnosis, participating in sports, craving snacks and meals like a regular kid.

NP. This is such a fantastic list. I just ordered some Benecalorie!

Anonymous wrote:NP here- for the 14:56 poster, you sound like my daughter. She gets nauseas when her stomach is empty. She is petite, 65 lbs, 13 years old, 4'7". She struggles to put on weight. She grows and gains weight very slowly. Been this was her entire life. Would you mind Sharing what you eat to get to 2000 calories a day? Looking for small, Calorie dense snacks. Thank you!

I'm not that poster, but I've been following this thread as I am the parent of a child recovering from anorexia. I had a great number of small "footprint" high calorie snacks and meals in my repertoire when we were "refeeding" my kid.

- nuts
- sunflower seeds
- Clif bars
- scrambled egg w/ cream and lots of butter mixed in
- full fat yogurt (trader joe's Greek, e.g. honey flavor, is quite high in calories)
- premium ice cream (Haagen Daaz, Ben & Jerry's, trader joe's)
- smoothies/milkshakes made with fruit, heavy cream, full fat yogurt or ice cream, plus a few tablespoons of canola oil blended well
- avocado (as guacamole with tortilla chips, or on avocado toast with butter spread underneath the avocado, or just on its own)
- rice, with canola oil drizzled on top after cooking.
- dried fruit (many more calories per serving than fresh fruit)
- trader joe's meatalls (beef, not turkey) have a lot of calories-- we microwave a few and serve with ketchup as a snack
- trader joe's belgian chocolate pudding (near the yogurts)-- decadent and high fat/cal
- mashed potatoes with lots of cream and butter mixed in

There is also an amazing product called "Benecalorie" that can be purchased on Amazon; it comes in little tubs of a few ounces each, and can be stirred into many foods (e.g. yogurt, soup, smoothie) for a caloric punch with little or no change in flavor or texture.

Good luck to all of you struggling to get weight on your children, whatever the cause. My anorexic child is now thriving 3.5 years after initial diagnosis, participating in sports, craving snacks and meals like a regular kid.

NP here- for the 14:56 poster, you sound like my daughter. She gets nauseas when her stomach is empty. She is petite, 65 lbs, 13 years old, 4'7". She struggles to put on weight. She grows and gains weight very slowly. Been this was her entire life. Would you mind Sharing what you eat to get to 2000 calories a day? Looking for small, Calorie dense snacks. Thank you!

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.

This. If her pediatrician says she needs one that is one thing. But I have met too many nutritionalists that have eating disorders themselves to take them seriously.

Anonymous wrote:

Anonymous wrote:Were either you or your husband short and skinny as kids or were you both always tall and very thin? If you were short, skinny kids who ended up being tall adults I wouldn't worry as much. But if you were both always tall there is something seriously wrong. Have you really ruled out all medical conditions? I would visit specialists like gastroenterologist, endrocrinologists for another opinion.

DH and I were both tall and painfully thin as kids. I remember getting letters home from the school nurse - my grandmother accused my mother of starving all her kids. This is different. Late puberty runs on DH’s side, and that’s one possible explanation but doesn’t tell the whole story. DD has been tested by endocrinologists who ran every kind of blood test, a radiologist who measured her growth plates, and a top gastroenterologist who performed an endoscopy and biopsy. All conclude there is no underlying illness.

New poster here.

OP, do all the doctors know that both you and DH were "painfully thin" as children? Do they really take that on board when looking at your child?

I know you say "this is different" but OP, your situation sounds a lot like our goddaughter's. Tiny, couldn't gain weight--doctors, more doctors, dietitians and programs etc. Yet a healthy kid. And it took two years of stress and tests before yet another new doctor actually LOOKED at the two parents and said, "You're both quite a bit smaller than average and dad is especially lower in weight than average--this is genetics, not a disorder." The dad can eat and eat and doesn't gain weight. The parents were small kids, especially dad.

But until this one doctor asked things like, what are your eating habits and what were you built like as kids--no one ever connected the parents' childhood body types with the child's size and lack of weight gain. You'd think going so would be obvious but our friends found that it wasn't. Has any doctor truly delved into your and your spouse's childhood eating, weight gain and size?

