OK... HOW do I get my 5 year old to eat/gain weight??

[laohaire]

I'm putting this under Health and not Nutrition because I think there must be an underlying health issue here. I'm not looking for suggestions on WHAT to feed her (unless it's to address a specific deficiency that might be causing the whole issue), but rather ideas on what might be going on.

My 5 year old weighs around 33-34 pounds. I don't know exactly how tall she is, but her height is normal, probably a bit on the shorter side but she's not stunted. But her weight is a problem!

She is hypotonic (low muscle tone) and received EI services for PT until she aged out. We didn't pursue further therapy because she has roughly caught up with her peers on global skills. She does swimming and gymnastics, and keeps up fine. Her energy level is fine, too - she doesn't tire extraordinarily quickly or anything. We have no diagnosis, just noticable (to us) hypotonia. She can run, jump, climb (just not as fast, high, or well as most 5 year olds).

Her father (DH) and I both were super skinny as children too, so we understand there may be something genetic going on. DH was hospitalized at one point for this, they didn't actually force feed him but they threatened it and were just really aggressive about getting him to eat. I was not hospitalized but it sounds like DH and I were very similar (maybe DH being a boy made them more concerned; girls are "allowed" to be skinny, you know?).

DD is a carb addict. I was a carb addict as a kid too. I grew up eating cereal (not Trix but Cheerios, Rice Krispies, that sort of thing - not that those are exactly great of course), bread, pasta and rice. DD likes the same stuff, plus fruit, and has the same sweet tooth I did. Except even when we feed her whatever she wants, she doesn't eat much at all. I try hard to encourage her to eat protein, but it's not easy. I can usually sneak some amount of fat into her food (for example, a fruit smoothie with a good chunk of coconut oil, or a nice spread of butter on her toast, or chick pea in a curry sauce with plenty of oil, etc.) but protein is harder.

I went grain-free a while ago just for the heck of it and was surprised to see that grains apparently were a problem for me. I never even suspected. My grain-free experiment was purely a shot in the dark. I suggested to DH that maybe we try DD on grain-free and see if her appetite increases and maybe her absorption too, but DH is scared to do it. And I see his point. We feel like she is barely eating at this point, and grains are almost the staple of her diet (along with dairy). I don't know if we can even afford to have, say, a few days adjustment when she doesn't eat anything, you know what I mean? On the other hand, if grains are a problem for her, I want to fix that. Dairy of course is another possibility, but I just don't know how to deal with adjusting her diet when it's so limited anyway.

I've heard zinc deficiency can lead to low appetite, so I am ordering Floradix Calcium-Magnesium supplement which has a decent amount of zinc. So I'll see if that helps her appetite any.

Honestly, DD's weight is probably normal for our genetics (my mother thinks I weighed the same, and it's a big family story about how my mother's sister supposedly weighed 35 pounds through first grade) but I want to do BETTER than just sigh and wave it off. If there is a mineral we're deficient in, I want to solve that. If we can't process grains, I want to eliminate those.

Oh, and the obvious answer is: see a doctor. Unless someone can recommend a very specific person that has very specific skills in this area, I'm not convinced. DD has been seen by 3 doctors (none recently) and they all had advice we thought was stupid. Like one instructed us to feed her ice cream every day, as much as she wanted. OK, yeah, we want her malnourished but diabetic. No thanks.

[Cupressa]

It could be low stomach acid resulting from food sensitivities and excessive carbohydrate consumption.

Zinc is required to produce hydrochloric acid, but can't be absorbed without it. Exposure to foods one is sensitive to can inhibit stomach acid production, as can excess carbs. So, if dairy and grains were a problem for her, I can see how she may have a zinc deficiency. It sounds like she may also have a protein deficiency, and protein foods cannot be properly utilized without stomach acid. A hydrochloric acid deficiency results in a loss of taste for protein foods and a preference for carbohydrates.

