19 month old FTT and Nutritionist Appointment....help!

[ryan'smom]

I will skip the terribly long story about my 19 month old ds.  He has recently been labeled by our Children's Hospital as FTT for poor weight gain & growth.  He is hitting all his milestones and is a happy & very active toddler.  He is 19.4 pounds and 30.5". 

He has undergone a multitude of tests: bloodwork, endoscopy, etc.  He is scheduled for a sweat test to check for CF.

The GI doc says that he "is not getting the nutrients that he needs" from breastmilk and sent me home with cans of Pediasure and told me to get him to drink 3-4 cans a day to help him "catch up".  She also wants me to pump to see "exactly how many ounces he is actually getting".  And 3rd, to have a meeting with a nutritionist to count calories, etc.

I tried pumping, but I do not respond well to a pump.....I know that I can weigh before & after feedings, but would have to rent a scale.... not sure if I want to go through the hassle, especially when I know that my supply is fine.  I think I'm going to come up with a reasonable number of ounces and just go with that????  I don't know what to do about that.

I know this is pretty standard for GI's.  I "offered" the Pediasure to ds and he took one sip and then pushed it away.  OK, so at least I can say I tried with the Pediasure...even though I would nurse instead anyway.

Moving on to the appointment on Monday with the nutritionist.....I know that breastfeeding is going to be a topic of interest.  I would like to come prepared.  Aside from the Kellymom links, what would you do to arm yourself in defense of nursing and the nutritional value it offers??

I want to walk in to the appointment with as many facts as possible. 

P.S.....yes, I offer high fattening foods to his diet:  advacado, coconut oil, nut butters,  olive oil, etc.  He just does not eat a large quantity.

[DomerJen]

Just offering support.  My DS is just like your son.  He's 22lb at 2 years, now.  He was 20lbs at 18mo.  They harrassed, did blood work, etc... but there is nothing wrong w/ the poor kid, other than having a tiny family.  Is your or your DH's family smaller? 

If there is not a specific issue in the bloodwork, he appears "healthy" (good skin tone, not losing hair, head circ and height inc), and he's meeting developmental milestones, I would really try and let this roll off of your back.  Keep offering him healthy high cal foods (we even spike his whole milk w/ half and half).  We're still nursing, but more comfort/routine, now. 

As far as arming yourself, there will probably just be a lot of nodding and smiling going on - but who knows, maybe the nutritionist will be able to give you add'l ideas on high cal foods you can try.

[TiredX2]

What is your gut telling you?  Do you feel he is healthy, but small or do you think there is something going on?

You didn't mention if he has always been small or this is a new thing.  You did mention that he is developmentally on track, though, which is a great sign.  Is there any obvious explanation for his size (small family size, small size at birth, etc...).  Has his head circumference kept increasing?

How often is he nursing?  Does he nurse during the night?  If you want to increase fat, I would definatley encourage him to nurse during the night (fat content of milk is higher during your sleeping time).

From what you have posted, I'm not sure what you will get out of going to a nutritionist.  It sounds like you know the warning signs of true FTT and also that you have tried to increase fats and calories. 

Good luck!

[OdinsMommy0409]

First, I've been in your shoes. My DS didn't hit 20 lbs until 20 months and was shorter as well.

Second, have you charted him on the WHO charts? It's quite different than the CDC chart, and I think a powerful tool for comparison when seeing typical peds. 

Third, if he's hitting his milestones appropriately and seems otherwise healthy, ignore the peds. I had to start ignoring them for my own sanity, and my DS is thriving without supplementation or continual pokes and prods. (We've had growth hormone stimulation tests, loads and loads of bloodwork and urinalysis, etc). 

Finally, do you instinctively think your child is healthy? I felt my son was healthy (just short and skinny like his daddy and me), but the doctors kept trying to convince me otherwise even though no tests indicated he was unhealthy).

