Underweight 18mo. Need to fatten him up.

[ElliottsDad]

My 18mo son is 80 percentile height and 7 percentile weight (and dropping). My wife took him for his scheduled checkup and the Nurse Practitioner was very upset with her about his weight (21.5 lbs=9.75 kilos) and practically accused up of being negligent. She told us to put him on pediasure to get his weight up and come back in a month to see how he is doing. I'm not very happy that the number one ingredient in pediasure is sugar.

Here is a typical day:
Wake up, 3 oz whole milk with vitamins
Breakfast 1/3 cup (when dry) oatmeal with berries, raisins or bananas. Sometimes healthy no-sugar cereal instead. Sometimes French toast or blueberry pancakes.
Snack: Full fat home made yogurt with flax oil and wheat germ (loves it). 6 oz whole milk
Lunch: Peanut butter and banana sandwich, wheat crackers, pear/banana/pineapple, fig newtons, 6 oz whole milk
Snack: 4% milk fat cottage cheese, whole wheat crackers with peanut or cashew butter, 6 oz milk
Dinner: frozen Peas, macaroni and cheddar-sauce (made from scratch with whole milk and flour) or beans and rice, fruit.
another 3 oz of whole milk right before bed.

Some days he will eat well, and some days he eats almost nothing. I usually give hime one or two cookies with dinner, and he will eat many more if offered. I'm worried that despite our best efforts he only likes sweet things. At his day care they sometimes feed him awful things like pop-tarts and oatmeal cream pies despite my objections. He is not as energetic as I would expect him to be but he is not lethargic.

There are lots of things he used to eat which he refuses 100% of the time now, including fish sticks, squash, carrots, and avocado.
He has never eaten meat or eggs when offered. I can sometimes sneak chicken into other food if I chop it up finely.
He is often constipated (large very hard stools) so I'm reluctant to give him more dairy. He was taking Lactulose for a while to get things moving again (successfully) but it's becoming a problem again.

Other than his weight, he is very healthy. He had his first cold at 17 months

Neither myself or my wife are at all overweight despite eating large portions and less exercise than we should get.

Any suggestions on foods that will fatten him up? More protein or carbs? Making the yogurt with cream and powdered milk? Too much dairy?

Thanks

[oilerbaby]

To be honest it looks as if you've got a nice eating schedule going on there.  He's eating really healthy!  As for the eating habits (not eating some days and others lots, not eating stuff he used to love) that all sounds like a normal toddler!  You can't force him to eat more just to fatten him up but you can keep offering him healthy food choices and some days he might eat them and some days he might not.  You might offer him a certain food upwards of twenty times before he tries it.  There is also nothing wrong with giving him a couple of cookies after supper (dessert is the best part right?  )   

For the constipation I would try giving him some apple/prune juice (you an dilute with water half and half if you want to cut down on the sugar).   You could also whip up a smoothie with lots of fruits to try and get the system moving...  if he'll drink it (put it in a funky cup with a straw to make it more fun). 

If you are really concerned I would make an appt. with your doc or perhaps even a nutritionist (although your eating menu looks very good and healthy to me).  It sounds to me as if you're doing a good job.  Here's another perspective for you - if his height was at 40 or 50% and his weight was at  7% would the nurse still have been commenting on it?  Oh, and in my opinion she had no right to make you feel as if you are being negligent - that is wrong of her to do so.  Hope some of this helps you feel better!

[deb]

I'd also say it looks good. You're already feeding him a bunch of the stuff I was going to suggest. I would take the day care SERIOUSLY to task for the, um, cr@p they're feeding your DS too. We have issues here with high fructose corn syrup, so I TOTALLY hear you on the sugar concerns.

The only other stuff I can recommend would be fish oil (Nordic Naturals makes lemon- and orange- and peach-flavored fish oil which DOES NOT taste fishy!!!); we often mix it with full-fat yogurt and a bit of vanilla and the orange makes it taste like creamsicles when we sweeten it a bit with a drop or two of stevia.

Oh, and you say he's not into avocado any more, but will he eat guacamole, with all the seasonings? Makes a great dip for cheese, crackers, cukes, carrots, the works, and you can add olive oil. We've also successfully sneaked pureed broccoli and kale and spinach into guac on one occasion or another. How about ranch dressing, made with the yogurt?

If you're leery about any more dairy, you can add protein powder to milk or even rice milk; Natalie CHUGS rice milk with rice protein powder we get at Whole Foods; it also happens to be loaded with green veggies like kale and spirulina and dandelion and beet greens, but she doesn't need to know that.