I understand why you are reluctant to remove dairy and grains from her diet, but I think you may be surprised at how she responds. I don't think a child would let themselves go hungry or be undernourished under normal circumstances. Picky eating is a sign of food sensitivities. What about removing gluten, corn, and cow's milk first, and substituting goat's milk, millet, quinoa, and buckwheat, and see how she does?

I think diet changes are important in correcting stomach acid deficiency, if that is what's going on. Avoiding excess starches and separating them from protein is a good start. Bone broth will provide minerals and some protein, and can be used in a variety of ways that would hopefully appeal to your dd. When her appetite improves, you can encourage more vegetables instead of starches, and maybe even add something like beet kvass or apple cider vinegar water to support digestion.

[springmum]

Some good suggestions already. I have just a couple more things....

How are her stools? Do they appear "normal" - does she go daily? Is she gassy? That may give an indication of absorption.

How is her sleep? Is she restless, have growing pains, nightmares, not sleep enough etc. Might be an indication of something bothering her.

How are her teeth? Any cavities or issues?

How is her skin? Eczema or other issues?

Looking at those things can sometimes help narrow down an issue.

I have a suggestion for someone to see that may actually be helpful. A holistic nutritionist is a nutritionist who take the whole picture into consideration. They can look at the environment (toxins at home or school that may interfere/cause something), emotional state, diet (including nutrient absorption, improving digestion) etc. 

I don't know where you live, but it would be worth looking one up (sometimes they work in ND's offices)

Has she ever had any bloodwork done? 

Testing her B12, iron and Vit D would give you a little insight into where her nutrients are. Yes, you would have to see your Dr for this, but in my experience they've have always honored my bloodwork requests for basic things like this.

Just something to think about too for genetics. It may be that your husband and yourself had food intolerances as children, and that's why you were thin as well. You've noticed feeling better without grains, it may have been an issue for you as a child, but it was not common back then.

Sometimes it's hard to really know what is "genetics" and what is just issues with certain foods.

(e.g. Anecdotally - With celiac becoming more prevelant, more adults in their 60's even, are getting tested and finding they have it. Meaning they've had it all their life undiagnosed - and they can see the connection to all their health issues.)

[34me]

If you were to write a list of everything she eats, is there a texture pattern?  With her hypotonia she may get tired eating those "hard to chew foods".  Most carbs are easier to chew than say a chunk of raw broccoli or most meats (if you eat meat).  I have a 14 yo who will starve himself if one of his 15 or so preferred texture foods are not available.  I think you have good info from pp and I think I'm going to try it with my ds too.

[laohaire]

Stools - I think are normal. Daily. I'm not aware of any constipation or struggles in passing. As for me, I was fine in this department before quitting grains. Then after quitting grains, and then spending a week visiting my parents and putting grain-free on hold, I had major issues in this department. So I know that this could be fine just because of protective adjustments the body may make.

Gassy - yes, sometimes, though I'm not sure if it's more than usual? Doesn't everyone pass gas sometimes? She does seem to pass gas more than DH or I (lol) unless it's just a matter of being less discrete about it (lol again).

Sleep - she seems to sleep well, though she has always slept fewer hours than most children her age.

Teeth - awful. Dentist just found 10 cavities and I feel awful about it. Additionally, her teeth have lots of gaps between them.

Skin - seems all clear, I don't see any problems.

Other things:

She occasionally gets bruising in her legs. Me too. And this bruising doesn't seem to be related to any injury. I've assumed in the past that B12 or iron would help, and I get Floradix for both of us (which covers both bases). Unfortunately we can't afford to be on it consistently. Of course I'd rather we not get deficient in the first place.

Bloodwork - we haven't had it done. I agree, I don't mind asking a doc to run a specific test, but I just feel like I'm on my own to decide what to run and what to do if there's a deficiency, etc. I like your suggestions.

