Failure to Thrive in 15 Month Old

[laliu]

Hi everyone,

I was wondering if anyone has been in/is in this situation and maybe had some advice to offer?

At 9-12 months my son was in the 80+ percentile for both weight and height. Fast forward to today, at 15 months, he weights only 20 pounds and is around 31 inches tall. Height is okay, but his weight is in the less than 5 percentile which would qualify him as "failure to thrive."

He has never been a big fan of solid foods, only eating a little bit each day, and mostly wanting fruit. He was breastfed almost exclusively up until around 1.5 months ago when my supply started to drop as I'm 4 months pregnant. He still nurses but I don't think gets much.

To top it off, he has allergies to dairy, coconut, nuts, eggs which makes it even harder to get "high fat" foods into his diet. We are supplementing as much as possible with soy milk right now, but he doesn't drink more than 4-6 oz a day no matter how much I follow him around with it.

We have our next well baby visit in around a month, was hoping to head off a visit with a nutritionist by showing some weight gain, but it isn't looking promising.

Has anyone had a similar experience and can possibly shed some light/provide encouragement of a positive outcome? It's to the point I am almost regretting this new pregnancy as I feel it is taking needed nutrition away from my first baby

Thanks guys!

[APToddlerMama]

No suggestions other than to post in special needs parenting and/or allergies forums...and a hug.

[oaktreemama]

I have to say I would find that much of a decline across percentiles alarming. I too have a small toddler and have worked through the FTT diagnosis. But, my kid has always been small. So, he went from the 15th% to the 0%. Which just wouldn't worry me as much as a drop like your toddler.

I would go to the nutritionist in your shoes. Ours was wonderful-very supportive of nursing and really helped us get a game plan. She was able to recommend so many foods and different combos. Especially since you are dealing with so many allergies.

That said I would start introducing avocado pronto. I would do fruit smoothie and add avocado and even oilive oil.

I would really wonder about that many allergies as well. Have you done any testing at all?

[laliu]

My concern about the nutritionist that the suggestions are what we have already tried. Was yours understanding and willing to work with you?

Avocados we've pushed, but he is not a fan in any form. Adding oils to a smoothy is a good idea though, because he loves fruit!

Unfortunately the allergies have all been confirmed with testing. The dairy and nut allergies are both quite severe (We carry an epi-pen now) and so no budging on those. Hoping he outgrows at least the dairy by mid-childhood.

I just keep thinking he start loving to eat eventually, but it isn't happening yet. Am just at kind of a loss because things were going so well with breastfeeding and then suddenly not.

[oaktreemama]

Ours was very willing to work with us. The nice thing too was we could send her emails of our meals and she would offer suggestions of where we could beef up calories.

And in your shoes since he has such severe allergies, a good nutritionist will be able to give you good ideas. There is something to be said for seeing an expert. And, something to be said for seeing someone who is a bit removed you know?

The FTT diagnosis can hit parents hard because you feel like the implication is somehow it is your fault your kid isn't growing or something. And a good nutritionist will help lessen any worries and/or guilt you might have.

[3xMama]

I totally feel for you on this! My son was such a nursing fiend, and then once I also hit about 4 months pregnant, things went from great to very much not great within a week it seemed. He also dropped a good bit on the weight scale and our ped started threatening FTT. Luckily we managed to turn it around just enough just in time but we were able to push the high fat foods and whole milk.

I second adding the olive oil to smoothies or even just drizzling it over cut up fruit, veggies, etc. Have you tried adding a little flavor to the soy milk? A strawberry or chocolate mix or Ovaltine if that works into his allergies. I'm not a big fan of doing that, but desperate times call for desperate measures, kwim? He will get more into finger food, but its a big change from nursing to a cup and chunks. It may take a bit longer, but he'll figure it all out.

Has your dr suggested testing for any underlying causes such as a bacterial infection? I think I'd want to have any other testing done before saying my kid was FTT.

