Underweight

Yesterday the girls had their 18 month check-up. We found out they are only 19lbs each and have fallen completely off the charts. The doctor was watching them very closely at the appointment to see if they were ill or malnourished. She then made me tell her everything they eat on a daily basis. First of all, I couldn't even name everything they eat because these girls EAT everything in sight, but they don't eat much of it. I thought this was a normal toddler thing, to graze instead of eating three separate meals per day. I felt really judged at the appointment she kept going on and on about how small they are. I never even realized it was a problem...I just thought I had small girls and think it's a genetic thing since everyone on both sides are small.

She wants me to give them each pediasure once a day. We tried yesterday and they HATE it. She also said that it could be because they drink soy milk instead of whole milk. I'm pretty sure my girls get bad reflux from regular milk. Right now Aurielle has the hiccups and she only drank about 2 ounces of chocolate milk. This morning I gave them a carnation instant breakfast with whole milk and they did okay with that, but like I said they have issues with whole milk and won't drink the pediasure. The doctor said that adding the carnation instant breakfast to the soy milk was counter productive because soy milk doesn't have the calories or fat that whole milk does. Plus, I would be lucky if they drank 20 ounces of that, but they probably only drink about 16.

Keep in mind that I am constantly cooking for them. Adding butter, whole milk to foods and baking them cookies, muffins. I'm so tired and all this news of them being underweight has really gotten to me. I don't know what more I can do. I can't force them to eat or drink. UGH

So, doing some research online and find out that an average 12 month old needs about 1000 calories per day. I know that my girls don't even come close to that...what am I to do? In a month they will have another check-up to see how much weight they gain or don't and to be honest I'm scared. She mentioned sending them to the Gastro, but I will refuse because they aren't sick. They aren't even cranky! They sleep and eat well, IMO. IDK...any thoughts/advice is welcome...tia.

 

were they on the charts before? and if so, where on the charts? i'm just wondering if they've dropped a couple of percentile points, or if this is a really huge change from prior growth checks.

the fact that they otherwise seem healthy would to me indicate that regardless of the numbers, they're getting what they need. i wouldn't give up on the pediasure yet. i would try offering it a couple of times throughout the day & just keep offering (without any pressure - just put it somewhere they have access to it, or with a snack or meal) & i bet they'll warm up to it.

:hug: i'm sorry you're having to deal with this & that you felt judged at your appointment. that really sucks. is there any possibility of getting a second opinion?

 

We will most likely see a different doctor next month because that's how it works there. We were seeing the same doctor, but I don't care for her much and she's not that great with the girls. However, the doctor we saw yesterday was awesome with them and they didn't fuss once. I think she was really concerned because yes, they were on the charts. They were following the curve and for the most part about in the 10th percentile. I will try the pediasure tomorrow morning, but knowing my two they won't have anything to do with it.

 

This is just my advice to you... All pediatricians look at things differently and I think you may need a second opinion as well. It will probably help you rest assure that you are doing everything just fine and that your girls might just be smaller. If they are eating, drinking, etc. then I'm sure things are fine.

We just had our one year appt and one of my girls barely made 16 lbs - totally off the charts, the other was just barely at 17. My doc wasn't concerned at all. When I questioned it he said that he was plenty happy with how they are growing (they've always been on the smaller size). He didn't even say we had to be on whole milk and said 2 percent was fine. I'm sure things will be okay with your little ones will be fine but a second opinion never hurts!! Good luck.

 

We went through the same thing at the twins 18 month appointment. They both were around the 50% and my dd fell totally off of them. She's also one of my better eaters.
I wouldn't worry too much, I know that's much easier said then done :laughing: I would just push the high calorie foods more. I would use the carnation instant breakfast with the soy milk, I wouldn't ruin their great eating habits by giving them something that might make them sick, kwim? I think most doctors are great, but with everything you have to think about their advice in relation to your situation.
I would just put more butter on things, more cheese and go from there. My dd is now 2.5 and she is just barely on the chart but is following a very little growing pattern so my ped isn't too worried. She did have us do some blood work just to make sure but everything turned out fine.
:grouphug: It sounds like you're doing a great job and they'll be fine!

