Underweight toddler and other issues

[WhiteHorse]

My 2 year old has a dairy and egg allergy and we have been watching closely hoping he will soon grow out of it. As a result of the allergy, he has had a limited diet over the last year. He is also very picky and very stubborn and will not eat even what he CAN eat. So at 2, he weighs 23 lbs with clothes and shoes on and is 34" tall. Skinny is an understatement. He also is delayed in speech and has low energy for his age. On average, he consumes probably less than 400 calories a day.

The question - is there a milk free calorie supplement out there I can use for him? He needs calories, protein and everything else, but most of what I am finding is milk based.

[Ruthla]

Are you breastfeeding him? If so, are you counting the calories in breastmilk in the calorie calculations?

[wife&mommy]

Do you add fats to the things he will eat?
Would he eat avocados or something like that?

[deditus]

Has he been tested for celiac disease? Sounds like he has other things in his diet causing pain, thus his food avoidance.

[kjbrown92]

I'm wondering if there are food intolerances as well as the food allergies.

There are rice protein powders that you can add to things (like smoothies). We use a lot of coconut milk since it's high fat (in smoothies and in baking). We also use animal fat. As in, cook bacon, and then use the bacon grease to fry something else in. Or take the drippings from the roast chicken, and then make gravy out of them. We make chicken bone broth (24-36 hour simmer time) for our calcium (we are dairy free as well, and corn, gluten, soy, and a number of other things, including eggs for one of the kids). We use coconut oil to fry things in.

What types of foods DOES he like, and maybe we can help you figure out a way to make them higher fat, or similar things...

[WhiteHorse]

Hi and thanks for the replies. Yes he is still BF. I am not counting calories exactly but here is a typical day:

Breakfast: 1/4 sausage patty, 1 or 2 cereal bites (chex), 1-2 oz. soy milk or oj and when I can get it he will eat 1-2 strawberries or blueberries or grapes.
Lunch is hit or miss, sometimes he will eat 3-4 spoonfuls of ramen noodles made with natural broth or chicken noodle soup, 1/2 cupful of diced fruit like peaches or oranges
Early dinner (before DH gets home) is 1-2 chicken nuggets, 1-2 bites sweet potato or corn or broccoli.
Late dinner is bites of whatever my husband is eating, usually a bite or two of bread and sometimes a banana.

He does not like avacado or any other food with that texture. PB is also out and he is not into sweets too much either. He does not eat much bread or other starches, but he is not in pain as far as I can tell when he does. He sometimes likes pancakes I make with rice milk/soy milk mixture. I USED to add fats into his food like a little olive oil or beef drippings into the pasta but he is not liking pasta anymore so this doesnt work. I do put soy margarine onto his toast or pancakes and in the sweet potato.

It seems he does like some things fine, but I think the problem is more that he will not consume enough quantity of anything - it's like he's full after 2-3 bites and he refuses to eat anything else, yet, he whines like he's hungry and wants to nurse again. The only time he ate normally was when he was on prednisone for asthma - he gained a pound it seemed in those 2 weeks.

[mnnice]

My four and a half year old DS was the same size at that age and it still pretty tiny, but now it at the 5-10%tile for both height and weight. Just now he his finially outgrowning his size 2 pants (only because they are getting very short).

It always concerned both me and the family practice doctor I see. Then one day I was at my MIL's and looked at some old pictures of DH at a similar age. DH was equally tiny (despite being a pretty average 5ft, 10 in, 170-175 lbs adult) anyway since that time I've worried less.

Anyway if there aren't any other hidden health concerns he may just be the size he is because that's what he is suppose to be, ykwim?

[leafwood]

sounds similar to my ds (although he is very high energy). he has oral motor struggles and was evaluted through EI. weekly speech/lang therapy has been priceless in his progress. that and we elimiated all dairy and eggs (he and i b/c he's still nursing). coconut ice cream mixed w/ rice milk was our lifesaver for fat and calories. i avoid all soy as well b/c it is allergenic to some and the nutritionist and GI recommended it. he eats bread and i douse it w/ olive oil. i am also able to add coconut butter to his oatmeal each morning which adds some punch. almost butter is good as well. i also borrowed a friends infant scale to document how much breastmilk he is getting overnight and was suprised to find it was 12-16oz per night (240-320calories!). i eat two huge bowls of oatmeal a day to keep up, but it's worth it to give him the energy. he is going to have an endoscopy next week to determine if he has esophigitis (sp?) which now seems like the case, but he has been dx fft since 15m. he is 22m and 21lbs even on a good day. i think he is 32 inches.

anyway, sorry to ramble. hope you get some good feedback.