[mtm]

laliu, my dd has/had ftt starting about 6 months. She too did a massive dive down the percentiles. What was his weight at 9 months? Has he lost any? How is his height and head circumfrence growth?

We saw a couple of nutritionists, one was fairly helpful, the others not as much as my dd was gf and dairy allergic and the standard advice of add butter to everything didn't apply. What the one nutritionist did was look at what we ate to find out what we could sub in to add more calories. In your case, I'd look at adding a lot of avocado to things (added it to banana bread, smoothies, etc). We also used duocal (calorie additive) in everything but I think that's coconut based.

Are you sure you've got the allergen's under control? I screwed up on the dairy for a while before I got it all out. Are you keeping a food log? Can you do soy? I wonder if a soy formula is a possibility in the short term? Oh and my dd outgrew her dairy allergy at 2 and a half so there's hope there.

We went the specialist route as my dd was losing weight but I'd go the food route with you first and see if you can get it back up. My dd has slowly hit the growth charts so we're hopefully coming out the other side but its a stressful experience. PM me if you want to talk about it.

[AFWife]

I would also agree to add avocado to everything. If you put it in a fruit smoothie you can't taste it! (And if you add strawberries it doesn't make it turn green)

Does he eat meat? (I didn't check to see if you're veg*n or not) Maybe some higher fat meats? I'd also check out the Traditional Foods section of this board to ask about healthy high fat things you can do...

[3xMama]

I just thought of something else. My DD's friend has a severe peanut/nut allergy but her parents use soybutter in place of peanut butter. Not sure of its caloric count or fat content, but it might be a good additive to foods to up calorie/fat count.

[TiredX2]

I would be interested in seeing some actual numbers.

According to the WHO statistics, to be in the 75% for weight at 12 months of age (they don't have an 80th line) a boy would have to weigh right around 23 pounds. At 12 months, 20 pounds is just over 25%.

Meanwhile, at 15 months, 20 pounds is right at the 10th%.

You can see this here:
http://www.cdc.gov/growthcharts/data..._24LW_9210.pdf

You'll notice that the site that is on is the CDC site, because they recommend that children under 24 months be plotted on the WHO charts.

So, my question is--- did someone completely misinterpret his percentiles when he was younger OR has he actually lost over 3 pounds in three months? If he had lost that much, that quickly, I would expect him to be lethargic, to have poor skin tone and color, to have brittle hair. I would also expect you to be seeing some pretty obvious behavioral issues.

My DD gained absolutely NO weight from 10 months to 15 months (I think she lost one ounce). But she was perfectlly healthy. It is very common for children to plateau in weight at that age (with increased movement). According to what we were told at the time, weight *alone* should not cause a concern. Develoment (meeting milestones), head circumference and height are all BETTER predictors of health/growth. Additionally, sometime around 6 months, most childrens own genetics start taking over. Because of mom's health or diet you can get a very small or very large baby that, according to their own genetics, will be average sized. Around six months, you start to see that completely take over and kids who were born very large, but are destined to be thinner, start thinning out or those who were born small but are going to grow larger bulk up.

What concerns, other than weight, do you have about DS?

Since you are pregnant, I would be concerned about his fat intake and try to up that. I know you are trying If his diet is so limited, though, you might want to try increasing your milk supply, safely of course. What have you tried so far? How limited is your own diet because of his allergies?

Good luck!

[Marissamom]

DD had a severe drop in her percentiles from 4-9 months. the way we turned it around was to start really pushing solids, especially starches (potatoes and grains). also, soymilk is lower fat than cow's milk, so adding in some kind of oil to up the fat content would be a good idea, though has he been allergy tested for soy? because it's another common allergen, so I'd be concerned about introducing soy to a kid with so many allergies unless it was known that he wasn't allergic. I know you can't add butter to everything, but you can add olive, canola, or vegetable oil to a lot of things. also, with things other than fruit, are you seasoning them? some kids won't eat things unseasoned, some kids won't eat things that are seasoned

[laliu]

Thanks for all the responses!

