My 32 week preemie, now 2 years old, weighs 21 lbs, all drs freaking out, how big are your...

[New_Momma]

My son was born most unexpectadly of course at 32 weeks. He was 4 lbs 7 ounces. He spent 3 weeks in the NICU. He was on a cpap, then nasal canula, his body temp was regulated for him and he was on a feeding tube of my breastmilk until he left the NICU. He breastfed on demand up until a couple weeks ago because i'm pregnant again and high risk. Breastfeeding was causing me contractions so the DR said I had to stop immediatly. He is now 2 yrs and 2 months old. His pediatricians have always freaked out about his weight. There was a period of his life where he did not gain not even a pound for about 7 months. His weight has started to pick up in the last few months he has gained 3 lbs and now he is 21 lbs. He has been sent to just about every specialist trying to figure out why he wont gain weight until I wised up and put an end to the madness. He's seen gastro, who said he's fine. He also went to a feeding clinic where he saw a psycologist, occupational therapist, and pediatrician. They determined his eating problems are behavoioral. The psycologist said preemies can hold on to painful memories of the NICU and feeding tubes. Has anyone else ever heard this?? Thoughts?? They suggested I leave him in his highchair crying for hours if thats what it takes until he eats, thats not an option for me. He has just never seemed to have any appetite or interest in food. I can do all that I can to get him to eat, but if he doesn't want it i cant force him to swallow and that's been my battle. Recently he saw a new pediatrician who also freaked out saying on the growth chart 100 percent of 2 year olds are bigger then him. He showed me the chart but i have a real hard time believing that. If that is true then I am very concerned. Thoughts??? How big ar e your 2 yr olds preemies and full terms?? Please share!! I just read in Dr Sears portable pediatrician that the average 2 year old is 27 lbs and they can comfortably give or take 4 lbs, if thats the case whats all the fuss about???? Please help!!!!! Thank you.

[TiredX2]

If he has gained 3 pounds in the past few months, that is rapid growth at his age! 

Here is the recommended growth chart for children 0-24 months (WHO is the recommended one until 2, then CDC):

http://www.cdc.gov/growthcharts/data/who/GrChrt_Boys_24LW_100611.pdf

That shows 21 lbs being just under the 2nd percentile. His birth weight would have been well under the 2nd percentile (I don't know his adjusted weight at birth, so I can't comment on that).  Unless he was 18 lbs before 15 months, he has GAINED in percentiles not lost.

 He is not the only child I have known to be that weight at two years so I'm surprised you are getting that much grief given that it looks like he has stayed in his same basic percentile category.  Are there other concerns?  Height?  Head growth?  Developmental milestones?  A lack of energy?  Poor skin tone, brittle nails, brittle hair?

Since he is actually 26 months, I looked at the CDC chart as well:

http://www.cdc.gov/growthcharts/data/set2clinical/cj41l067.pdf

Wow, that makes a huge difference.  When  your son is compared to other *breastfed* children he is right under the 2nd percentile, when he is put on the (largely formula fed and white) chart he is way off the bottom.  If I were you, I would plot his weight on both charts and see if he has basically been following his own line.  Once again, though, he is not the only 20 lb two year old I have personally known (I only know *of* him).  Are you small?   Your husband?   Any relatives that are small?

That said--- is he eating?  You said that he has "behavoral" eating issues.  What does that mean?  What does he eat in a day?  How far are you in your pregnancy and will you be open to tandem nursing after delivery (though, if your stopping nursing him and his putting on 3 pounds in a matter of months coincided, it doesn't sound like that would necessarily be a weight gain technique--- my DD did put on around 5 lbs in a couple months after the birth of DS, though, due to tandem nursing).  If the concern is him having negative associations with eating, I don't see how leaving him to scream for hours will help that!

ETA: I am not a premie parent, just saw your post.  I think the information is applicable, but you could also consider him to be 24 months and use the first scale if you adjust his age.

[4midablemama]

My daughter was born bang on her due date, at a normal weight, and if I remember correctly, she still had just barely cracked 20 lbs. when she was your son's age. She was born long and slender, and that's the way she's stayed, our doctor has never seemed worried at all about it. If your son is active and happy at his current weight, then I wouldn't be concerned, I would just continue to encourage him to eat and let him continue to follow his own growth pattern. I definitely wouldn't try highchair CIO, that sounds like pure torture to me, and totally counterproductive to the process of trying to change his view of eating.