Will he eat fish at all? My girls will both eat salmon that's been marinated in and then baked with a can of coconut milk, and coconut is LOADED with good fats. (The coconut is good in veggie curry too! Coconut oil in general has lots of health benefits and we cook in it pretty often, even to make popcorn (which I make in my pasta pot with the colander-type lid).

Eggs? Even with his own selection of seasonings? Both my girls enjoy exploring the spice cabinet and smelling/tasting the contents thereof, and we have a pretty amazing one as we like ethnic touches in our food. (In our house, for example, many meat dishes aren't complete without the tiniest sprinkle of cinnamon.

Anything in there to work with?

[RachelC]

FWIW, my dd2 is 30 months and barely 24lbs, she's in the 3-5%tile.  Her doctor wants to run some tests, but isn't overly concerned, as she is the picture of health as well (was on antibiotics for the first time ever at 29 months for pink eye)

I would consider finding a new practice that doesn't make you feel negligent.  He certainly doesn't look like he's starving   

[EmMUK74]

Wow your meals seem just great and I couldn't make any suggestions.  Rachel has a similar situation, over 91% for height and below 7% for weight and they like to worry but she's healthy and energetic and built like her dad's side of the family (me and my side have the opposite issues).  she also has days when she eats all day and then days when she won't eat more than a piece of toast, but I know that she's in control of what she needs to eat and never lets herself stay hungry.  If you are worried I would go and see a peadiatric specialist rather than getting caught by a system obsessed with charts, after all everyone is built differently and as long as they're healthy then it's best not to set up crazy eating patterns.

hth, good luck

[Mydreamcametrue]

Hi, your post really struck my attention, because it reminded me of my son at that age.

First, if you can, change doctors.  My first son's Ped made me feel like that for 6 months.  He told me I had the new mommy syndrome. 

Is the doctor worried because he has actually dropped on HIS weight curve?  Personally I hate the charts and percentiles of what they should be.  If he has a steady curve for his own weight, then I would not worry, BUT like if he is like my son at that age He actually went down on his curve.

We went to the feeding clinic, had a ton of test ran, etc.  Now at 2.5 we are still trying to figure things out with him, BUT he is in the 65% for his weight.

He drinks Pediasure everyday and a lot. 
Right now at the moment, I have mixed feelings about Pediasure.  I will deft. have to say it gets their weight up, no question about it.  BUT I think it can curve their appetite and they might not eat as much.  Also you are right about the sugar.  For us though, it is the only way he is getting his vitamins and calories.

I have a list that I got from the feeding clinic on ways to add more fat to foods:  One thing you can add to his foods is  Duocal. 
You can also add wheat germ or flax seed meal. 
The coconut milk and oil are excellent. 

Non-Dairy Calorie Boosters

Product            Calories      Where?   

Oils/ Margarines

Canola, Vegetable, Corn, Olive Oil   1 Tbs = 120 calories      

Smart Balance Light         1 Tbs = 45 calories      

Parkay Squeeze Margarine      1 Tbs = 70 calories      
   
Fleischmann’s Light Spread/Stick   1 Tbs = 40-50 calories      

Fleischmann’s Unsalted Spread      1 Tbs = 70 calories      

Spectrum Naturals Spread      1 Tbs = 80 calories      

Earth Balance Natucol or Soygarden   1 Tbs = 100 calories      

Whole Soy & Co. Soy Spread      1 Tbs = 35 calories      

Mayonnaise

Hellman’s or Kraft  Real Mayo      1 Tbs = 45 calories      anywhere

Naysoya Nayonnaise (soy based)   1 Tbs = 35 calories      Ukrops

Follow-Your-♥ Vegenaise      1 Tbs = 90 calories      Ellwood Thompson’s

Spectrum Natural Mayonnaises      1 Tbs = 100 calories       Ukrops, Ellwood Thompson’s

Cheese/ Cream Cheese

Follow-Your-♥ Gourmet Cheese      1 Tbs = 35 calories      Ellwood Thompson’s

Vegan Rella Cheese Substitute      1 Tbs = 25 calories      Ellwood Thompson’s

Parma! Vegan Parmesan      1 Tbs = 25 calories      Ellwood Thompson’s

Soyco Foods Vegan Cream Cheese   1 Tbs = 30 calories      Ellwood Thompson’s

Tofutti Cream Cheese         1 Tbs = 60 calories      Ellwood Thompson’s

Tofutti Sour Cream         1 Tbs = 40 calories      Ellwood Thompson’s

Salad Dressings (always double check food label for ingredients)

