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Since most of the MDC moms do not take growth charts very seriously, how do you tell when your child is too thin? My son is in the 1%. Right now he is 31 mos, not sure how tall, but he is as tall as my friend's 3 yo, who is avg. and right now he weighs around 22-23 lbs. The doc has referred us to a nutritionist, which I am having a bear of a time trying to get an appointment. They messed up our bloodwork weeks ago with the promise they would handle it, but now we have to have it done again.<br><br>
Weight and height aside, you might say, "maybe he is just small build." My answer is both my DH and I are on the big side, all of his brothers including our twins were much larger/sturdier at this age. You might ask "is he healthy and active?" My answer is: not always. He seems to be sick a LOT. He is sick right now, which has pricked my concern even more - he has diarrhea, and has had it for days and will not eat. He doesn't normally eat very much - some days he will go the whole day eating one bite per meal. I try not to make a big deal over this, not wanting to create a power struggle. But some days I just pull out my hair and think, one day he is just going to fall over because he starved himself to death. Developmentally, he is slightly behind, but I don't see this as a problem, he is progressing verbally. What does concern me is he is still a bit unbalanced physically. He will not jump down from any height, even his mattress which is flat on the floor. He seems to fall a lot, whereas he never did a year ago. Maybe he just grew tall quick and needs to learn to get around on his taller frame? Who knows. Energy wise, he fluctuates.<br><br>
He is so thin that I can see every bone in his body (except maybe those little ear bones) - I can see his entire pelvis and hip bones and every vertebrae. He is a walking skeleton. Anyone who looked at him without clothes would definitely wonder if he were malnourished. People have commented on it, and that was just looking at him with clothes. I hope the nutritionist can help us. Is there another specialist that treats this sort of problem?
 

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What does his doc think? Will he drink his calories in something like a smoothie? Does he have textures or strong flavors that he shys away from?<br><br>
My ds at almost 14 is really thin. You can count all his ribs from behind. It's kind of icky. He has major texture aversions.
 

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I would be extremely concerned about that. It may be food allergies or some kind of texture aversion but what you're describing does not seem normal to me at all and I have a hard time understanding how your pediatrician let it go for so long?
 

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I would be very concerned as well. Maybe an occupational therapist could help you?
 

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I third the encouragment to get yourselves to a nutritionist - I hope they can help you figure this out
 

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I am wondering if it could be something like Crohn's disease or something along those lines..since you mentioned the digestive issues and not eating.??? It might just be fresh in my mind though since DH's coworker was recently diagnosed with this.<br><br>
At any rate, I certainly would get him to a nutritionist and possibly a pedi gastroenterologist to make sure everything is ok with his digestive system.
 

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I am thinking allergy, digestive or possibly metabolic disorder as well. What I tell others is if the <i>only</i> concern is weight then it's probably nothing, in this case there are other factors that cause some worry as well.
 

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I'm with it being a problem if the "low weight percentile" is accompanied by a child who generally seems unhealthy or has other concerns. And possibly, but not ALWAYS, if the child is a child of two average-to-large build people. (I say that because I have a friend who's really short who fits that description. Her grandmother is also very short, and it follows that every-other-generation pattern through that entire family.)<br><br>
I have two children who I was told by a nutritionist that they were 'underweight' based on some sort of combined height/weight percentile thing. (they both fall fairly tall--dd is 95th%, ds was I think 75th) but really *low* (around 10% for weight.)<br>
Guess what? Their dad is over 6 foot and weighs about 150 lbs. I'm near positive if anyone plotted him on a chart, he'd fall the same way. Anyone who has so much as LOOKED at him knows exactly what they are seeing in my kids <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol"><br><br>
Their actual pedi has never said one word about their weight. They are also rarely sick (DS1 had his first several-day blah flu thing *last year*--he was 4) They have had a combined total of less than 10 prescriptions ever in their lives, and that includes DD's hospitalized whooping cough episode.<br>
They spend a considerable part of every day now that it's summer running and playing outside and riding their bikes--no energy level concerns! Appetites are good, general age-related pickiness aside. And they *look* healthy.<br><br>
I think that's the difference between being "normal" at the bottom of the chart and "cause for concern."
 

