How slim is too slim?

[grethel]

My apologies, because I know this subject has been done to death, but I'm curious for others' experiences. My 19 month old dd has always been on the "tall and lean" side. Since she became a toddler she's been slipping down in the weight percentages - at 6 months she was at 60%, at 9 months (after she'd learned to walk/run) down to 40%, 18 months hovering between 20-25%, and now at 19.4 months she's down to  around 14%. I know someone has to be at the bottom, but she is still quite tall for her age (current height is at 88%) so it's not that she is just petite. (Her actual stats are 33.65" tall, 22.2 lbs.)

She is a very active, energetic girl who seems to have a small appetite and doesn't care to sit still to eat for very long. Since she started solids I've been very careful to feed her nutrient and calorie-dense foods, paying special attention to fat content (olive, coconut and flaxseed oils, butter, cream, full fat yogurt, avocado, nut butters). I wouldn't call her a picky eater, since she likes a lot of different foods - she just only seems to eat a little and her favorite, preferred foods are vegetables and fruit. She does not like cow's milk or alternatives (I make my own almond and cashew milk and offer it to her often, as well as offering cow's and goat's milk). She will sometimes sip a little on a smoothie but probably less than an ounce. Our method of feeding solids has been mostly BLW, so I offer her food throughout the day but don't force it. I let her graze - often she'll say "all done," get down from the table, go play and 10 minutes later will come back and want more (we tried keeping her at the table and taking the food away when she got down, trying to teach her that she had to eat her fill while the food was there -- but she would only eat the same amount). She is a child who rarely asks for food and if I didn't offer it many times per day, I think she'd go all day without eating.

I still nurse pretty much on demand. I did start, at about 16 months, to offer solid foods before nursing during the day and to nurse her after meals/snacks, not before. Her pedi suggested nightweaning as a way to get her to take in more food during the day, but I am not convinced that will help and am worried it will remove a source of calories.

I'm feeling conflicted because on one hand, she is a very healthy, active, strong, lively girl who is meeting all milestones and seems fine - just slim. But on the other hand, sometimes when I see how she is slipping in the percentiles, or when I'm holding her on my hip and I feel her knobbly little backbone against my hand, I really want to make sure there's not something I'm missing. I'm hesitant to take her back to the pedi because I think she might suggest weaning or adding a supplement like Pediasure (which is gross and I'm sure DD won't drink anyway). She also mentioned going to the nutritionist if she kept slipping. I saw the nutritionist when I was pregnant (I had GD) and frankly I don't have a lot of faith in her suggestions -- all she did when I saw her was show me the food pyramid and suggest I use artificial sweeteners.

Anyone else have a tall, lean toddler? Or one who thinned out dramatically at this age? Any advice? Can it be normal, or is there something else I should be doing/looking for?

I've wondered about a gluten intolerance or other food allergy, but she shows absolutely no symptoms.

Thanks if you got through this very long post.

[HidaShara]

Well, we're not in exactly the same position... DD was 7 lb 14oz when she was born, and has been dropping off the charts ever since.  She wasn't even a percentile as of about 7-8 months.  She hasn't been on the charts since then.  She was just shy of 16lbs on her 1st birthday.  Now, at 35 months (just she of her 3rd birthday) she's 23-24 lbs.

Now, DD is really short too, but there's no question she's scrawny.  Still, nobody has given me any cause for concern. She's happy, healthy and active.  Just really little.  A miniature.

So, again, I wouldn't sweat it.  In my eyes, your DD sounds plenty big. :)  It's also normal for them to lean out going into their toddler years. 

[NZJMama]

Similar situation here. DD was 7lb 9 oz at birth and has slid on down to under the third percentile. At 18 months she weighs only 18lb 9 oz. She isn't terribly tall 25%ile maybe? She eats what she wants and leaves the rest. I can't force her to eat and as long as she seems healthy, is meeting milestones, eats some and continues to gain then I wont worry. Our ped has never been overly concerned either. Unless you think there is something to be concerned about I just wouldn't worry.

[mamandedeux]

I could have written this myself! DS2 is 19 months old and slightly bigger (24 lbs), but he too has been steadily declining in percentile. His eating habits are exactly the same as your DD (I also offer tons of good fatty foods because he prefers fruits and veggies). I'm not worried, and I do think that they'll beef up once they stop nursing. I suspect DS2 doesn't eat a lot in one sitting because he figures he'll get to nurse if he gets hungry (and he's right...)