[lovepickles]

DD was born two weeks late and average weight at birth. She's about 22 pounds now. We are just a small bunch.

I forgot to mention she's 2. <3

Edited by lovepickles - 1/8/12 at 9:36am

[JamieB]

My ds was born on his due date at almost 8lbds and now weighs 24lbs at 26 months. 

[cristeen]

What's his height doing?  During those 7 mos when he didn't put on a pound, what did his height do then?  Some kids seem to concentrate energy in height or weight, and can't seem to do both at once.  When they gain weight they stop growing in height and vice versa, so if you have the numbers for both, looking at them side by side might show a pattern. 

I would also recommend using his adjusted age and the correct (BF) chart to plot his growth.  I know with my DS they always use the FF chart even though he was BF until 9 mos, which makes a big difference in where he lands. 

As for him eating - is he eating anything (obviously he has to be eating *something*, or you'd be far more worried)?  What things does he seem to like?  Has he been checked for allergies/intolerances (since that can effect growth)?  Have you checked his iron levels (which can effect appetite)?

Is he drinking milk or another caloric beverage (something other than water)? 

If you're truly concerned about it yourself (and not because your doc is freaking out), you could try offering him a cup of formula each day to increase his calorie/nutrient intake.  But I probably wouldn't intro that at this age unless I really had to. 

[Adaline'sMama]

I dont have a preemie, but I just wanted to pop in and say that I think your ped is way out of line. 3 lbs in a few months for a child of this age is considered rapid growth! I have a daughter that isnt even on the charts right now, at 20 lbs, 3 oz at 22 months old and my ped isnt concerned about her weight because she is low in percentile for height and otherwise healthy. She also went months from the 11-18 month time period without gaining at all. She started walking, the running, and burned off everything she ate. We weaned due to pregnancy at 16 months, and she has gained about 1/2 a month since that time, but she doesnt have a huge appetite and some days she drinks a cup of milk, eats a pancake, and doesnt want to eat all day. Some days she eats a ton. Her mood changes all the time, and with it her want for food changes. I think children at this age are demonstrating a sense of control by what they are choosing to eat, and like you stated before, you cant force them to swallow.

A few times a week I make sure that DD gets a meal that is high in fat: butter, heavy whipping creme, lard, or some other fat. Strawberry banana shakes made with heavy whipping cream and whole milk are a huge hit, we do a couple a week. Just frozen strawberries, bananas, 1/2 creme, and 1/2 milk and then I let it sit in the freezer for about 30 minutes before I give it to her. She wont touch avocados- hates them no matter how I fix them. Even with honey. On a daily basis, I try to get her to eat nuts (even candied nuts if I have to), fish, seeds, food cooked in olive oil, cheeses, ect.

The only constant that she will eat that is high in fat is fresh ground peanut butter with a tiny amount of honey. She will eat it by the tablespoon, and I let her because I feel like she needs the fat and the protein. One thing I figured out a little while back is that she loves to control her eating. If she is sitting in a highchair, she'll barely touch her food. If I give her a plate of apple slices with peanut butter and honey in the middle where SHE has the control to dip it in the peanut butter and eat it, she will clean it up. I dont know if that is something that you've tried with your LO, but it also might encourage some self eating since you have a new baby on the way too

Honestly, Id look at a ped that was more breastfeeding friendly for this next babe. If this ped isnt even using WHO charts and is suggesting that you leave your kid in a highchair crying it sounds like you guys have totally different ideas about how to care for children. IMO, it is really important for a ped and a mom to be able to get on the same page about healthcare issues and if he is suggesting things that you find to be completely and totally out of the question then it makes me wonder if you guys will ever really see eye to eye. I'm not sure where you live, but you could try posting in Finding your Tribe in your tribal area to see if there are other peds that moms here at MDC recommend: http://www.mothering.com/community/f/76/tribal-areas

Also, this is a thread supporting moms who have skinny babies that you may find useful: http://www.mothering.com/community/t/1289635/skinny-babies-tribe

[New_Momma]

Originally Posted by TiredX2 

If he has gained 3 pounds in the past few months, that is rapid growth at his age! 