 

Well, the second opinion will come soon. Thanks...maybe she's worried because at 12 months they were about 18lbs. They didn't go to the doctor for their 15 months, so 1 lbs in 6 months. We can't do too much cheese/dairy because they get backed up. I told the doctor that as well and I don't think she took that into consideration. They don't have diarrhea or vomiting. They aren't sick in anyway, so I wasn't worried. I'm more peeved that she wants me to get them to eat more when they eat a ton. If it ain't broke don't fix it, right?

 

First off, I'm sorry your girls' weight is a concern, and that the doctor has you freaked out. :hug: Instead of (or in addition to) a second opinion, can you ask for a referral to a nutritionist? Someone who specializes in feeding issues might be better suited to address your LOs' specific problems.

Secondly, toddlers *can* graze, but really they should be eating 3 squares per day (and 1-2 snacks in between times), just like us. Eating is as much social as it is nutritional, and structure really helps kids learn feeding competence (when to eat, how much, and how to recognize true hunger). HERE is a link to a brief article on feeding underweight children from Ellyn Satter, who writes books about feeding issues and nutrition. I highly recommend her book Child of Mine, but her website also has some good tidbits of advice.

I really hope you get some good answers. I sounds like your girls don't have any physical problems that are keeping them from eating well, so perhaps a feeding specials can give you some guidance. Good luck and let us know how it goes! :hug:

 

First, we were eating three square meals a day, but due to teething the past week they have been grazing - I only mentioned grazing because that's what it has been this week. I should have clarified more, sorry about that. It's always been really important to me that they eat well socially and nutritionally. I'm sorta a freak about it and I get a lot of crap from family and friends for it. It seems as though today we are getting somewhat back on track. Thanks for your input. I really appreciate it.

 

Can I make a suggestion? Have you tried the whole or 2% lactaid milk instead of soy milk? My oldest ds had terrible reflux, whole milk was as bad as formula was, but when I tried the lactaid milk it wasn't near as bad. He was on lactaid until he was nearly 2 yrs old. It has more fat in it than soy milk but has that added lactose intolerant med that helps out (I can't think of the name of it right now). I couldn't find whole milk at the time, but I think i saw they have it now.

I'm sure you have already tried like full fat yogurt and stuff with them. I think I remember reading avacado's have lots of good fat? I could be wrong though! :blush: I have chubbier kids so I've never had to worry about too little chub, more of too much chub! :laughing:

I do agree that if they are happy, are healthy, and do eat pretty good...then a dip in growth isn't a huge deal. The ped should have had you come in for a recheck in a month though, because there's a good chance they'll hit a growth spurt since they haven't grown much since 1 yr. Also, how much has their height increased? They may have had a height growth spurt, but not a weight one yet recently.

 

Thanks for the info. We haven't tried lactaid milk. TBO, they don't like the taste of any milk even with the soy it's a struggle to get them to drink it. Yes, they eat full-fat yogurt, I also make them high protein, high fat smoothies. When I say these girls eat well and a lot I mean it. They also eat a lot of avocados (we are BIG avocado eaters.)

Their height is fine. They are 34 inches tall. I think that's tall, but I could be wrong. They had a height growth spurt, but their weight has stayed the same.

 

My jessy was tiny and we knew see had a heart murmur but we didn't find out she had a hole in her heart until she was 4 which was the cause of her small size and lack of appetite. We had her on pedasure on off days for 2 years. What flavor did you try? I know its expensive but it may just be the flavor. Was it cold when you gave it?

edited to add:
Jessy is currently 33lbs and in the 9% for weight and 69% for height

 

They tried the chocolate and it's cold. DH is going to try with the Pediasure tomorrow morning. I can usually get them to guzzle something when they first wake up, but then it makes breakfast a little wonky and then the whole day is weird.

 

We usually gave it at night not to mess with meals. I've tasted all the flavors except banana and my fav is the berry or strawberry, The chocolate is kinda chalky to me. On the pediasure website they have recipes which include pediasure but I have never tried any. We do alot of peanut butter and nuts but they are a bit young for that. We did lots of cheese at this point though. They suggest fried foods but neither of my girls want any thing with breading on it :blush: They don't even really like chicken nuggets, they much prefer grilled

 

so sorry for the freak out with the doctor!! my kids only gained 2 pounds from 12 to 18 months, (19 to 21 for my ds and 18 to 20 for my dd.)