Right now we've started a grain-elimination diet for the whole family (DD, me and DH). I think I will wait a few weeks and see if we observe any good improvements. Dairy is also a big suspect; DH was dairy intolerant as a child though he seems to have muted his reactions to it (though I suspect he would still greatly benefit from eliminating dairy even so, even now. However, I think it's too big a bite to chew to eliminate grains and dairy at the same time, especially since DD's diet is basically grains and dairy. The reason I opted to cut grains first, before dairy, is because grains tend to lead to crap food. Grains are cheap and filling. So they are in packaged cereal, packaged crackers, packaged pizza, etc. I feel that eliminating grains might be a god move even if DD is not celiac or something. I have also replaced the grocery store milk with excellent, local raw milk.

Yes, I now suspect food intolerances were the culprits for me and DH as children. Also, for me, insulin resistance. I am a prime candidate for diabetes; for all I know, I might have actually been diagnosed with Type II if I'd had the tests run. (I think I'm managing that a lot better now - I don't eat sugar at all anymore, not even sugar substitutes, plus I've cut grains, and shifted my diet away from almost exclusive carbs to a better balance that includes more protein and fat). I was diagnosed as "prediabetic" on my 12th birthday, though I was assured by the doctors that it didn't have anything to do with what I ate, and that's why it took 10 more years before I even started to do anything about it. I was also "hypoglycemic" as a child. Of course it didn't have anything to do with what I ate (sarcasm, sorry) and of course the proper cure is to always carry around a candy bar in case your blood sugar drops (darn, more sarcasm). Since DD eats pretty much exactly what I ate, she must be headed the same direction - I hope we can finally put a stop to it.

I didn't know there was such a thing as a holistic nutritionist; sounds like just my kind of professional. Unfortunately we live in the middle of nowhere and there's not much for alternative medicine around here. We have one traditional Chinese doctor in the area, and he is so swamped that you have to practically be dying to get an appointment. Funny how there's so much demand being unfilled, you know? However, if this isn't working - or even if it is, but we feel we need more help - I'm willing to drive hours to see someone; and we're within a few hours drive of a couple major cities.

[laohaire]

Originally Posted by 34me 

If you were to write a list of everything she eats, is there a texture pattern?  With her hypotonia she may get tired eating those "hard to chew foods".  Most carbs are easier to chew than say a chunk of raw broccoli or most meats (if you eat meat).  I have a 14 yo who will starve himself if one of his 15 or so preferred texture foods are not available.  I think you have good info from pp and I think I'm going to try it with my ds too.

This could be. She does indeed find it difficult to chew some things that require more work of everyone (like, there's no way she could work through a piece of beef jerky, for example; she can eat an apple off the core but always needs someone to "start" it for her, and she never eats that much).

For sure, bread, pasta, rice, cereal are easier to chew than carrots, apples, meat.

Also, I may have "primed" her body to be carb-centered by eating this way while pregnant. I was health-conscious during pregnancy, but not as far along in my nutritional journey as I am now; plus nausea limited my vegetable intake. I dunno, I just know that simple carbs are a cycle, but fortunately I also know that it's possible to break free :) It's just much more of a challenge with a 5 year old than with yourself. I can make myself eat something or not eat something knowing it's good for my body, but that's not really in the realm of a 5 year old, who can't even really picture being an adult much less getting older and having health issues. However, I'm really optimistic right now since we've got a good plan in place and DH is onboard and it seems to be going fine so far. I really hope I have some fabulous updates in a week or two.

[springmum]

Good luck Mama! I know it won't be easy, but hopefully you'll get some pieces to the puzzle answered. It may just be the beginning, it may just be that one piece. Please do keep us updated.

[Rainy229]

OP - You said dairy is a staple of her diet?  Is she getting more than 3 cups of milk a day (24 oz)?  A lot of children that get more than 24 oz of milk daily often don't eat a lot - when they do, they're picky... because they're really not that hungry for anything else - kids that drink that much just have bellies full of milk.  A schedule of meals and snacks (set it around when she wants to eat to make it easiest) with only water between (aka milk/juice with meals/snacks only) can help with the cavities too (sipping on milk/juice/etc. all day long lets sugars (lactose, etc.) sit on teeth all the time - and we all know what sugar on teeth cause...), as well as increase her appetite (water-only giving her a chance to "get" hungry between meals/snacks).  

HTH!

--Rainy