Here is the recommended growth chart for children 0-24 months (WHO is the recommended one until 2, then CDC):

http://www.cdc.gov/growthcharts/data/who/GrChrt_Boys_24LW_100611.pdf

That shows 21 lbs being just under the 2nd percentile. His birth weight would have been well under the 2nd percentile (I don't know his adjusted weight at birth, so I can't comment on that).  Unless he was 18 lbs before 15 months, he has GAINED in percentiles not lost.

 He is not the only child I have known to be that weight at two years so I'm surprised you are getting that much grief given that it looks like he has stayed in his same basic percentile category.  Are there other concerns?  Height?  Head growth?  Developmental milestones?  A lack of energy?  Poor skin tone, brittle nails, brittle hair?

Since he is actually 26 months, I looked at the CDC chart as well:

http://www.cdc.gov/growthcharts/data/set2clinical/cj41l067.pdf

Wow, that makes a huge difference.  When  your son is compared to other *breastfed* children he is right under the 2nd percentile, when he is put on the (largely formula fed and white) chart he is way off the bottom.  If I were you, I would plot his weight on both charts and see if he has basically been following his own line.  Once again, though, he is not the only 20 lb two year old I have personally known (I only know *of* him).  Are you small?   Your husband?   Any relatives that are small?

That said--- is he eating?  You said that he has "behavoral" eating issues.  What does that mean?  What does he eat in a day?  How far are you in your pregnancy and will you be open to tandem nursing after delivery (though, if your stopping nursing him and his putting on 3 pounds in a matter of months coincided, it doesn't sound like that would necessarily be a weight gain technique--- my DD did put on around 5 lbs in a couple months after the birth of DS, though, due to tandem nursing).  If the concern is him having negative associations with eating, I don't see how leaving him to scream for hours will help that!

ETA: I am not a premie parent, just saw your post.  I think the information is applicable, but you could also consider him to be 24 months and use the first scale if you adjust his age.

This is so thorough and informative. Thank you, i appreciate that!

Thats correct, he was stuck at 19 lbs for about 7 months, then for the first time in his life started eating like crazy. He gained those 3 lbs and has now pretty much given up eating again.

Af far as the charts, thanks and thanks for explaining them. I honestly try to not ever look a tthem because they scare me. So I can't say I understand all too well. I know at 2 yrs old I stop adjusting his premature age. He is 26 months old in a week. I feel like i'm not to sure about these charts, I sure hope I don't offend anybody but most babies are pumped up with fattening yucky formula. Thats why I think they are so huge. But anyway, in the 2 percentile doesn't sound concerning to you?

None of those other concerns. Quite the opposite. They tried to send me to OT since he wasn't walking, at 14 months he literally took off running and never looked back. Then they tried to send me to ST because they said he needs 50 words by age 2. Well I stopped keeping track at 200 words, he speaks in full sentences already and is 26 months old. So no worries. :)

Oh and yes, were small. I'm 5'2, 120 when i'm not pregnant, haha. My husband is I guess 5'6 and about 140. Ive always thought that too, like hello, were all small!! They pushed genetics so hard to look for any "disorders" I refused that too. He's been through enough. It's lik ethey wont stop until they find something "wrong" with him.

Some days he eats well. Some days he may eat a cheese stick and thats it. It used to really really get to me. I get a lot of pressure from every angle, esp family and all these crazy drs. Now I know I just have to let it go. Worry was literally consuming and ruining my life.

I'm always so proud of tantum nursers!!! Good for you! The only thing they said and this family dr I tried out said he must need a psycologist. Does this sound insane to anyone but me????? He's 2!! I feel confident in saying i'm the best momma he could ever hope for, he needs have always been met, exceeded/ and his dad is an amazing AP dad as well, he's had the most wonderful life. They did say that babies can remember and have truama from the nicu and feeding tubes..thoughts???

Thanks again!!!

[New_Momma]

Originally Posted by 4midablemama 

My daughter was born bang on her due date, at a normal weight, and if I remember correctly, she still had just barely cracked 20 lbs. when she was your son's age. She was born long and slender, and that's the way she's stayed, our doctor has never seemed worried at all about it. If your son is active and happy at his current weight, then I wouldn't be concerned, I would just continue to encourage him to eat and let him continue to follow his own growth pattern. I definitely wouldn't try highchair CIO, that sounds like pure torture to me, and totally counterproductive to the process of trying to change his view of eating.