[not_telling]

DS was 9 lbs 7 oz when he was born and his weight stayed in the uppermost percentiles for quite a few months.  And then it dropped.  And dropped again.  And dropped again.  Until, at some point (sorry, can't remember which WBV's these were), he was hovering between the 15th-25th percentiles.  At our last visit (when he was 2 yrs) he was pretty much at the 25th percentile (his height has always been around 50%).  When his weight percentile was dropping with each new visit, our ped said it was something to keep an eye on, but she wasn't concerned.  I think I posted on here about good high-fat foods to try to cram in his mouth .  Ultimately, though, he ate what he wanted to eat and is just slim.  Which means this will be the third summer in a row that he'll be wearing some of his shorts and bathing suits...they get shorter on him, but still fit around the waist.  Saves us money!

ETA:  Snufkin!!

[Bokonon]

My 25 month old is in the 65th percentile for height and the 15th (if that) for weight.  She's healthy, eats a good, balanced diet, and is very active.  I'm not concerned.  Her ped. isn't concerned.

I'd rather have a slender, healthy toddler than an overweight one, especially considering my husband and I have both struggled with our weights.  1 in 3 kids in the U.S. are overweight or obese, so I don't worry at all about having a child on the low end of the charts!

[Peony]

Every single one of my kids have done this. DD1 was the least noticeable because she never was a very chunky baby and is of average height. She has a slight frame so she just appears smaller then she is. SHe is 8 now and is weighs somewhere around 50 lbs (I can't remember!), a good portion of that is muscle. DD2 was chunkier, thinned out a lot before her 2nd B-Day, held steady for a while and then did it again. She is 4.5y now, tall for her age, and now just about as thin as DD1 was at that age. DS I thought for sure was going to be solid kid, he was 20 lbs around 6 months, and now at age 2 he is 24 lbs so no he didn't stay solid! 

[akind1]

I wonder, will she dip her fruits and veggies in a fatty concoction? like celery and peanut butter?  (just a thought)

but I wouldn't worry. DS - 18 months - is 80-85% for height and has always been around 15% for weight. But we don't do WBV either (as we don't vax). I keep track of his % on an iPhone app that supposedly uses the WHO charts.

He weaned about 3 months ago, and honestly I don't know that that really increased his solid intake much. He sure drinks a lot more though! I really think that as long as she is meeting milestones and seems happy enough she is likely fine. DS is always leading me to the kitchen for a snack, so there is no need to remind him to eat! but it is good to keep snacks out, grazing is supposed to be a healthier way to eat - maintains a steady blood glucose level I think - so I wouldn't be too concerned about her not sitting down to eat all at once.

[MommaBirdie]

My DD went from being 98th percentile when she was 6 months to dropping at each check up after.
She actually didn't just lose percentiles from 18 months to 24, she also loss actual poundage.
But the pedi just said that it's typical of toddlers and that as long as she is meeting her milestones, is active, and is eating, then there's nothing to worry about.

[grethel]

Thank you all so much for the reassurance -- I feel a lot better hearing that so many toddlers are like this! My first was a very fat baby and solid toddler, so it's new to me. It's amazing how different they can be.

ps. not_telling: Moomin fans unite!

[flightgoddess]

Your child is fine. My son, at 2 yo, wasn't even 25lb yet, he was on the 5% for weight or something? But he's tall and his head was the right size. But he EATS a wide varied healthy diet. He can knock back 1 or 2 eggs and 2 toddler bowls of cereal for breakfast, or 3-4 pancakes, or 2 waffles and a sausage.... Now he's almost 3, and I bet he will barely be 30 at his 3yo appt. He is fine. Your child will be fine too. Now if she ever LOOSES weight, then begin to be concerned.

[AKA_PI]

My little guy is almost 3 and just recently hit 28 pounds. It's funny because he was stuck at 21 for months. I didn't stress because he is a great eater but is very active and probably has a fast metabolism like his dad.

