underweight 1yr old

[delancepants]

DS2 will be one next week.  He's only 25th percentile for age/weight.  I expected him to be a little on the small side as DH is Indian and in his state the people are generally quite small.  also DS1 is on the small side but as a baby never really went down below about 30th or 25th percentile.  However, DS2 was a good size at birth, 3.6kg full term, so his growth rate has obviously been dropping.  .  He started crawling at 4 months and he suffers badly with phlegm when teething nd sick, which I think may reduce his appetite.  the last year has bee pretty crazy with us emigrating to India, so I didn't notice that he wad small until about two months ago.  Although retrospectively I can see the problem went back at least to 7 months, but maybe longer, but we didn't get him weighed between 4-7 months.  Anyway I started trying ti feed him up and from 9th percentile at 7 months, I git him to 15th percentile at 10 mo and 22nd percentile at 11 mo.  However I just got him weighed two days ago and he's slipped back down ti 15th percentile.  I cant really see any specific cause, he wasn't sick, teething or going through anything else extraordinary in those few weeks, he just stopped eating as much.  I decided it was prob just that he'd become aware that we were eating other stuff and he decided he wasn't happy with his own food anymore!  (I had him on quite a simple diet, fruit, nuts, seeds, lentil, beans and veggies, which clearly was working for a while, until he changed his mind!)

So...I have changed his diet to increase variety and calorie content.  I'm not questioning 'what' to give him, I have some nutrition training, so that's not an issue.  But I do have a couple.if questions.  The first one is that the doctotold me to avoid giving him snacks, just stick to three meals a day.  I can see the logic in this in order to stretch his tummy and also to keep him going over night, but I'm wondering if anyone has any experience in thus area, I wonder if I could add in one small snack without affecting meals too much.  Or maybe drinks like juice...

Second question...  He seems a little picky in that he will eat a little but if something and then refuse it.  so I've found myself offering up to 8 different things at a meal, just in case he will agree to eat more.  And actually it seems to be working, he might refuse the first two things, but eat the third, then refuse the next two things and eat the fifth, then refuse a couple more but eat a ton of the next thing I offer.  I'm sure it's partly because I'm trying to start with the healthier things or the higher calorie foods rather than what he wants to eat out if choice, but I'm too scared to stop doing this now as it is working to get him eating more!  Am I digging a home for myself by giving so many choices?  Has anyone else been through this?  Will I be able ti change this later or is there some kind of compromise I can make now?

[eva026]

Second question...  He seems a little picky in that he will eat a little but if something and then refuse it.  so I've found myself offering up to 8 different things at a meal, just in case he will agree to eat more.  And actually it seems to be working, he might refuse the first two things, but eat the third, then refuse the next two things and eat the fifth, then refuse a couple more but eat a ton of the next thing I offer.  I'm sure it's partly because I'm trying to start with the healthier things or the higher calorie foods rather than what he wants to eat out if choice, but I'm too scared to stop doing this now as it is working to get him eating more!  Am I digging a home for myself by giving so many choices?  Has anyone else been through this?  Will I be able ti change this later or is there some kind of compromise I can make now?

That's what I end up doing some meals too. It's either offer lots of alternatives or have DD not eat because if she isn't in the mood for something, there is no way I can coax her to eat it. Also hoping that she'll either outgrow it or be able to tell me what she wants. Hope I'm not creating a monster though;)

Our case is the same as yours, DD was born in the 50th percentile and from the 5thmo fluctuates between the 15th and 25th.
A lot depends on the doctor. At the 6th mo checkup the Dr we saw freaked out and stressed me out too but since then we have found a lovely lady that make much more sense.
She is fine with DD's weight because her dirty/wet nappies are OK and her physical and mental development are going well too. We do 3x meals, 2x snacks and 3x formula, her metabolism is just a bit faster than other kids. We went in to the Dr about a month ago and she reassured me that as long as she doesn't suddenly drop off the charts weight-wise or stop meeting her milestones, then her weight is nothing to worry about.
We do: WU, formula, breakfast, snack, Nap, formula, lunch, nap, dinner, snack, formula
Some days she'll eat like a horse, other days just pecks so I guess she's one of those kids who monitor food intake on a weekly basis rather than daily.

[delancepants]

Interesting, thanks for posting, it's good to know I'm not the only one going through this! 
 