[umsami]

Other than what others said.. I wonder if you're offering food enough times? I seem to remember reading that toddlers should be offered three meals and 2-3 snacks per day... (of course, often all of their meals are the same size.)

I remember that Dr.Sears recommended using an ice cube tray as a sort of feeding tray and putting lots of different bits on it.

I'd also offer solid food prior to breastfeeding.

To be honest, DD doesn't weigh much more than he does (she turned 2 in July)... and it's not something I worry about. I have one kid who has always been above the 95th percentile and two who've always been in the bottom for weight. They all have the same food options/environment... and are all growing fine... just different weights.

[Satori]

You might want to leave out a snack tray, there was a huge thread a while back that was great for idea's.

[WhiteHorse]

Thanks for all the replies! Good to know he's not the only one. My biggest concern about his low weight is that he gets sick a lot and I wonder if he gets enough nutrition. He just getting over the flu. The week before that it was a cold. It seems he is always sick every other week. I also want to wean him but I fear he will not get enough if he is only eating bites of food here and there. Yes we do keep out a snack assortment throughout the day usually - in a baggie so he doesn't fling it everywhere and he picks out what he wants from that. He likes sesame sticks and raisins the best. I do nurse overnight but my supply was very low until he got the flu and nursed every hour - then it's back up. I suppose it will drop again and I am not unhappy about that, since we are trying to wean. He was down to 3 times per day, then here and there overnight. I am trying to keep it to nap-bed-times only. I would love to see some easy food ideas (not expensive since we are low income).

[elmh23]

Will he drink smoothies? Use soy milk and rice protien, add an avocado (though try not to let him see this, my son wouldn't drink it if he knew there was avo in it ), frozen strawberries and a banana. I also add flaxseed.

Ds was 22lbs at 2 and 36 inches. Serious string bean. He somehow gained 6lbs and is now 28lbs. He'll be 3 in February.

Have you talked to a doctor about this? My doc sent us for GI testing based on some of my concerns (he still has very loose stools for a child who is no longer breastfed) and I would really want to have him checked out further considering he has low energy. My son never had that (rather the opposite in fact.)

Good luck!

[mamadelbosque]

He sounds about the same size as my DS1 was at that age, maybe even a bit bigger - DS' 32 months now and ~35.5" and just barely 27#s. He was fairly average for a long time and then ~2 he got super active and started talking and seemed to just hit a wall and not grow much... after a few months I started pushing calories at him whenever/however I could - ie offering juice or choc milk instead of water at least 1/2 the time, adding butter/oil to anything and everything I could, buying/offering pudding as a snack (I saw they have soy pudding yesterday, so maybe that'd be an option?), hotdogs, chicken nuggets, anything he'd actually eat I gave to him, just to get as many calories in him as I could... and he's grown a couple inches in the last couple months since I started this, so I think he's doing OK. It can be fustrating & scary though. s

[elanorh]

My dd1 was in the 3-5% for weight (or off the charts) and in the 90-100+% for height until she was four. I think she's up to the 20% now for weight. She was allergic to egg at the age of two (and avoiding peanuts/treenuts/fish/shellfish, had JUST outgrown her dairy allergy at that age).

We worried a lot about her weight and I did a lot to try to get more calories into her food. Fortunately she didn't do too many of the toddler 'living on air and water' episodes, she had a big appetite and held off 'til she was three for the periods where she didn't really eat much of anything.

It was at her two year appointment when my dh commented to the Ped, "You know, I think I was in high school before I was ever above the 10th percentile for weight." And we know that I was a skinny kid too. So genetics were likely partially in play at least with her. Having watched dd2 (also with allergies, but ones identified before near-FTT, which is how we really got dd1's under control) - she was a CHUB as a babe but has slimmed down to not too different a build than her older sister at the same age. So I suspect that part of Ina's skinniness was because she never laid on that early baby fat that her younger sister was able to lay on. It's just a theory though.

I didn't read Child of Mine until this past summer, and I wish I'd read it when we were worrying so about dd1's weight. It's written by an RD about childhood nutrition and is backed by a lot of different research studies about infant and child nutrition. I think if I'd read it, I would have worried less about dd1's weight, and at the same time, I would have known more about how to discuss/move forward with her allergy and food issues. I really recommend that you read it!!