I hope you find out something that will help them to gain. ours were on a 50% curve up to 6 months then by 12 months it slowly fell to 10%, then below the curve... and finally around 18 mo it picked up to 5th and now they've been closer to 20% for my ds and 10% for my dd. just to say that maybe it will turn around soon and they'll start gaining... OR maybe they're just small...

the doctor is really just trying to keep their best interest in mind, so I would try to keep that in mind, though its hard not to worry and take it personally. We tried Soy milk the time between 12 and 15 months too... and the doc was concerned... I was trying to avoid "cow's milk"... since its for cow's... and I was/am still breastfeeding... human milk for humans ... so I tried the Soy. But then I finally figured out the Soy gives them the runs. So I tried cow's milk... and sure enough it gives them the runs too! UGH!! so now we're on Almond milk - which is even less fat. so that's not an option for you. anyway all that is to say that you need to figure out what works for your children too.

What I thought was interesting about what you said about milk is that you said it gives them reflux... doesn't that go away once they can sit up? I'm not educated on reflux. and then you said that it backs them up... that's the opposite of lactose intolerance, isn't it? I only say that b/c I don't think the Lactaid milk will help... I thought lactose intolerance what more along the lines of why my kids are exhibiting... with the runs / diahrhea...

I haven't read that book by Ellyn Satter, but I've heard her recommended here many times. Maybe she'll have some good tips for you.

anyway, the only other thing I was going to mention was that for me, I know I have a hard time getting snacks in sometimes as it seems to make them not hungry for the next meal, and it sabotages lunch. so then they've got crackers or an apple in their system from the snack and don't want the peanut butter sandwich or grilled cheese that I'd rather them have... so for me its moderation and just trial and error.

good luck! its no fun trying to worry about what they eat and when!

 

Okay so 34 inches is a very good height, so I'm guessing they've had a height growth spurt but not a weight. Since they were so low on the weight chart before, that's why they've dropped off of it now. I bet in a month or so they'll have that weight growth spurt and be right back around their same %.

 

Just wandered if your pedi's office always tracked on the general chart or on your own LOs curves. We have never been on the chart but have stayed on our own curves for weight so pedi has not been concerned. This is a tough one, especially if you see nothing in their habits or personalities that would signal anything weird. If you are trying pediasure, you may have to try it several times for them to develop a taste. I know that stuff is so expensive. Let us know what you find out. We are 17 mos and we sit down for 3 meals and 2 snacks but I find many times I have to stick bigger snacks in there to make up for their meal time fiascos. But it sounds like you have eaters. Keep up the avocado! (Big fan here!)

 

Maybell I just wanted to say that reflux does usually get better once they can sit up, but not always. My ds spit up until he was 18 months old, almost the day he turned 18 months was the last time. I remember it clearly because it was sooooo nice not having him spitting up all the time! :lol: And yes usually lactose intolerance causes the runs but it can also cause constipation problems too It can depend on the severity of the intolerance I think, if I remember right.

 

You can have reflux your whole life. For most babies, they outgrow it within the first year, but a small percentage can have it forever. Also, you can be lactose intolerant but can handle eating a small amount of lactose. In addition to diarrhea, lactose intolerance can cause constipation. Reflux and spitting up are two different things as well. Sometimes babies will have both. When they get the hiccups I know it's from drinking cow's milk. The acid is coming back up into the esophagus which causes the burning sensations and the hiccups. Now that I think about it, Aurielle kept pointing to her neck so I think she was trying to tell me she had heartburn. UGH, now I feel even more terrible!!!

Tomorrow is a new day to try all over. I just clued DH in and he told me that the girls are built exactly like he was when he was their age. He was tall, skinny with a big belly and you could see his ribs. We can see the girls' ribs as well, but they don't look malnourished if that makes sense they just look small.

 

We went through a lot of that with DS. I didn't look into it, but a lot of patients that I work with that need to put on weight is something called "magic cup". It's a berry flavored icecream. It packed full of extra protein and calories and other vitamins. When it melts, it actually becomes a pudding consistency versus a big watery mess. The reason I use it is because as a Speech Therapist, I work with a lot of older people that have a hard time swallowing thin liquids, but many times the dietician places people on it to help with putting weight on.