What do you give for snacks?  (just wondering how much to give)

[anna*]

Is the 15th centile 'underweight'? My GP friend keeps stressing to me that ALL the centiles are normal, as long as they're not fluctuating too much, or a big discrepancy between height and weight. My daughter is 99.6th centile but I don't think she's overweight?

[MasynSpencerElliotte]

Is the 15th centile 'underweight'? My GP friend keeps stressing to me that ALL the centiles are normal, as long as they're not fluctuating too much, or a big discrepancy between height and weight.

I was wondering the same...when we go for vaxes the health nurse now checks the kids BMI, but I told her I didn't even want to know.  If you don't mind me asking OP, how much does he weigh, and did they give you a weight/height percentile? DD2's weight and height separately put her at 50%, but taken together she is up in the 70's.

[~inbalance~]

If I can be honest both of my boys have followed similar paths and I have never viewed it as anything other than normal because I could always see that they were developing fine. I don't know what percentiles they started in (7 12 and 8 4 at birth so not small!) but after 4 months their weight plateaus and they have always grown in spurts rather than steady gain. Now I think they are 5th and 10th percentiles for weight and 25th for height and they are fine. We went through picky phases where they ate little but I didn't worry as toddlers are notorious for that.

All that said, to answer one of your questions I think it is fine to offer a mid morning and mid afternoon snack, I stick to fruit and veggies. I know some people take a grazing approach but I want my kids to be sufficiently hungry at mealtimes. I have also noticed that they started eating significantly more at meals by eliminating (for ds2) and limiting (for ds1) their milk consumption, as well as removing almost all carb type foods from their diets (so no cereal, cereal bars, crackers, pasta, and very limited oatmeal, rice, and gluten free bread). When we did this their protein and veggie intake shot through the roof, and I would rather they get their nutrition that way than from carbs which was what they were doing before. I haven't had them weighed and I am sure they are still in lower percentiles but I wouldn't be surprised if they have climbed a few.

I don't offer a huge variety in the hopes they will eat more. We make things they usually like and offer one healthy bedtime snack after dinner in case they didn't eat much, but that is rare.

I used to think my kids were picky but they aren't. And they are small in size I know and always have been but I know that's how they are (I am very small myself).

[creations]

I don't have much time right now but wanted to say my DS was 9th centile for weight and 25th for height and not considered underweight at all.  Any of the centiles on the chart are totally normal and healthy.  It's also fine to have weight and height on different centile lines so long as they are VERY dramatically different so for example 9th and 25th is fine where as 9th and 90th would be considered as something to look at to see whay they were so different.
My LO has just turned 2yo and is now on 25th for weight and 50th for height, again totally normal.  he recently had a development review and they were very happy with his weight and height.

I give at least two snacks per day, sometimes more.  you don't want snacks to impact on main meals but they only have small tummies so can only fit a certain amount in.  There's no way mine could go without snacks (all healthy).

[delancepants]

Thanks for your replies!  I must clarify re my use of the word 'underweight'...that's not a medical assessment, just my own personal assessment!  DS2 was 67th percentile at birth and dropped to 9th percentile by 7 mo.  I managed to get him back up to 22nd percentile at 11mo and at that stage he was 50th percentile for height/weight.  Now he's dropped down to 15th percentile weight/age and 10th percentile height/weight.  Even though he was bigger than DS1 at birth, he's now markedly smaller.  Of course they are different, but in addition to the other factors, I am worried about it and I personally think he is underweight.  I know they grow in spurts but the last spurt wasn't even enough to bring him up that far.  I want to be sure in my own mind that I'm doing everything I can to allow him to gain weight when the next spurt kicks in.

That's a good suggestion to stick to fruit and veg for snacks, might try that.  I don't give cereals much as they are poor choices nutritionally, unless in using them as a vehicle for fats that is.

Thanks, I feel reassured now that I can give snacks. I guess in a few weeks I'll have a better idea of a wider range of foods that he likes so that I can offer those more frequently.

[delancepants]

Also, re milk intake, I think he may be taking less the last few days since ive been feeding him up, we're breastfeeding so I'm not sure, but I'm not sure if exchanging breastmilk for solids is a good thing, who knows, hopefully I'm doing the right thing and he'll figure it out!

[~inbalance~]

Can you up his fat intake by adding coconut or olive oils to his foods? Will he eat avocados?