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To me it sounds like food allergies too - celiac possibly? The non-eating could definitely be sensory along with it. It could be he is refusing to eat b/c he's old enough to make the association between eating and it causing him pain?<br><br>
We have friends that had a son who wasn't growing well. He was behind verbally, and something seemed "off". They discovered he had celiac. Since removing gluten he has started growing again, speaking better, behaviour/moods have stabilized (for a toddler anyway) They have commented that he is a totally different child.<br><br><br>
I hope you are able to figure some things out soon.
 

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<div>Originally Posted by <strong>MusicianDad</strong> <a href="/community/forum/post/15471251"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I am thinking allergy, digestive or possibly metabolic disorder as well. What I tell others is if the <i>only</i> concern is weight then it's probably nothing, in this case there are other factors that cause some worry as well.</div>
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Agreed.<br><br>
My two oldest are at the very low end of the growth chart. But they are making milestones etc. They are just tiny skinny kids. My third weighs almost as much as her 4 year old sister. In fact they can wear the same clothes.<br><br>
I would rule out medical conditions and seek the guidance of a Nutritionist and possibly Occupational Therapist.
 

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Im with the the other mommas it sounds like it could be a food issue. I would look at celiac to start w/ possible dairy. Talk with your ped and get to a nutritionalist.
 

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My three year old is the same way. When he was around 2, we went to see a ped GI (he basically had diarrhea all the time) and they weren't very helpful, but tested him for celiacs and cystic fibrosis. In the end, they diagnosed him with "toddler diarrhea" which is another way of saying they have no clue what's going on but he should outgrow it by 3.<br><br>
He's now 3 and about a month ago I decided to get him tested for food allergies. Nothing came back positive, so we decided to take gluten out of his diet (mostly because every damn thing he ate had gluten so it seemed most likely.) It's been 2 weeks since we started that and I can already tell he's gaining weight (he also started talking and sleeping somewhat better and his appetite has exploded!)<br><br>
All that to say, check in to food allergies or diseases that deal with the gut (celiac, crohn's, etc.) or both.<br><br>
Good luck!
 

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Discussion Starter · #14 ·
Monday we are going to the nutrition center at the children's hospital here. I do not really know what to expect. Blood test maybe? The last time we went there (to see the allergist at age 1) the doctor we saw was not very helpful (along with barely speaking English). I hope they can start getting answers right away instead of billing for another appointment in the future, which seems to be the trend.<br><br>
So, send some good vibes our way! Thanks <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/innocent.gif" style="border:0px solid;" title="shy">
 

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Good luck! I hope they're able to help and at least order tests that can you lead you down the right track. You'll be going back to get the results and talk about a "plan," even if nothing comes back, so just prepare for that (I hate that specialist do that but it is what it is.)
 

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<img alt="" class="inlineimg" src="/img/vbsmilies/smilies/hug2.gif" style="border:0px solid;" title="Hug2"><br>
That does sound concerning (from a mama with a child with issues--he's been failure to thrive and is currently/he has a metabolic condition found at 3.5, ).<br><br>
The first thing they are going to want is food intake records. They need to determine that he is (or, it sounds like isn't) taking in enough calories, enough protein, enough carbs and fat for energy, etc. I'd start keeping them now if you can/if you haven't. Get a food scale. They make recording easy because you can weigh the foods before and then the left overs after he eats so you know what he actually ate. Our scale allows you to weigh the plate/bowl first and then it adjusts to tell you just the food weight.<br><br>
You need to know how many calories, how much protein, etc. he's taking in.<br><br>
Not enough calories (or enough of specific things) can cause both lack of energy and even developmental stuff.<br><br>
That said, how is his muscle tone? Am I understanding that he cannot jump? Can he jump from standing? Has he missed any other gross motor milestones? Other issues?<br><br>
For a failure to thrive work up they usually check iron and regular blood counts initially. I can't remember what else if anything is in there. If the intake is good they would often do a stool sample to try to catch malabsorption (not always accurate). Malabsorption stools might look greasy or float. My son had a CF sweat test to see if it was cystic fibrosis The GI also did celiac and food allergy testing.<br><br>
But diet records are really important. If this is "just" an intake issue they will be able to work with you on that so he gets what he needs to grow.
 

