Dr wants my underweight, L/O veg, low muscle tone preemie on Pediasure?

[preemieprincess]

DD was born at about 33-34 weeks. She is now 15 MO. She was EBF from birth- ~7.5 months, and did not really start eating a substantial amount of solids until around her first birthday.

She has been diagnosed with low muscle tone. We have are fighting to get Early Intervention to make house visits. They had deemed her "mildly delayed" in gross motor development, so she did not qualify the first go-round because she did not have a "severe enough" delay. We are taking a "wait-and-see" approach as far as a more definitive diagnosis. She is having trouble maintaining a steady growth pattern. She is underweight for her height. Dr. is fully supportive of veg diet and my plans to continue BF until at least age 2. She understands the prematurity, veg diet, lead exposure in utero/ infancy, and BF all contribute to a smaller baby, but she is concerned with her height/ weight ratio. Dr. believes her gross motor delay is affecting her ability to gain weight, and therefore recommended Pediasure.

Due to a family history of anaphylaxis, I am hesitant to give her nuts. We are veg, so I have some reservations about introducing meat. Fish is a definite no-no due to said family history.

She is having such issues with her gross motor skills that she cannot eat much other than stage 2 or 3 baby food, over cooked beans, eggs, cheese, pureed dates, and astronaut food. I have added in some beans and other squishy foods. She often gags on things like Cheerios and similar finger foods that most children her age can eat. She never got used to a bottle, as I quit pumping as soon as she learned to latch at ~3 months. She does not have much interest in a sippy cup as anything more than a teething toy or blowing bubbles and dribbling all the liquid out. We have experimented with, quite likely, every kind of sippy cup there is. We've got 6 different styles of sippy cups, and none works.

I've been attempting to give her some Pediasure anyway, even though I am a bit grossed out by how heavily processed it is. It has several ingredients in it that I would never put in my own body, so I'm sure you can understand how I feel about giving it to DD. You would think I was trying to feed her bleach with the way she refuses to drink it.

Anyone have any suggestions for either getting her to eat/ drink the Pediasure, or possibly some pointers for alternatives? I'd prefer to raise her veg, but would consider adding some locally raised meat if necessary.

Thanks!

[AbbyGrant]

Have you tried whole milk yogurt?  

My son won't eat many foods, but yogurt has been one of the things I've consistently been able to get him to eat.  It's his main source of protein and fat. He also gets a multi vitamin and omega-3 supplement to help fill in the gaps.  

I think at your daughter's age I was still mixing plain with flavored yogurt to cut down on the sugar.  Now he gets the flavored straight.   I think it's the only thing that's kept me form having to go the pedisure route.  I'm fairly certain he wouldn't drink it anyway.  

[Spring Lily]

I had to click on your thread because it sounded like you were describing my own DD. Born at 34 weeks, L/o vegetarian, hypotonia, same issue with solid foods and allergies. She never even hit the 3rd percentile for weight until she was around 2. Her height is slightly above that, but I still ended up asking our ped for a referral to a dietician. Our insurance covered it. I spoke to a couple different dieticians, one who was helpful with recipes and things and one who was not. We had allergy concerns and had to run a whole allergy panel for her at about 13 mos because she couldn't tolerate many foods. She couldn't have grains (except rice) or dairy until 18 mos because she couldn't digest it. Nuts and a few other things were out because of the potential for allergies, and she couldn't tolerate dairy. The dietician was able to give me a few things to focus on to really help her.

I would definitely suggest meeting with a dietician, and if possible contacting him/her before the appt to let them know the limits of her diet. That would give them time to gather some specific suggestions and recipes for you. I remember our helpful dietician suggested that I focus on giving her a lot of protein and using a lot more oils in her food. Protein and fats are the main things that are going to help her reach a healthy weight for her size and let her build muscle strength. I mixed a lot of olive oil and flax seed oil into her food before serving. When she could tolerate dairy, I'd fry her vegetables in butter before blending them up. Do you make your own baby food? That will give you a lot more ability to add fats to the recipes. I remember cooking eggs for her and doing lots of beans. The tiny lentils were great because they're not choking hazards and good for dexterity.