If you saw my boys you'd be shocked at how tiny they are! And like I said they started big too. That is just the curve they follow.

[amayzie]

I don't give cereals much as they are poor choices nutritionally, unless in using them as a vehicle for fats that is.

Some cereals are actually quite good as a snack. HEre the cereals are often fortified with extra vitamins, and you should be able to get a low sugar option. They can also be interesting and easy to take out and about. Perhaps look in the health food section- or just opt for things that are lower in sugar?

[delancepants]

Yes I'm adding coconut milk and olive oil to his foods.  I'm giving avocados when I can get them but he doesn't seem too keen, I'll keep trying.

My objection to cereals was really to the food group as opposed to the breakfast item, in general they're just not good nutritionally, which is why they're fortified.  I'm trying to make healthy stuff more appealing at the moment, but if that fails I will bear breakfast cereals in mind, many children seem to like them, thanks for the suggestion.

I just don't understand what's going on with DS2, yesterday was a classic example.  We had to go out in the morning, while we were out I fed him some dried fruit/nut mix that I make at home.  He used to love it, but recently went off it, but he ate it happily while we were out, I put it down to him being distracted.then at dinner time we had the usual scenario, he took 4 or 5 bites of some of the foods offered, then DH gave up.  He hadn't eaten much, so I offered scrambled egg and he wolfed down most of it.  When he finished, I didn't bother offering anything else as DH had already offered a ton of stuff and he'd refused it all.  Ten mins later DH and I were snacking and DS decided to partake in the very food he'd refused 20 mins earlier at dinner.  I don't understand at all.

[~inbalance~]

I found my kids to be particularly picky around the one year mark. It sounds like you are doing the right things and taking the right approaches. If he is otherwise healthy and doing well I'd try not to worry yet, it might be a phase. Is he teething? Maybe that is affecting his appetite.

[eva026]

I just don't understand what's going on with DS2, yesterday was a classic example.  We had to go out in the morning, while we were out I fed him some dried fruit/nut mix that I make at home.  He used to love it, but recently went off it, but he ate it happily while we were out, I put it down to him being distracted.then at dinner time we had the usual scenario, he took 4 or 5 bites of some of the foods offered, then DH gave up.  He hadn't eaten much, so I offered scrambled egg and he wolfed down most of it.  When he finished, I didn't bother offering anything else as DH had already offered a ton of stuff and he'd refused it all.  Ten mins later DH and I were snacking and DS decided to partake in the very food he'd refused 20 mins earlier at dinner.  I don't understand at all.

That's identical to DD!
 I'll be cooking us a whole meal that she'd like too and she takes two bites and starts throwing the rest on the floor. Then I try another thing with the same results and another. So I figure she's done. DH comes along, gives her the same thing we started with and suddenly she's like "yuuuumy, give me more!".
Scrambled her an egg for dinner, she spat it out and made a "yuck" face, the next day she ate most of DH's scrambled eggs for breakfast.

[delancepants]

I don't think he's teething, i'm sure it's going to start again soon but not yet.  and this fussiness with food has been going on a month, he certainly hasn't been teething for the last month.

wow, i'm sorry to hear you're having the same trouble as me, but i'm relieved because it makes me hopeful it's just a phase or something!  i'm just coming to realise that Ds1 was so easy, he just ate everything that was put in front of him for the first 2.5 years without question!

[creations]

Appetite does tend to drop around 1yo, picks up again later.  I think it makes a big difference if other people are eating at the same time.  Also I found that there were many foods DS turned his nose at which he'd previously enjoyed.  It was as though he had reached a stage of development where he naturally questioned what he was eating, I used to half joke and say I was the court jester, you know testing the food for poison before offering it to the King.  If I served his food and he looked suspiciously at it I'd take a piece from his plate (despite the same thing being on my plate) and 'test for poison' by taking a bite and telling him it was fine.  Then he ate it all.
To me it is is like they have a developmental leap and begin to question their world all over again.  It makes sense if for example they are becoming more mobile because out in the 'wild' (so to speak) a mobile LO could realistically reach poisonous foods which they previously didn't have access to.  It makes sense to hang back and get the all clear from mum before eating it.  I know it's not like that in reality in our homes because we are providing all the food.  Just the way I looked at it, same as a phase of SA coming with greater mobility, it stops LOs falling off cliffs if they feel the need to stay close to mummy.