That said -
A. Are you certain you are aware of all your little one's allergies? Ina plateaued on her weight gain for the three months that I was eating eggs occasionally. She showed no other sign of an allergy other than the halted weight gain (9-12 months). Once we directly introduced eggs to her, we realized what had been happening.

B. I know there are lots of reasons to wean, and I don't want to pressure you. But have you considered letting your little one continue to nurse for another six months or so, to see if his appetite and weight gain catch up? Ina nursed 'til she was 2 1/2 and I think it made a difference for her. Right now, you have a low-weight kiddo and it's one of his favorite foods. Removing that food from his diet doesn't mean he's going to eat other foods to make up the difference. I know this is frustrating and it's often the first assumption that people make to 'solve it.' But your milk is a high-calorie food and it's got antibodies etc. to help keep him healthier while he's low weight.

Look for Child of Mine at the library - you can skip the infant feeding sections and go directly to the toddler stuff (you might need to skim a bit of the intro and infant sections) and then apply it.

[WhiteHorse]

As far as the allergies go, his 12 mo. testing indicated eggs, peanuts and dairy with the most severe being the dairy. He gets very sick at the tiniest lick of milk. The other two I am doing exposure and he's pretty much grown out of it. He saw his doctor at 15 months and again when he got the flu but I avoid the regular checkups because I dont want to expose him to the germs at the office when we don't have to. As far as family background, I was on the small side but not this skinny and dad was/is a big dude! DS older brothers (twins who are 20) and a 14 year old were average sized and now are huge as adults/teen. We will have real health insurance in Jan and at that point I am planning on getting him checked out at a speech therapist.

[umsami]

Yes, any of Ellyn Sater's books are excellent (Like "Child of Mine").

Basic rule... your job is to provide the food... your child's job is to decide how much to eat of it.

http://www.google.com/url?q=https://...5CFsCy79MBHuwA

[Satori]

Originally Posted by WhiteHorse

As far as the allergies go, his 12 mo. testing indicated eggs, peanuts and dairy with the most severe being the dairy. He gets very sick at the tiniest lick of milk. The other two I am doing exposure and he's pretty much grown out of it. He saw his doctor at 15 months and again when he got the flu but I avoid the regular checkups because I dont want to expose him to the germs at the office when we don't have to. As far as family background, I was on the small side but not this skinny and dad was/is a big dude! DS older brothers (twins who are 20) and a 14 year old were average sized and now are huge as adults/teen. We will have real health insurance in Jan and at that point I am planning on getting him checked out at a speech therapist.

Why wait till you have insurance? Its free though Early Intervention and every state/county has one

As for exposure for allergies, for food allergies I've never heard of that working, it usually works the other way around and they get more severe the more there exposed to it. I mean by that reasoning I should have never developed a life threatening peanut allergy, I ate peanuts in some form every day of my life then 1 day boom! It nearly killed me, by the time I got to the ER I couldn't communicate and was convulsing. Thankfully I survived but I ended up talking like Donald Duck for a couple days while all the swelling went down in my throat and tongue. As far as I know the only accepted/known way to outgrow an allergy is complete avoidance. It could very well be an allergy to those foods causing weight gain issues.

[elanorh]

Originally Posted by WhiteHorse

As far as the allergies go, his 12 mo. testing indicated eggs, peanuts and dairy with the most severe being the dairy. He gets very sick at the tiniest lick of milk. The other two I am doing exposure and he's pretty much grown out of it. He saw his doctor at 15 months and again when he got the flu but I avoid the regular checkups because I dont want to expose him to the germs at the office when we don't have to. As far as family background, I was on the small side but not this skinny and dad was/is a big dude! DS older brothers (twins who are 20) and a 14 year old were average sized and now are huge as adults/teen. We will have real health insurance in Jan and at that point I am planning on getting him checked out at a speech therapist.

Cut all eggs and all peanuts. If he tested positive for them, he shouldn't have them, even if he seems to be "OK" with them and even if it's small quantities.

Exposure to allergens when it is a food allergy will prolong and can worsen the allergy.

I know it's hard to be dairy and egg-free, but you can do it. It will take awhile for his appetite to bounce back if he's been struggling with a low-grade allergic reaction, but as he starts feeling better, his appetite will improve.

[kjbrown92]

And there's still food intolerances to think about, which wouldn't show up on a food allergy test, but can cause low weight gain. A custom flower essence really helped my DD2's appetite.