This is just my own theory, not based on any science, but my DD did sooo much better with eating once her hypotonia was being treated. I know it could just be that her system matured with time, but I have to wonder if building up the core muscle strength helped her be able to handle eating and digestion better. I know that getting her more active helped her appetite a lot. But I still wonder if those two things were related.


Keep fighting EI for services! My DD's delay from the hypotonia was enough to qualify for EI but the PT was amazing for her. Is there any way you could get your insurance to cover it? Seems like with the low muscle tone they're be able to. We didn't go too far with testing to find out what causes the hypotonia, but we did get a blood panel done for genetic conditions and met with a neurologist to discuss options. That was very useful because we found out what testing we could do, what the most likely causes were in her case, and what possible other issues may arise in the future. I know you weren't asking about hypotonia, but it really did help ease my mind about it and make me feel informed about what to be watching for. DD is now 3 and people are always surprised when I say she has hypotonia because they can't tell. She also eats a TON and a good variety. So there is hope that this is just a temporary obstacle for your DD, too.

Anyway, it sounds like we have a lot of similarities with our DDs, PM me if you want to talk more.

[RiverTam]

Will she take a straw?  What if you show her to use it like Mommy?  Will she take a regular cup?

If she doesn't like the Pediasure, I'd try her on a thick version of Carnation instant breakfast. If that doesn't work, I'd try Yoplait Smoothie Mix -- they sell it in the frozen breakfast section. If that didn't work, I would try her on ice cream and just about any kind of fruit juice I could find. 

[devon]

I'd do PediaSmart before I do PediaSure. 

http://www.naturesone.com/pediasmart-dairy/

It's organic, non GMO, and other good things.  If I had to pick something, I would try that.  It's not as 'scary' looking as pediaSure.

The other things suggested are good advice - upping the whole milk yogurts, healthy fats (avocado might be a great one!), and beans are the way to go.

[fiddlefern]

Unless you've got milk allergies, heavy whipping cream really packs in the calories.  I used that in smoothies and also added to my milk/ cow milk in straw cups (would your kiddo like a crazy straw?).  I put lots of butter on his peas.  Peanut butter (or sun butter if there are allergy concerns).  If she can't eat dry stuff, just put the peanut butter on a spoon.  Avacado, if your kid will eat it (mine wouldn't/ won't).  Mix the thick part of coconut milk into plain yogurt.  Or plain whole milk yogurt mixed with honey (still a huge favorite at age 7).  Love the PediaSmart idea.  Wish I'd known about that.  Would've saved me a lot of heartache.  Pediasure, as our naturopath said, "Is made up of every allergen known to man, but at this point he needs it."  Another option would have been nice.

btw, it sounds like you need an eval for the feeding issues in addition to physical therapy for the hypotonia.  Neither one of these was covered by EI for my kid (got them through health insurance), EI only covered the speech therapy.

Wishing you the best!

[*~Danielle~*]

Avocado, yogurt, kefir, beans, if she can stand eggs...all these things are good and could give her the good fat she needs and calories.  I think doctors sometimes want to measure what our children are taking in and if you can come back with her weight up a bit and feedback about what you are feeding her, that would satisfy the doctor's need for input.  The doctors go for easy and quick, because most people want easy and quick.  What is easier than opening up a can of pediasure and then giving doc feedback, "Oh yeah, she is drinking 2 cans per day."  

But if you come back with, the fact you made her kefir or yogurt smoothies with avocado and bananas twice a day...that is whole foods, and good fat.  Win.  Buying avocados and bananas and yogurt would probably equal price of keeping up with pediasure and they are whole foods.  

[Piglet68]

Agree with whoever said protein and fats are really important. If nobody else has suggested it, coconut oil is a great stuff.

Pediasure is pure processed crap and I would keep that as an absolute last measure. Honesty I can't think of a single reason why one couldn't provide the same nutrients using whole foods. 

Meanwhile, if you do eat eggs and dairy try to find a source of pastured chicken eggs and pastured cows milk - feed her full fat milk, make yogurt out of it, soft cheeses, butter, etc. It's really important that the animal protein and fat she does get comes from pastured animals: the fatty acid ratios are much different than in grain-fed animals (for the better). 

You want good healthy fats, like those in animal products, avocado, olive oil and coconut. I would avoid any grain based oils, as they are full of potential inflammatory substances and unhealthy fats.