 

This is exactly how my DH (and his sisters) was built as a child and both of my children are built the same way. My kids have been on the 5th percentile for weight since 12months to 24 months. Just looking at my son's weight chart from the pedi, he gained 4.5 lbs in a year. I have done and continue to do what Brigette said earlier in the thread, add carnation instant breakfast to their milk, add butter, cheese to foods and serve full fat dairy for the kids. I know you are dealing with reflux and lactose issues but keep in mind that they are more mobile, so this is the year that they might not be putting on as much weight as they did during the FY. I know I stressed when the pedi told us that the kids were in the 5th percentile and we needed to put weight on them and I kept thinking "HOW?" Because mine are pretty decent eaters but once the pedi saw that they were pretty much starting to stay in the 5th percentile, she was okay with their weight.

 

Well, they did okay with the pediasure. I think we will try a different flavor though. Aurielle drank just about all of it and Isabelle drank 3/4. I really don't want to get them into fried foods, but a little here and there won't hurt so tonight it's fried chicken (so much for my diet - lol.) Thanks everyone...I couldn't do this without you!

 

I just wanted to say that I feel like I'm in a similar boat. It's difficult and stressful as a mom to want to help your child learn healthy eating habits, not push more food on when they don't want it, and struggle with the decisions of giving fatty, fried,sugary, unhealthy foods in an effort to just get them to gain weight.

Ughhhhhhhhhh.... I guess we just have to keep doing what we are doing, and offering good stuff, and see where we end up....

 

It is hard, but I'm glad I'm not alone. I already fatten up there foods, so I'm not sure there is much more I can do. Just like you, I will continue to do what we do because it seems to be working for us.

 

I'm glad that it seems that the Pediasure is going to be a hit, or at least that they will drink it.

I didn't know that lactose intolerance caused both diahrhea and constipation... guess that makes sense depending on how it affects different people.

good luck with figuring it all out!

 

One of my sons is and always has been small so this has been an ongoing struggle for us.
BUT – we had one doctor appointment that went similarly to the way yours went – the doctor freaked out which in turn freaked me out. Told us to feed him whatever, whenever he wanted it. Anyway at the next appointment it was determined that the height measurement was wrong from the previous visit and this in turn threw all of the other calculations off and he really had not fallen so far off the charts as originally thought.
So in addition to all of the great info you have already received I would have all of the measurements double checked just to be sure.

 

[quote name='Shelly's twins' date='14 August 2010 - 04:18 PM' timestamp='1281817113' post='1680444']
One of my sons is and always has been small so this has been an ongoing struggle for us.
BUT – we had one doctor appointment that went similarly to the way yours went – the doctor freaked out which in turn freaked me out. Told us to feed him whatever, whenever he wanted it. Anyway at the next appointment it was determined that the height measurement was wrong from the previous visit and this in turn threw all of the other calculations off and he really had not fallen so far off the charts as originally thought.
So in addition to all of the great info you have already received I would have all of the measurements double checked just to be sure.
[/quote]


Thank you! We will definitely have their measurements checked again. They are quite sloppy about that stuff there. Thanks again!

 

I'm glad the pediasure went over not too badly!! But I didn't even think about the height thing, and come to think of it, at our 12 month appt our twins were measured at 34 in tall, way up from about 28 the appt before! It was a new nurse and she stretched their toes out to measure them to. We had a regular nurse come back in and recheck and they were only 31 in tall. So that's definitely a possibility to consider too!

 

They actually were all scrunched up until we straightened them out and told the nurse to go ahead and measure, so now I'm thinking that they are that tall. They are tall which if from my dad's side, but they're all pretty slender people. I just think they're small, but tall.

 

My boys are small too (both 20lbs even at 18mos appt, but 32inches tall) but have always been small (18lbs 5oz-10oz at 12mos), although once Rhys made it to the 5th percentile :lol: it feels like they eat EVERYTHING!! I do worry about their weight sometimes (especially since DH and I are average height) but our pedi has assured us many times its not so much where they sit on the chart but that they stay consistent, which I was guessing your girls didn't ?? I did a food diary for their 18mos appt, turns out they eat more than my 4yr does. So for now we continue along without supplements or fattening up foods. Hopefully you find something that works for you girls, having twin toddlers is enough stress without having to worry if they are consuming enough calories.