Thank you!! I think you are so so right. That exsactly what I thought about the highchair, theres some sick ppl in this world!

[New_Momma]

Originally Posted by lovepickles 

DD was born two weeks late and average weight at birth. She's about 22 pounds now. We are just a small bunch.

I forgot to mention she's 2. <3

Thank you. This makes me feel so much better. Esp since she was full term, or late even. Ha.

[New_Momma]

Originally Posted by JamieB 

My ds was born on his due date at almost 8lbds and now weighs 24lbs at 26 months. 

Great. This is encouraging. Thank you. I'm a little confused with your description. How many children do you have? I hope to have a huge family one day!!

[New_Momma]

Originally Posted by cristeen 

What's his height doing?  During those 7 mos when he didn't put on a pound, what did his height do then?  Some kids seem to concentrate energy in height or weight, and can't seem to do both at once.  When they gain weight they stop growing in height and vice versa, so if you have the numbers for both, looking at them side by side might show a pattern. 

I would also recommend using his adjusted age and the correct (BF) chart to plot his growth.  I know with my DS they always use the FF chart even though he was BF until 9 mos, which makes a big difference in where he lands. 

As for him eating - is he eating anything (obviously he has to be eating *something*, or you'd be far more worried)?  What things does he seem to like?  Has he been checked for allergies/intolerances (since that can effect growth)?  Have you checked his iron levels (which can effect appetite)?

Is he drinking milk or another caloric beverage (something other than water)? 

If you're truly concerned about it yourself (and not because your doc is freaking out), you could try offering him a cup of formula each day to increase his calorie/nutrient intake.  But I probably wouldn't intro that at this age unless I really had to. 

I'm expecting another in March. Congradulations! :) Thanks a lot for your help.

His height has never been a concern or issue. Thats interesting what you said. I never heard that before but it makes since.

I did not realize there was two seperate charts but that makes a lot of sence!!

Some days he eats like crazy, some days he doesn't eat, when I say that I mean he may have a cheese stick and a cracker all day. He has grown out of intolderances thankfully. His iron is good. He does drink cows milk, usually chocolate, pediasure which is a life saver for us and lots and lots of juice.

Thanks again.

[New_Momma]

Originally Posted by Adaline'sMama 

I dont have a preemie, but I just wanted to pop in and say that I think your ped is way out of line. 3 lbs in a few months for a child of this age is considered rapid growth! I have a daughter that isnt even on the charts right now, at 20 lbs, 3 oz at 22 months old and my ped isnt concerned about her weight because she is low in percentile for height and otherwise healthy. She also went months from the 11-18 month time period without gaining at all. She started walking, the running, and burned off everything she ate. We weaned due to pregnancy at 16 months, and she has gained about 1/2 a month since that time, but she doesnt have a huge appetite and some days she drinks a cup of milk, eats a pancake, and doesnt want to eat all day. Some days she eats a ton. Her mood changes all the time, and with it her want for food changes. I think children at this age are demonstrating a sense of control by what they are choosing to eat, and like you stated before, you cant force them to swallow.
A few times a week I make sure that DD gets a meal that is high in fat: butter, heavy whipping creme, lard, or some other fat. Strawberry banana shakes made with heavy whipping cream and whole milk are a huge hit, we do a couple a week. Just frozen strawberries, bananas, 1/2 creme, and 1/2 milk and then I let it sit in the freezer for about 30 minutes before I give it to her. She wont touch avocados- hates them no matter how I fix them. Even with honey. On a daily basis, I try to get her to eat nuts (even candied nuts if I have to), fish, seeds, food cooked in olive oil, cheeses, ect.
The only constant that she will eat that is high in fat is fresh ground peanut butter with a tiny amount of honey. She will eat it by the tablespoon, and I let her because I feel like she needs the fat and the protein. One thing I figured out a little while back is that she loves to control her eating. If she is sitting in a highchair, she'll barely touch her food. If I give her a plate of apple slices with peanut butter and honey in the middle where SHE has the control to dip it in the peanut butter and eat it, she will clean it up. I dont know if that is something that you've tried with your LO, but it also might encourage some self eating since you have a new baby on the way too
Honestly, Id look at a ped that was more breastfeeding friendly for this next babe. If this ped isnt even using WHO charts and is suggesting that you leave your kid in a highchair crying it sounds like you guys have totally different ideas about how to care for children. IMO, it is really important for a ped and a mom to be able to get on the same page about healthcare issues and if he is suggesting things that you find to be completely and totally out of the question then it makes me wonder if you guys will ever really see eye to eye. I'm not sure where you live, but you could try posting in Finding your Tribe in your tribal area to see if there are other peds that moms here at MDC recommend: http://www.mothering.com/community/f/76/tribal-areas
Also, this is a thread supporting moms who have skinny babies that you may find useful: http://www.mothering.com/community/t/1289635/skinny-babies-tribe