He isn't allergic to soy (although his test showed a false-positive per the allergist and his eczema is starting to flare up again so am not 100% certain on this.) We have been giving him soy milk, but the ideas on soy butter and maybe even soy formula may be an option. We aren't vegan, so he does consume some meat, although his intake is limited due to his own preferences.

TiredX2, I just saw the WHO charts this morning... interestingly he is not doing so bad on that chart as compared with the chart my ped. is using. I think I am going to point this out at his next appointment. It is a little reassuring. To be more accurate, he was in the 80 percentile on his 9 month apt... but has not gained any weight since then. He is VERY active which I think is a larger contributor as well as the simply not eating.

As to getting my production up, I'm trying oatmeal, drinking lots of water, but haven't been able to find any other options that seem safe during pregnancy. What I'm doing now doesn't seem to be working. My diet is limited due to son's allergies as well, so I guess I may need to up my own intake? He still nurses 8-10 times a day... but just isn't getting much. He keeps switching from side to side looking for more. Makes me sad to feed him anymore since I don't have much to give and it is obviously his food of choice. Any suggestions on that front?

Thanks again, really appreciate the support!

[laliu]

Also, he's otherwise in great health which is why I'm having mixed feelings vs what ped is telling me. Son is meeting/beating all milestones physical and otherwise. Not lethargic at all.

[AFWife]

Remind me how his height is doing? Are you and his father tiny people by chance? Are there tiny people in your family? Genetics can play a role...

I know it's an iffy thing...but adding homemade lard to your cooking can be good for you and help get him some fats. I'm more of a Traditional Foodie so I know some people get all aghast about lard.

[crunchy_mommy]

My 21-mo DS is 31" & 23lbs so your DS sounds OK to me though I understand your concern, and I know weight can look different on different kids. I would definitely show your ped the WHO charts because IME, breastfed babies' weight gains really do level off quite a bit after age 1 or so...

For fats, we put olive oil or olive-oil based margarine on almost everything DS eats. He also gets a lot of avocado. You can also try flax oil, add it to his food or in smoothies.

DS's pedi recommended trying a multivitamin to get him to eat more & it really did seem to work. It also helps DS if someone else hands him his food (DH or friends) or if I give him food while we're out somewhere (playground etc.)

Is your DS allergic to all nuts? And what about seeds? You can make hummus with lots of tahini if he can tolerate sesame seeds, and DS loves these little treats I made him that are just dates, cranberries, cinnamon, & nuts/seeds ground up & rolled into little balls. You could use pumpkin seeds or something. Also try sunbutter (sunflower seed butter)...

[Kmama2]

My doc told me that to qualify for failure to thrive the child had to be small/tiny AND NOT meeting milestones. Is your son meething milestones?
Number-wise my son could be failure to thrive. He is even smaller than your son. He was only 28 inches tall and 17 lbs 8 oz at 12 months. ( he is almost 13 months) I too am pregnant ( due April 2nd) and my lack of mlk suppy stresses me greatly. But if your son walks, talks etc... and because of his allergies I would expect him to be small. Allergic kids often weigh very little and have lots of food aversons. I don't think seeing a nutritionist would hurt.
My dd is allergic to peanuts and she eats Sunbutter instead of peanut butter.... he should be able to eat that ( its made from sunflower seeds which are not considered nuts) Its fatty. Avacadoes are a good idea, sausage. Add oil olive to all his steamed veggies, rice, pasta. I do flax seed oil in applesauce.
Also coconut milk is a good source of fat ( it doesn't have cholesterol though so I would make sure he gets some cholesterol from something else) Add vegan butter to all his toast etc. Make sure every time you feed him there is some form of fat.
We do cereal with milk ( so you could do cereal with coconut milk)
Sunbutter and jelly toast

Be careful of too much soy.. soy can be dangerous ( the estrogens) I personally don't like giving my kids soymilk or soy butter.
You can also find coconut milk yogurts.
Bacon....
I sort of obsess about ds getting enough fat as I hardly have any breastmilk left and he is teeny tiny and fat is so important for brain development.
A nutritionist might have some ideas of ways to get him to eat more- My dd only has one allergy but my friends son that has multiple allergies has all kinds of aversons to food and overall just hates eating.
( FYI I didn't read all posts so I apologize if I asked a question you already answered.