Kraft Catalina            1 Tbs = 50 calories      

Ken’s Country French         1 Tbs = 65 calories      

Ken’s Honey Mustard         1 Tbs = 65 calories      

Ken’s Zesty Italian         1 Tbs = 50 calories      anywhere

Ken’s Thousand Island         1 Tbs = 70 calories      anywhere

Naysoya Veg-Dressings (soy based)   1 Tbs = 30-35 calories      Ukrops

Annie’s Dressings         1 Tbs = ~65 calories      Ukrops
   
Nut Butters

Peanut Butter            1 Tbs = 100 calories      anywhere

I.M. Healthy Soy Nut Butter      1 Tbs = 85 calories       Ukrops, Ellwood Thompson’s

Sunbutter (Sunflower Butter)      1 Tbs = 100 calories      Ukrops, Ellwood Thompson’s

Sweeteners

Honey               1 Tbs = 60 calories      anywhere

Maple Syrup            1 Tbs = 50 calories      anywhere

Brown Sugar            1 Tbs = 50 calories      

Karo Syrup            1 Tbs = 60 calories      

Apple Butter            1 Tbs = 30 calories      

Fruit Spread, Jam, Jelly         1 Tbs = 50 calories      

Strawberry, Chocolate Syrup      1 Tbs = 50 calories      

Instant Jell-o            1 Tbs = 30 calories      

Dr. Oetker Vanilla Pudding Powder   1 Tbs = 30 calories      

Others

Ah! Laska Organic Cocoa      1 Tbs = 55 calories      

Coconut Milk/Cream         1 Tbs = 30 calorie

[marensmama]

Wow, you're already doing everything I would have suggested.  Good for you!  If it were me, I'd get a second opinion.  Some kids need pediasure, but I'd want more than one doctor to tell me that before I gave my child a sugary, non-natural supplement that seems like it would not encourage them to eat more.  But that's just me, we eat whole grain everything, organic/local when we can, lots of fruits and veggies, not much meat, not much sugar (but we're not anti-sugar, just cautious with it), not much sodium.  We avoid trans fats and fructose as much as we can. 

FWIW, I have a more friends with low-weight children than with higher weight kids, and they're all healthy, rambunctious 2 or 3 year-olds.  I would truly get a 2nd opinion especially if the doctor did not make any attempt to support you and made you feel as though you had somehow done something wrong!

 

[Mydreamcametrue]

Just a question:  Why does everyone seem to think Pediasure is so sugary?  The first ingredient is Water and the 2nd ingredient is Sucrose (table sugar), BUT that is replaced with lactose for the carbohydrate. 

If you look at formula's, espicially Ready To Feed Alimentum.  The first ingredient is Water and the 2nd is Sucrose (table sugar).  That is the only formula that does not have corn syrup solids in it.

Anyhow, just wondering, maybe I am missing something.

Pediasure bascially is a toddler formula in my opinion and it does help them grow.  However, I do think it does curve their appetite.

I would deft. get a 2nd opinion first, but if they say Pediasure also you can rest easy knowing it is good stuff and good for them. 

Wendy

[Jenn©]

Backing Wendy on the Pediasure thought. 
And then sending my child to Elliot's house for a couple of weeks to pick up on his variety habits.   
We use a fiber supplement for constipation.  Caloriewise, you can mix some powdered milk into the whole milk for more protein/calories.

[binxyboo]

I think the problem with comparing Pediasure to formula and saying that they are basically the same, is that formula is also artifical feeding. No offense meant to formula feeders, but it is not really a standard by which to judge other things.

But it does contain a lot of calories, and will then obviously help with weight gain in that respects. I feel the same as Marensmama about it

[Jenn©]

Good point Binx!     I can't say the stuff encourages Mouse to eat more, but it does add more calories then she eats without it.  And makes mama feel better that my child is not planning to starve herself.   

[binxyboo]

I know what you mean. Riley is not eating great again lately, although I have a feeling he would eat a hundred cookies if I let him. It's trying to come up with healthful, calorie laden foods, that really have good nutritional value that has me stumped as well. He does still like his veggies, but not many calories there.
*Jenn....LOVE the avatar!!!

[Giorgina]

Elliottsdad, are either your or your wife of small stature?  My LO is a featherweight for his age (17lbs at almost 1 year old).  My doctor had to tell me ME not to worry as my son probably takes after me.  I am petite 5'3 110lbs so not to expect my child to be a big baby.  That made sense to me.  Ironically my parents had the same concern about me when I was a baby.  And I turned out fine.  I happen to have a great metabolism.  You are the parent, if you feel your son is doing fine physically, emotionally, etc, then don't let the numbers get to you.

Jenn, which fibre supplement do you use?  I need one for my LO.

[Jenn©]

We use the Benefiber chewables.  A bit of experimenting led us to 1 1/2 tablets daily.  I give them to her as 3 pieces.  Orange flavored, so she happily takes her "piber".