need advice for toddler diet

[4JMJ]

Our son had his 1 year check up this morning and was diagnosed as "failure to thrive". He has always been on the smaller side (highest percentile he ever was was 25th), but he has now fallen below the 5th on both height and weight. He is an excellent nurser and eater, they are saying this may be related to some other issues which are being looked into. The doctor advised us to cut way down on nursing (which I am not going to do), and told us to feed him fatty foods like ice cream, and "put butter on everything". I understand the need to up his calorie and fat intake, but want to do it in a healthier manner, rather than just feeding him empty calories, sugar and junk. I am starting him with some peanut butter and am looking for suggestions for some healthier, calorie/fat dense foods. He eats a lot of fruits and vegs, the doctor is saying this is a problem because of the lack of calories.
TIA for any suggestions and advice!

[Asparagus78]

My niece is having the same issue. She eats tons, but weighed only 16lbs at 14 months. They tested for celiac, CF, parasites... and found nothing wrong with her. I've done some research for my sister, and she (with her dr.'s approval...) added the following to her diet:

-almond and pumpkin seed butters;
-avocado (puree and add to pasta if your child won't eat it):
-olive oil (on everything, even fruit purees!);
-full-fat cheese;
-legumes and hummus

My niece was eating a lot of fruits and veggies, but very little fat and protein. She's already gained 2 lbs in a month with these foods. Also, my sister was (unknowingly) feeding low-fat yogurt and low-fat margarine. She's switched to full-fat dairy and unsalted butter.

FWIW, both my babes are mostly on a vegetarian diet (I'm vegetarian) and were always on the 75-90% in height and weight, mostly I think because I also serve full-fat foods and olive oil, as well as tons of legumes. They love fruit and veggies, but it is never the ''focus'' of the meal, even as infants.

If it helps, here's what my almost 11-month old had yesterday (typical day - we also nurse every 2-3 hours and he gets no other liquids):

breakfast: half cup bircher muesli, pear in small pieces

mid-morning snack: almond butter on toast (spread thin)

lunch: half cup brown rice with black beans and diced veggies, topped with shredded cheese, carrots and bananas mashed together, plums in small cubes

afternoon snack: strawberries

supper: angel hair ww pasta with pesto (homemade with pine nuts, basil, parmesan), bread with butter, half a homemade pumpkin muffin (no sugar added)

I will sometime give him some of the oatmeal I keep for the birchermuesli at night if he still seems hungry. He also nurses through the night.

Good luck mama!

[4JMJ]

Thank you so much, these are really great suggestions!!!
Do you make your own almond and pumkin seed butters or buy them? I don't recall seeing those in the store, but I may not be looking in the right places!
Also, what is bircher muesli?

[Asparagus78]

I buy the butters from the store - look for them in the health food section. They are quite pricey, but you could make them easily at home if you can get good fresh nuts and seeds.

I don't have a recipe for the birchermuesli; it's basically just oats that you soak overnight in the fridge in whatever liquid you want, then add yogurt and fruit and nuts to. If you google it, you'll find a ton of different recipes. I typically make mine by soaking rolled oats in almond milk and adding 6% fat plain yogurt and fresh berries the next day, but I've also made it with leftover smoothie and cream, and have added just about everything I can find in the fridge to it, sometimes successfully, sometimes not so much. We all love it.

[cristeen]

Personally, i would really limit grains, particularly refined grains. Nutritionally, vegetables are a better choice, even though its not a popular choice in our society. The only thing grains offer is a convenient vehicle to transport fat. You can achieve the same thing by tossing veggies with a generous amount of olive oil, co or melted butter, covering them w cheese or serving them w a high fat dip.

Hows your supply? Do you pump? You can fortify your bm by skimming the fat and adding it to another bottle. The skim milk is not suitable for bottle feeding at that point, but you can use it for other things.

Also, how much fat are you getting in your diet? If you're not getting enough, your milk wont have much. Consciously adding healthy fats to your diet can naturally fortify your milk.

Also, is your doc using a bf chart or a ff one? It makes a big difference. How much weight has he gained since 6 mos? Is he walking? And ultimately, someone hasto be in the lower portion of the charts. Not every child can be in the 50th percentile, thats just how these things work.

[4JMJ]

asparagus, thanks for the recipe, can't wait to try it!!