[heavensearth]

If your son is meeting milestones, I wouldn't be concerned at all!

My little guy has always been skinny, under the 10th % until very recently (he's now 22 months) and he stopped eating solid food when I stopped breastfeeding at 15 months. Of course we were alarmed by the fact that he only drinks milk, but our pediatrician isnt concerned at all, as he's growing and thriving on it. Sometimes we go days and days where he only eats a cracker, but he does drink 10L's of goat milk a week.

Our pediatrician said that you can't force a child this age to eat and suggested that we give him a multivitamin in addition to his milk, which we do.

Try not to stress about it, its not good for him, you or the new baby

[Abraisme]

Originally Posted by laliu

Thanks for all the responses!

He isn't allergic to soy (although his test showed a false-positive per the allergist and his eczema is starting to flare up again so am not 100% certain on this.) We have been giving him soy milk, but the ideas on soy butter and maybe even soy formula may be an option. We aren't vegan, so he does consume some meat, although his intake is limited due to his own preferences.

TiredX2, I just saw the WHO charts this morning... interestingly he is not doing so bad on that chart as compared with the chart my ped. is using. I think I am going to point this out at his next appointment. It is a little reassuring. To be more accurate, he was in the 80 percentile on his 9 month apt... but has not gained any weight since then. He is VERY active which I think is a larger contributor as well as the simply not eating.

As to getting my production up, I'm trying oatmeal, drinking lots of water, but haven't been able to find any other options that seem safe during pregnancy. What I'm doing now doesn't seem to be working. My diet is limited due to son's allergies as well, so I guess I may need to up my own intake? He still nurses 8-10 times a day... but just isn't getting much. He keeps switching from side to side looking for more. Makes me sad to feed him anymore since I don't have much to give and it is obviously his food of choice. Any suggestions on that front?

Thanks again, really appreciate the support!

If it makes you feel better my nearly 15mo DD has gained less than 1lb since she was 9mo. She's also now right at 20lbs and maybe 29" tall. It just seemed normal to me that she'd stop gaining and start to stretch out.. I don't do well-baby visits, so I haven't had to deal with a doctor, but I really don't see an issue with it.

[mckittre]

I think doctors have widely varying views on how small is "too small". My son was similar to yours - weighed barely over 20lbs at 15 months, and was 30.5 inches tall. My doc wasn't worried at all about him - pinched his thighs and said he still seemed to have enough fat, and he was otherwise doing great. At 20 months he's still a small guy, not quite 22 pounds (haven't taken him in for an appointment since that 15 months). He was born average, and spent his first year steadily dropping down to small, where he's stuck.
I know I was a super skinny toddler myself, though (and am a short, though fairly average weight adult).

Making sure he gets good fatty food is probably a good idea. But it's also true that someone has to be at the bottom of those charts - my guy eats well, is never sick, and is not allergic to anything.

As for the pregnancy nursing, I'm not sure there's anything you can do about the loss of milk - it's hormonal. I lost mine in the second trimester (am 7 months pregnant now), but I have it easier because my kid can drink whole cow's milk.

[kittn]

my now twelve year old son was FTT. at 12 months aj was just over 12 lbs and 19lbs at 2. developmentally delayed and so tiny! by 5 aj was 28lbs and 28 inches tall. we did need to remove ajs tonsills (apparently causin sleep apnea and preventin growth) and it got better(but not a lot).
at 12 now aj is still small, but... amazing!!!!!
fantastic at sports, music, school you name it.
just piece of mind, it can work out. aj does have a diagnosis of septo-optic dysplasia and it can effect growth We didnt know until 8-9 y/o

http://www.ninds.nih.gov/disorders/s..._dysplasia.htm