Adaline is such a beautiful name!!!!

Thanks a lot for your help! i appreciate it.

Your daughters story is identical to my sons, as far as the weight pattern. I'm so glad your not being hassled. Even as far as what he eats day to day, he's just like her!! Glad to hear he's not the only one that does this! That is so true about the highchair, I gave up on that a long time ago. I'm not a parent that needs control, if he wants to eat on the floor I don't care, not a battle i choose to fight. ya know? He does tend to eat a lot better not in the highchair.

Thanks for all the food suggestions!! some of that we do and some well try. :)

I am trying so so so hard to find a new ped. I'm having a lot of trouble. I've put hours of research in at every place/website you can imagine. NO LUCK! There is NOTHING in my area. I'm willing to travel, but i'm talking 3 to 4 hrs away which I obviously cant do. I'm still trying. Thanks also for skinny babies link, so cute!

[Sharon, RN]

I don't remember DS#1's weight at 2 (because, that was a long time ago!), but DS#2 is 2 years, 4 months and just made it to 25 lbs.  He was stuck at 22 lbs for a long time- like months.  My niece is 20 months old, and 19 lbs.  Both babies were full-term.  My BIL and SIL are tiny people, but I am not- I'm short, but NOT skinny at all, so I don't know why DS#2 is so little, although my husband is on the smaller side.  The range of normal is all over the place.  Just concentrating on the child's weight without considering other factors (developmental milestones, activity, mood, etc.) does not seem like thorough care by your doctor.  I'm sorry. :-(

[cristeen]

Originally Posted by New_Momma 

I did not realize there was two seperate charts but that makes a lot of sence!!

Some days he eats like crazy, some days he doesn't eat, when I say that I mean he may have a cheese stick and a cracker all day. He has grown out of intolderances thankfully. His iron is good. He does drink cows milk, usually chocolate, pediasure which is a life saver for us and lots and lots of juice.

If you have these numbers (you may have to ask your ped for a copy of his chart to get them), I'd pull up the BF weight chart for 0-24 mos and plot every age/weight you have data for.  See what his curve is/has been all along.  Use his adjusted age.  If he's been steadily at 2% his whole life, someone has to be, and it just means he's a little guy.  If he was up at 10%, and then suddenly dropped to 2%, that's something to worry about.  If he was at 1%, and now is at 2%, then that's an improvement, and again not something to really worry about.  But i would suggest plotting the graph yourself and seeing what the growth curve looks like, and if you need to take it to your next ped appt to get him off your back, I would.

As for the food - my 28 mo giant eats like that.  It's totally normal for a toddler.  Some days he eats more than my DH, and some days he has a banana and a cheese stick, maybe a piece of toast (and he doesn't drink milk, just a bottle of diluted formula at bedtime).  And he's in the 98%, so I wouldn't blame his eating habits on his size - just his age. 

As for high chair vs no high chair... I noticed the same thing and got rid of the high chair around 22-ish mos.  And then we went to see the g'parents at Xmas, and they had a Keekaroo high chair (similar to a Stokke Tripp Trapp).  He could climb in and out of it on his own, and he adored it.  This child who we have been struggling with communication (he's autistic), would climb into the high chair, sit and say "eat!" a couple times a day.  Where at home it's about half and half whether he'll ask for food or just have a screaming tantrum because he's hungry or wants something different (he free feeds from a plate on the coffee table, but I have to fill it several times a day).  So I'm actually keeping an eye out for deals on one of these high chairs now (they're pricey).  So he might just want a bit more control over his eating situation.