Cristeen, My supply is fine, always enough available when he wants it!! He nurses at bedtime, at least once in the night, morning, afternoon naptime and usually at least a couple of other times thrown in there as well! He has plentiful wet dipes. I've never pumped or used a bottle with him. I DEFINITELY get enough fat in my diet, haha! (good and not-so good fats!) And I love olive oil! I could eat veggies sauteed in olive oil every single day!
I'm assuming the doc used a ff chart. It is a military hospital, and they are not very, um how to put this gently? natural minded, I guess. The doc made me stop nursing him so she could examine him. She also told me basically to stop nursing him, only to do it for comfort. She told me that, any time he wants to nurse, to give him "food" instead of milk. I just "uh-huh'd" her, but I'm definitely not following that advice! He is a super great nurser, we are both enjoying it very much, and I'm not jeopardizing that! He eats 3 "food" meals a day, plus snacks, plus nursing.
We are moving to another state this weekend, and I have to get him in to see a ped down there asap. They want him to see a developmental ped as well, plus pt. They are afraid (and so am I) that this may be stemming from some serious medical complications we had (heart problems) in utero. He hasn't had heart issues since birth, but he had developed hydrops in utero as a result of the heart probs (hydrops resolved prior to birth), and this may be an underlying cause of the FTT. There are also some other areas of concern, such as his head shape, which will be investigated further when we get down there and established with the dev ped.
I feel pretty good that we can resolve the "FTT" by adding in these healthier fats, etc. I just refuse to "throw butter on everything and give him as much ice cream as he will eat", like the dr suggested. I don't mind some butter and ice cream here and there for him, but all the time is scary to me! He has always been on the smaller side (6lbs12oz at birth and always around 10-20 percentile), and I think he was about 16 lbs a couple months ago. He is now 18lbs11oz.

ETA - the doc also used terms such as "alarming" and "urgent" to describe his place on the growth chart (1st and 4th percentile for weight and height). I didn't thing almost 19 pounds was too alarming for a 1 year old, but maybe I'm wrong?

[redvlagrl]

I know 2 other toddlers who were less than 19 lbs at 1year old. DD was 20 lbs at her 1 year checkup. I don't think that is alarming unless your DS is very tall. Does he look scarily thin? Un-naturally so? What is your and your DH's build like?

DD was a huge 19 lbs at 6mths but then only 20lbs at one year so the Dr was concerned. After that she started gaining steadily though at a much slower rate (25lbs at 18mths i think). She always looked in proportion (except when she was a butterball baby, LOL - 95th percentile in weight and height). Someone has to be in the 5th percentile or below. Maybe that's the normal place for your kid to be?

[4JMJ]

I'm 5'4' my husband is about 5'8", relatively normal weights (though I could def stand to lose a few inches in my belly!)
He doesn't look too thin or small to me or my husband. But the dr said he looked small to her.....

[BetsyS]

I consider you and your dh to be on the smaller side. Certainly, Mama, do what you can to encourage healthy calories. And keep nursing.

but, a lot of it is genetics, I think. At one year old, my first son was in the 80-85%iles. A big guy. He nursed 6 times a day, and he ate like a bird. To the point where people would be surprised. He might eat half a grape, 2 crackers with a light smear of peanut butter between, and a cucumber slice as a meal. That would be ALL he would eat at that age.

Even now, I think our pedi thinks I'm not truthful when I say how much he eats. He is a very, very small eater, and he's on the opposite end of the charts (above 90%ile at 4 years old; he eats less than all his friends).

So, do what you can. Definitely pursue seeing another pedi. But, when it's all said and done, genetics have a big role here, too, you know?

[Brigio]

Fruits and veggies really shouldn't be the focus of a toddlers diet IMO. From what I understand it is much more important that we focus of high fat nutrient dense foods IE grass fed whole dairy (butter, yogurt, milk), fatty pastured meats, egg yolks, coconut products (milk, oil), avocado...

Fruits and veg are wonderful but applesauce w/ cream is better than just applesauce, cooked broccoli w/ butter is better than plain steamed broc... etc.

http://www.cookingtf.com/children.html

http://www.nourishingourchildren.org/Pyramid.html

[Brigio]

Why are you afraid of butter? I would and DO put grass fed butter on everything for my DD. Brain food

[4JMJ]

Originally Posted by Brigio

Why are you afraid of butter? I would and DO put grass fed butter on everything for my DD. Brain food

It's not that I'm afraid of butter, maybe just wary of too much butter, kwim? I just wanted some healthier suggestions to supplement the butter-and-ice-cream diet the doc wants me to put him on, LOL!

[4JMJ]

http://www.cookingtf.com/children.html

http://www.nourishingourchildren.org/Pyramid.html[/QUOTE]

Thanks for these links!!

[BeanyMama]

What wild advice he gave you! I would nurse the heck out of him and up his, and your, good fats. So many have been suggested; avocado, nuts, o.o, also coconut milk is super full of good fatness and much more tolerable than cow's milk generally. Sprinkling ground flax seeds on everything would be a great, too. Maybe you two can whip up daily creamy smoothies that pack a healthy fluff-up punch Good luck.

[cristeen]

How much has he grown vertically since 6 mos? From 16-19 lbs sounds about right to me. My guy put on 4 lbs in that time and hes in the 95% for height.

Id look up the bf charts and track him on that before freaking out. And id take those w you to the next ped, JIC. Definitely pursue dev ped for the other issues, but double check the FTT... That doc sounds pretty clueless.

[phathui5]

Well, you said it yourself, but I have to echo it: don't cut down on the nursing! Your milk is still the healthiest thing your toddler can take it and nursing "too much" will not cause failure to thrive.

When he does eat food, focus on calorie and nutrient dense foods like avocado, almond or cashew butter, egg yolks, organic meats, etc.

[4JMJ]

I have to look back and check how many inches he has grown. he wears 12-18 month clothes just fine though. Thanks for all of the great suggestions everyone, I'm definitely going to use them!