[Peony]

My DS will be 2 next month and just finally hit 22 lbs. He was born at almost 9 lbs so he has yet to even triple his birth weight. He is happy and healthy, eats fine, he hasn't meet all his milestones, he is in EI for speech and some mobility issues. Our regular doc isn't concerned about his weight in the least, no one has out of everyone that has seen him. He is just a thin child, as was I, and our DD1 is the same. She is 8 and 50 lbs, very, very active, average height and thin. I'd listen to your gut on this one, do you think there is an issue or is he just a thin child?

[happysmileylady]

Ok, so looking at the WHO charts, that looks like 5th percentile?  I think I read it right.  Has your little one always been small, always been in the lower percentiles?  Or, has been been in higher percentiles and has suddenly dropped off?  What sent you to the hospital and the GI in the first place?

If he's always been a little guy, always been in those single digit percentiles, and he's hitting all his milestones and is otherwise healthy, I would not even give it a second thought.  As my ped as told me about my 2nd percentile now 2 yr old, someone has to be in the lower percentiles.  Sometimes, little ones are small.  Just like sometimes, they are big.  We aren't supposed to all be the same size and there's no reason to try to "catch up" a lower percentile baby JUST because that baby is in the lower percentiles.  Now, if there's something ELSE going on-not meeting milestones, sickly, nutritional deficiencies, etc, then being small might be a symptom, and in that case it's the problem that should be treated, not the symptom.  If the little one was in the 99th percentile, would they be telling you to feed him LESS to slow him down?  No. 

[jksmith]

Here's a link to the new WHO child growth standards charts. These standards were developed with consideration of the breastfed infant as the norm. There are growths charts for weight, height, and BMI, and an instructional module on how to measure a child's growth and recognize problems.

I switched your son's measurements to metric (height 77.5 cm, weight 8.8kg, BMI 14.7) and he's ranks within the normal range on all charts except weight-for-age, which is just below normal. Of course, a plotted growth curve over time is a better indication so you might want to try doing that. You can also print off the info for your doc or the specialist.

Hope this helps! I've worked on this stuff for school so if you need help with the charting or anything, let me know.

[MovingMomma]

You've already gotten a lot of great advice, so I won't repeat it.  I just wanted to let you know that I've been in your shoes with a DD w/a FTT label and while the pediatrician was Pediasure happy and skeptical of breastfeeding, the nutritionist said I was doing everything right.  When we did the calorie count of our food diary with the nutritionist, the biggest thing was adding butter to DD's veggies.  One of the few foods she'd reliably eat at that time was broccoli, so I was chopping up her 1-2 Tbs of broccoli & cooking it with 1/2-1 Tbs of butter.  The nutritionist thought that was great.  I thought it was a heck of a lot better than Pediasure.  

[ryan'smom]

Thank you for the responses ladies!  It is always nice to hear other BTDT stories!

Ds started in the 50% for both weight and height.  He has steadily been dropping off the charts since around 9 months or so.  The only test that has come back abnormal is his iron level.  We recently had it recheck a couple of weeks ago and he is no longer anemic after taking Floradix daily.

Our family doctor referred us to an Endocrinologist.....who said he was "proportional" and to feed him more.  He is the one who referred us to the GI for FTT.

I am 5'6" and 115# and dh is 6' and around 205#.......I guess this is considered "average".

Some days I feel that there is absolutely nothing wrong with ds.  He is so energetic and runs non stop all day long.  Some days I cringe and think about all the calories he is burning and wish I could just get him to "relax" for a while and let his body use the calories for growth lol

Other days, I worry non stop.  I wonder how in the world he can be getting enough calories to sustain growth/weight.  He likes to nurse, but doesn't love it like my 1st did.  He nurses to take the edge off, then he's ready to jump down and resume playing.  The amount of solids he eats is minimal.  I leave food out for him to graze on, I follow him around the house popping bits of food in him while he's playing, feed him while he's taking a bath, etc. 

It's just so hard to hear that he is not getting enough calories/not eating enough and I need to get him to eat more when my whole day revolves around GETTING HIM TO EAT.  If he was truly hungry, wouldn't he eat???

Ds #1 nursed until he was 3 and didn't eat his first real "meal" until he was closer to 2.  I never worried about his growth. He was very active as a toddler as well.