I don't recall if I saw anyone suggest a feeding tray for him... I know a lot of mamas use a muffin tin, putting something different in each cup and letting them free feed out of it.  It gives them choices and control and minimizes your up and down having to find him food.  Might be something worth exploring.  And if you put foods you know he likes in a few of them and newer foods or foods that are iffy in some others, he has the option to eat it or not (control), and you don't have to feel the frustration of having him not eat his food. 

HTH

[nicolelynn]

I've had my 2 yr old foster son (who will be 3 next month) for almost 6 months, and was 22 lbs at placement. Doctors at the time said he was underweight, but were not alarmed since he wasn't losing weight. He has grown a bit now but hasn't put on a lot of weight. I'm not sure if he was preemie or not.

[TiredX2]

Originally Posted by New_Momma 

But anyway, in the 2 percentile doesn't sound concerning to you?

No, not by itself.  When added to the fact of two smaller than average parents, his percentiles actually make complete sense.

DD didn't gain any weight from 10-15 months (she actually lost an ounce in that time).  What I was told then, and have had backed up over and over is that weight is actually a weak indicator of growth/nutrition issues.  Indicators that are more important are height, head circumference and developmental milestones.  If there is an issue with one of those *and* weight there may very well be an issue.  If the only issue is weight, then a wait and see approach is perfectly fine.

If you want some help charting his growth I (or others here, I'm sure) would be happy to do so.  You can just list the stats you have from his various appointments and we can put them on the charts available.

I also wanted to respond to one other thing:

See what his curve is/has been all along. Use his adjusted age. If he's been steadily at 2% his whole life, someone has to be, and it just means he's a little guy. If he was up at 10%, and then suddenly dropped to 2%, that's something to worry about. If he was at 1%, and now is at 2%, then that's an improvement, and again not something to really worry about. But i would suggest plotting the graph yourself and seeing what the growth curve looks like, and if you need to take it to your next ped appt to get him off your back, I would.

If you do see that change (from 10th to 2nd percentile) that is not necessarily a cause for alarm.  It is something to watch for, but officially I think you have to cross two percentile categories (categories are denoted by the curves on the chart--- so one line is at 50, one at 25, one at 75...). Virtually no child sticks exactly to one of those average lines and you shouldn't be worried if they do.  I think my DD went from 75th% weight down to the 35% in a number of months.  Weight at birth is largely determined by the "health" of the mother during pregnancy, so it is easy to get a large baby who is destined to be small, or a small baby who is destined to be large.  You see their individual genetics take over more around the 6 months mark.  For my DD, she was born a bit larger than average and gained weight rapidly.  The rest of her life, though, she has been long and lean and that started to come out by 6 months and was apparent by a year.

[JamieB]

Originally Posted by New_Momma 

Great. This is encouraging. Thank you. I'm a little confused with your description. How many children do you have? I hope to have a huge family one day!!

We have three boys :D. 4yo,2yo and 6 weeks. My 4yo is also quite small. 30lbs and not quite 38 in. 

[Ratchet]

Some kids seem to love drinking lots of fluids and don't save room for food. You mentioned that your DS has lots of juice- the AAP recommends limiting juice to 4 oz/ day, and doing about 2 glasses of milk.  But if these are the foods (beverages) he loves- maybe find a way to add more calories, healthy fats, and protein to these (the shakes sound awsome- the blender is your friend!)  It sounds like he's doing great, so don't worry.  This would just be a way to add a little nutritional cushion when he's not feeling like eating much, and is a nice alternative to pediasure id you want to "mix it up" a bit.

[darthtunaqueen]

No ones commented on oral aversion so I will!

It doesn't sound like he has oral aversion, most of the time that comes from long term things in their mouths (most NICUs put feeding tubes in the nose for this purpose), things like breathing tubes, feeding tubes if they're on CPAP (putting it in the nose prevents the seal), suctioning, etc. 

Ive seen kids with oral aversion, and it's bad. They refuse to eat, don't grow, will gag or throw up when food is put in their mouth, etc. a baby I primaried in the NICU has oral aversion with food, but happily shoves everything in her mouth that isn't food...

Thus, I think he's a perfectly normal healthy toddler who is on the small side of the beanpole!