[eva026]

To me it is is like they have a developmental leap and begin to question their world all over again.  It makes sense if for example they are becoming more mobile because out in the 'wild' (so to speak) a mobile LO could realistically reach poisonous foods which they previously didn't have access to.  It makes sense to hang back and get the all clear from mum before eating it.  I know it's not like that in reality in our homes because we are providing all the food.  Just the way I looked at it, same as a phase of SA coming with greater mobility, it stops LOs falling off cliffs if they feel the need to stay close to mummy.

Very true! Nature is so clever, now just explain the thinking behind painful teething;) Maybe one of those things that seemed like a good idea at the time...

[creations]

Ah, painful teething, yes, well that's all to do with reducing the chances of competition - sibling rivalry if you will.  When the highly demanding NB stage is over and mummy and daddy are celebrating the STTN phase something must be done to make mummy and daddy think "wow this is impossible, let's not have another" or at the very least make them so sleep deprived that they have no time, energy or motivation to DTD.  That way LO has a higher chance of not having to share mummy's love or that tasty buffalo Daddy just dragged into the cave
I mean honestly would any couple have a second or third child if it wasn't for ibuprofen?

[MasynSpencerElliotte]

I mean honestly would any couple have a second or third child if it wasn't for ibuprofen?

Sure! When your second child has a super high pain threshhold and never, ever was bothered by teething. Darn that mother nature...I'm not sure I will be so lucky with #3!!

[malenka]

A couple of quick questions for you. Did you BF DS? If so, when/did you stop? In BF babies, you can get a pretty steep drop in weight when they stop/slow down BF. If you formula fed, have you changed that intake?

My DR had some concerns about my DS as he dropped through the percentiles, as you're mentioning. As some pp have said, it's not so much where they lie on the growth chart, it's if they drop drastically from one percentile to another. You mentioned that you recently moved - is it possible that they're using a different growth chart? I know there are a couple of growth charts out there these days and there's a pretty big difference in percentiles from one to another (one takes into account BF babies more so than others).

Anyways, just some food for thought.

[delancepants]

Creations thank you so much for this...it really seemed like he decided he wanted mummy's food or nothing.  so I think you may be right.  Yesterday he hardly ate again, and he woke at 11pm crying, I thought due to new sleep routine, but after a couple of rough hours I realised he was hungry/thirsty/both!  even after us trying so hard to feed him yesterday.  so today I've tried to make his food more like mine, sharing my plate, my cutlery, letting him feed me...he's eaten so much you wouldn't believe!! Maybe just cos he's hungry, but maybe the sharing helped too.  Love your explanation of teething pain too, that ones been bugging me for a while!

Malenka, no it's not a different chart, it's the WHO chart I looked up online.  I'm still BF him.but I think the decline happened even earlier than when we started weaning.  I think the crawling at 4 mo may have something to do with it, plus the fact that he wad sick and teething a lot around 6-9 mo which really affected his appetite.  Maybe I'm worrying unnecessarily...this last few days he's still hardly eaten anything despite my best efforts.  I just want to be sure that I'm doing everything I possibly can.  If he still chooses not to eat even when I offer plenty of tasty nutritious options well then fine. But at least I'll know I did everything I could and then I'll be happy to accept that he's just going to be in the lower percentiles.

[creations]

Another thing to take into account.  In the UK it's advised LOs this age aren't weighed more frequently than every 6 months (unless there is a valid medical reason).  I think it may be because through teething they tend not to eat and through growth spurts they eat SO much, that there can be fluctuation which can worry parents unnecessarily.  I would say if your LO has energy and LOOKS in proportion then all is likely fine.  See my boy is very small but he looks in proportion.  When I occasionally lift another child the same age to help out the mum I am utterly shocked at how heavy and solid they are in comparison to my small, agile boy but all of them are healthy.