[Asiago]

Perhaps I am reading the CDC/WHO growth chart incorrectly (?) but for her age she appears to be about 35% for weight (?)

http://www.cdc.gov/growthcharts/data/who/GrChrt_Girls_24LW_9210.pdf

Originally Posted by grethel 
18 months hovering between 20-25%, and now at 19.4 months she's down to  around 14%.

[Mama Petz]

This is exactly my daughter as well.  She has steadily been in the 90th and up percentile for height, and began dropping percentiles for weight once she started walking at nine months.  Now at 20months she weighs 21 pounds.  Her pedi mentions it each visit, but both her father and I are tall and lean (I'm actually considered quite underweight) and we and her pedi figure she will just have our body type.  She eats ok.  Sometimes more, others less.  Also loves her fruits and veggies, so I try to incorporate fat and calories wherever I can. 

[cyclamen]

I think it is quite common for most kids under age two prefer receiving most of their calories from breastmilk, formula, or cowmilk.

Regarding gluten intolerance, however:

I'll spare you the long story but my kid has a gluten intolerance that caused her to stop gaining weight around one year.  By 16mo, she was extremely ribby and "mini" compared to other kids.  (Not tall like the OPs DD.)  I think she was 18lbs?  The same weight she'd been at 8 months.  She was active and meeting all of the other mental and gross motor milestones.  And I thought she didn't have symptoms because I thought she didn't have diarrhea.  Well, more fool I, because the yucky, stinky, mucusy, watery, foamy poops full of undigested food, followed but hard turdlets?  Was alternating diarrhea and constipation.  I didn't even know to mention it to the ped because I didn't know it wasn't normal.  I thought the watery and green and yellow poops were because she still was drinking so much breastmilk at 16mo.

When we cut out gluten from her diet.... within a week she had normal looking poops.  Like grown up poops.  Smooth and solid rather than sticky.  No more taking five to ten minutes to poop rabbit pellets.   No more surprise diarrhea. 

So just want to throw that out there.  Sorry it's gross, but if I'd known what healthy breastfed toddler poops looked like, we could have done something about it way sooner.

[grethel]

Originally Posted by Asiago 

Perhaps I am reading the CDC/WHO growth chart incorrectly (?) but for her age she appears to be about 35% for weight (?)

http://www.cdc.gov/growthcharts/data/who/GrChrt_Girls_24LW_9210.pdf

That does appear to be the case! Maybe I've been misled ... I've been using a growth calculator that claims to use the CDC charts, but maybe it's inaccurate.

That does make me feel better, although I've been not worrying at all about it lately since getting such good responses.

[grethel]

Originally Posted by cyclamen 

I think it is quite common for most kids under age two prefer receiving most of their calories from breastmilk, formula, or cowmilk.

Regarding gluten intolerance, however:

I'll spare you the long story but my kid has a gluten intolerance that caused her to stop gaining weight around one year.  By 16mo, she was extremely ribby and "mini" compared to other kids.  (Not tall like the OPs DD.)  I think she was 18lbs?  The same weight she'd been at 8 months.  She was active and meeting all of the other mental and gross motor milestones.  And I thought she didn't have symptoms because I thought she didn't have diarrhea.  Well, more fool I, because the yucky, stinky, mucusy, watery, foamy poops full of undigested food, followed but hard turdlets?  Was alternating diarrhea and constipation.  I didn't even know to mention it to the ped because I didn't know it wasn't normal.  I thought the watery and green and yellow poops were because she still was drinking so much breastmilk at 16mo.

When we cut out gluten from her diet.... within a week she had normal looking poops.  Like grown up poops.  Smooth and solid rather than sticky.  No more taking five to ten minutes to poop rabbit pellets.   No more surprise diarrhea. 

So just want to throw that out there.  Sorry it's gross, but if I'd known what healthy breastfed toddler poops looked like, we could have done something about it way sooner.

Thanks very much for the detailed response! I think her poops are pretty normal (no foam, mucus, or constipation) although she still doesn't digest all her food. I think she doesn't chew it all. I'll kep it in mind to ask in the future.

[Valian]

My Ds1 started dropping percentiles after 9 mo and our ped was fine. We did have occasional extra weight checks but no one suggested dietary changes, weaning etc.

He was 21lb at 1 yo and at 5 years he was 33lb. I know 2yo who weigh as much as he did on his 5th birthday!  But he is healthy and thriving so no worries here!