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Honestly that sounds like "too thin" for a toddler. He, no doubt, would have developmental delays somewhere if he is not eating enough fat! (Fat=brain power) I'd be encouraging healthy fats and protein. You might want to look into celiac and allergies.<br><br>
Food ideas (unless allergies are found):<br>
yogurt<br>
cottage cheese<br>
cheese slices<br>
avocado cubes<br>
grilled chicken or fish<br>
coconut oil (for cooking)<br>
nuts<br>
seeds<br>
nut butter & apple or celery<br>
sliced olives<br>
olive oil (for cooking)<br>
flaxseeds in yogurt, smoothies etc.
 

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I read in another post of yours that his intake is about 400 calories/day? How long has that been for?<br><br>
that's very worrying <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug">
 

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The only thing I can add that hasn't already been said is to ask if he's had any respiratory issues? You mention that he has been sick. Respiratory issues or a salty taste (of his skin) could be an indication of cystic fibrosis.<br><br>
Andecdotally, when I was an infant/toddler/preschooler, I was unexplainably sick all.the.time. I had diarrhea so badly that there were no celia left in my intestines to absorb the food. Whatever I ate came right back out. I was dying of malabsorption. I had zero normal stools until age 5. I was eventually diagnosed with an immune difficiency. Having said that, I started improving after age 5, and I wouldn't say I had any issues since I was a teenager. I don't find myself any more prone to colds, etc than the rest of my family, but I do sometimes find that it takes me a little longer to get over things, and I'm more prone to having respiratory issues.<br><br>
The point is, that while my mom lost many hours of sleep caring for me as a young child, keeping diaries of everything I ate, logging all of my symptoms, and making sure I took all of my meds, I'm here now - healthy and happy, living my dreams. Be strong and figure out what your baby needs, and have faith that he will get better. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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Your DS has many similarities to my DS at that age. In short he was born 50%, moved up to 70% at 3 months, had dairy and soy allergies so we delayed solids till 7 months. By 8 months he stopped gaining weight completely and got stuck at 19.5 pounds for almost 3 years. Seems he thrived on breast milk because he comfort nursed all day long, but he had no interest in solids and eventually the breast milk wasn't enough to sustain him. Docs kept a close eye on him. Ran every test they could think of b/w 11-14 months. Then decided "he needs to eat better". We spent 1 year at the failure to thrive clinic at our Children's hospital where we got lots of nutrition advice, non of which helped. I finally stopped taking him there because it was a waste of time. At age 3 I BEGGED for answers. The pedi re-did all tests (celiac, cystic fibrosis, blood work) and again everything was normal, so he concluded "he is just meant to be small" - this based on the fact that we could not get him to gain weight despite every effort to pump calories into him. He just had no appetite. I also begged for an MRI of his head over and over again and was refused. Finally at age 3.5 he started getting headaches and the pedi humoured us in giving him an MRI. And I was right....he had a massive brainstem tumour. Benign and slow growing which is why he was still alive, but barely. He was so far off the charts for so long he too was a walking skeleton. I couldn't even look at him anymore. The specialists think he was born with the tumour. He didn't have any of the classic symptoms for a brain tumour which is why he went undiagnosed for so long. Whenever I asked for an MRI I was told "he's too smart. he's got no balance issues. he is developmentally on track...etc so he can't have a brain tumour".<br><br>
DS is doing great now. Surgeons removed 60% of his tumour - the rest was inoperable due to it's location (near/in the respiratory centre). The rest was treated with 16 months of chemo. He finished in January and is doing fantastic.<br><br>
Your DS certainly has enough concerning symptoms that you need to figure out what is going on. No appetite, balance issues, strength issues, developmentally behind - these are all telling you something and your doctors need to figure out what it is. In my opinion, looking back on the months leading up to DS's diagnosis I think he was a lot sicker than the doctors wanted to admit. His energy levels were declining too. When the tests starts coming back negative make the doctors keep digging till you find the answers. I wish I would have been more insistent - we almost lost our DS because the docs stopped trying to find out what was wrong and his tumour was invading the respiratory centre which would have killed him shortly.<br><br>
Best of luck...my thoughts are with you.
 
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