JKSmith:  I am going to plot him on the WHO chart again.  It's been a few months since I've done that.  He was off the chart last time I did.  Thanks for the reminder.

AServingMother:  I'll check out the link for the vitamin.  I have a liquid vitamin that I got from the health food store.  Ds doesn't really like it, so I like the idea of a powder.

Maybe I'll be pleasantly surprised at the appointment tomorrow and breastfeeding will not be an issue.  I am just so tired and exhausted, that the thought of hearing that not only am I not feeding ds enough, but nursing him is the root of all our problems......uugggg 

Thank you all again  for your support and I will update after our appointment tomorrow.

[lookatreestar]

just wanted to say good luck mama!

[D_McG]

Have you tried cutting back on the grazing? Some kids do better with structured mealtimes (and set nursing times, too).

[OdinsMommy0409]

How did the appointment go? I also wanted to add that we saw a huge (and completely unexpected) improvement in my DS's eating and thus weight after seeing a chiropractor. It might be a nice and natural route to try as well. http://icpa4kids.org/Find-a-Chiropractor/  

Originally Posted by ryan'smom 

Thank you for the responses ladies!  It is always nice to hear other BTDT stories!

Ds started in the 50% for both weight and height.  He has steadily been dropping off the charts since around 9 months or so.  The only test that has come back abnormal is his iron level.  We recently had it recheck a couple of weeks ago and he is no longer anemic after taking Floradix daily.

Our family doctor referred us to an Endocrinologist.....who said he was "proportional" and to feed him more.  He is the one who referred us to the GI for FTT.

I am 5'6" and 115# and dh is 6' and around 205#.......I guess this is considered "average".

Some days I feel that there is absolutely nothing wrong with ds.  He is so energetic and runs non stop all day long.  Some days I cringe and think about all the calories he is burning and wish I could just get him to "relax" for a while and let his body use the calories for growth lol

Other days, I worry non stop.  I wonder how in the world he can be getting enough calories to sustain growth/weight.  He likes to nurse, but doesn't love it like my 1st did.  He nurses to take the edge off, then he's ready to jump down and resume playing.  The amount of solids he eats is minimal.  I leave food out for him to graze on, I follow him around the house popping bits of food in him while he's playing, feed him while he's taking a bath, etc. 

It's just so hard to hear that he is not getting enough calories/not eating enough and I need to get him to eat more when my whole day revolves around GETTING HIM TO EAT.  If he was truly hungry, wouldn't he eat???

Ds #1 nursed until he was 3 and didn't eat his first real "meal" until he was closer to 2.  I never worried about his growth. He was very active as a toddler as well.

JKSmith:  I am going to plot him on the WHO chart again.  It's been a few months since I've done that.  He was off the chart last time I did.  Thanks for the reminder.

AServingMother:  I'll check out the link for the vitamin.  I have a liquid vitamin that I got from the health food store.  Ds doesn't really like it, so I like the idea of a powder.

Maybe I'll be pleasantly surprised at the appointment tomorrow and breastfeeding will not be an issue.  I am just so tired and exhausted, that the thought of hearing that not only am I not feeding ds enough, but nursing him is the root of all our problems......uugggg 

Thank you all again  for your support and I will update after our appointment tomorrow.

[blessedwithboys]

OP, you're doing everything "right".  I wouldn't even bother taking it any further at this point.  He will grow!  My ds1 was 8lbs 13oz at birth, 17lbs at one year, and now he's a big strapping 16.5yo who is 5'8" and 140lbs of solid muscle. 

If you do decide to add a supplement, plain old baby formula is better than Pediasure, considering your ds's age.  But Pediasure really is crap food, so maybe one from the HFS would be ok.  I like Goatein and Garden of Life makes a good raw vegan one.

[ryan'smom]

Well, it turns out that a few hours before our appointment, I found out our insurance would not cover the consult.  So I canceled.  There was no way I was going to pay $180 for someone to tell me to nurse less and feed more solids.  I am going to continue to keep a close eye on him keep offering the high calorie/high fat foods along with some of the other suggestions.  One thing I am sure about is to KEEP NURSING!!  Thanks again for all the advise and support!!