Anonymous wrote: Anyway, what eventually worked for me -- somewhat ironically -- was just constant grazing. I say somewhat ironically, because many doctors were convinced my snacking was why I wasn't hungry at meal time and told my parents to cut out snacks to get me to focus on meals; it totally backfired weight-wise, because my meal size remained the same and I lost the snack calories. Around age 12 a specialist suggested to my parents that they just let me snack/eat however I wanted for a month, but coupled w/ readily available snacks, treating snacks as meals from a nutritional perspective (so snacks were not junk food but just small servings of dinner foods, etc), and offering snacks; my weight shot up 5 lbs in 2 months (a big deal at the time and the difference between looking healthy or not), my caloric intake increased steadily and I felt nauseous less often.

This is almost *exactly* what happened to my son, at a slightly earlier age! He wasn't eating very much except snacks (and mostly empty calorie snacks like milk shakes or Goldfish crackers). I cut out the snacks entirely, hoping to make him hungry enough to eat his fill of a proper dinner -- but instead he just lost the snack calories without increasing any meal calories. And he fell off the BMI chart and just stopped all interest in eating for a few years.

When I finally started letting him snack whenever he wanted and eating whatever empty calorie snacks he was hungry for, he gradually started eating again, and putting enough weight on to grow again. It was definitely not true that "he will eat when he is hungry" -- not for this kid anyhow.

^^ Bet (not be) anything

Anonymous wrote:This Genetic Mutation Makes People Feel Full — All the Time
Two new studies confirm that weight control is often the result of genetics, not willpower.
The study subjects had been thin all their lives, and not because they had unusual metabolisms. They just did not care much about food.



https://www.nytimes.com/2019/04/18/health/genetics-weight-obesity.html

I would be anything that I have one of the mutations this tracks. I have been following this thread with interest, because many of the kids involved sound like more extreme versions of myself. I love food, but just can't eat that much of it at once and, somewhat paradoxically, start to feel nauseous if my stomach is empty for too long. I was super skinny/officially failure to thrive as a toddler/referred to a specialist by my pediatrician re: a possible ED as a tween (which the specialist ruled out). My mother says she never heard me say I was hungry until I was 6 after a long car trip (I get super motion sick, so my parents never fed me before a drive) and she nearly cried. Anyway, what eventually worked for me -- somewhat ironically -- was just constant grazing. I say somewhat ironically, because many doctors were convinced my snacking was why I wasn't hungry at meal time and told my parents to cut out snacks to get me to focus on meals; it totally backfired weight-wise, because my meal size remained the same and I lost the snack calories. Around age 12 a specialist suggested to my parents that they just let me snack/eat however I wanted for a month, but coupled w/ readily available snacks, treating snacks as meals from a nutritional perspective (so snacks were not junk food but just small servings of dinner foods, etc), and offering snacks; my weight shot up 5 lbs in 2 months (a big deal at the time and the difference between looking healthy or not), my caloric intake increased steadily and I felt nauseous less often. Having spent a childhood short, I ended up at 5'6" (slightly above height projections based on my parents) and am now have a totally normal BMI without thinking about it (19). 20 years after that doctor's intervention, I still graze constantly and only sit down to one "meal" a day (and only then for family/social reasons)... but routinely consume roughly 2000 calories/day.

Anonymous wrote:This Genetic Mutation Makes People Feel Full — All the Time
Two new studies confirm that weight control is often the result of genetics, not willpower.
The study subjects had been thin all their lives, and not because they had unusual metabolisms. They just did not care much about food.



https://www.nytimes.com/2019/04/18/health/genetics-weight-obesity.html

NP. Thank you for posting.

This Genetic Mutation Makes People Feel Full — All the Time
Two new studies confirm that weight control is often the result of genetics, not willpower.
The study subjects had been thin all their lives, and not because they had unusual metabolisms. They just did not care much about food.



https://www.nytimes.com/2019/04/18/health/genetics-weight-obesity.html

OP, I am really glad to hear this news!

The recommendation to feed your child three meals and three snacks a day, increasing the calories and keeping an eye on her caloric needs considering her exercise and other activities, sounds like a really good one. (Incidentally, it would also be the recommended treatment if your child were to turn out to have anorexia so you are covering all bases here with this approach! However if the child had anorexia usually she would resist the extra meals to some extent.)

The initial advice you got from your child's psychologist to just back off on the food pushing, presumably allowing your child to just eat whatever she wanted and how much she wanted, didn't sound like good advice to me. It sounds like you are able to give gentle encouragement and reminders, but your child is willing to eat and wants to eat, and hopefully is putting on some weight!

I think this new pediatrician is a good one and seems to have more of a sense of what treatment is needed than your old experts did. I wish you the best!

Anonymous wrote:

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.

That sounds like a really great doctor. Good luck, OP!