With regards sharing food etc.  It can help a great deal if dishes are put out on the table as communal food and every one serves up at the table.  I do this as much as I can, although usually still have DS's on a separate serving dish because i remove his earlier to cool down and try to keep the adult food warm.  It does still help though.  Also there are some great toddler cutlery which looks just like adult cutlery, totally stainless steal and fully functioning but smaller (and the knife is not so sharp), we have this for DS so that everything looks as much like the adult meal as possible.  When I first gave him a spoon it was plastic (my mum had given me some which I hadn't chosen) and he went crazy mad with me and didn't recognize this object as a spoon. As soon as I gave him an adult teaspoon he was happy and ate.  The cutlery sets I have for him include a spoon too.  Not sure where you are but they range in price in the UK form stupidly expensive to stupidly cheap - for the same thing.  So shop around if you decide to get some.  Or an adult cake fork could be a good solution because they are also shorter.  The 'real' cutlery is also much easier for LO to learn to stab food with the fork, some toddler cutlery is as good as useless as a tool because they are so rounded for safety, just leading to frustration rather than skill development.  Obviously use whatever you are comfortable with for your own LOs developmental stage.
I don't think there's any harm in having food from your plate for a short time, and no harm in gently pointing out that his food is the same too.

He shouldn't really be hungry/thirsty in the night unless he's been ill or is coming down with a cold.  I offer DS a small supper before his bath and bed time routine, just something like a piece of toast or a small pancake, and a sippy of milk to make sure he's had a chance to eat if he missed out at dinner time.

[delancepants]

That's interesting re weighing the babies...  I was in ireland when DS 1 was small and i was able to get him weighed any time i wanted at the local health visitor's clinic.  Now we're in India and they weigh DS2 every time I go to the doctor, so every few weeks.

He is in proportion, he just looks like a 9 month old rather than a 1yr old.  I suppose it's not his actual weight that bothers me, just the thought that I might be doing something wrong.  If I can do everything reasonable to encourage him to eat and he still chooses not to, well then fine, as long as he's healthy (which he is) I can accept that. 

Yeah last night was weird, as we'd worked so hard during the day to encourage him to eat but he refused to eat more than a few bites of anything.  I tried the bedtime snack too (which I think is a great idea and seems to have helped on some evenings) but still he was so hungry in the night.  I have just switched him to one nap (trying it out to see how it goes) so he is a bit overtired, and I did wonder if the teething is finally kicking in, but there are no other signs, so I guess we'll see how tonight goes.

[~inbalance~]

Hugs Fwiw I don't think you are doing anything wrong.

[delancepants]

Aw thanks. I guess I may be being hyper vigilant because i'd prefer to keep his diet near vegan for a while.  I've heard of kids getting into trouble with poorly planned vegan diets and whilst it was fairly easy with DS1 in Ireland with so much variety in food available, here the options are more limited.  Plus now I'm a lot more sleep deprived, sometimes I wonder if there are any brain cells left, ha ha?

[creations]

In the UK it's advised LOs this age aren't weighed more frequently than every 6 months

OK, I just checked my book again and I was a little out on my ages.
At 6-12 months age it is recommended to weigh at 2 month intervals.
At 1 year it's recommended they are not weighed more than once every 3 months and not less than once every 6 months.
At 2 years it is not more than once every 6 months then at 2.5 years and then at school entry.

The clinics in the UK are freely available so it is not uncommon for mums to take their LOs for weighing more frequently sometimes even every week, I know the clinics I attended they would never tell you if you went too often, they just do the weighing and mark the chart without questioning how often you go.
My LO has gone to hospital a few times and they always weight them there regardless of when the last time of weighing was, it's so they can be accurate with medication doses and monitoring of weight gain/loss if LO becomes very poorly.  These are like extra weigh ins rather than regular ones.

I don't think you are doing anything wrong, and I doubt your Lo is underweight or that there is a problem.  it's totally natural to worry though.
FWIW my boy still wear 9-12 month tops and 12-18 month trousers (in leg length) even though he has turned 2 years old!  His waist is the size of a new born, he fits 0-3 month baby trousers for his waist size but the length stops at his knees like shorts.  I've had all his 12-18 month trousers altered at the waist to account for his small build.

Are you sure he's hungry in the night?  Do you give water in the day and before sleep?
I had a short spell of DS asking for food just before BT (that is after having had dinner to his fill then supper to his fill) and was advised by BWers to increase his protein intake.  He didn't take much protein at that time, so I changed up his meals and made breakfast a protein meal because he is so hungry at breakfast that he is likely to take a good portion of protein then.  Because he had that, he was no longer asking for food before bed.  Breakfast seems a long way from BT but the calorie intake across the day is what counts for a 1year old rather than what they eat right before BT (like a new born).  overall his diet improved too because I couldn't rely on him always having protein at other times of the day, he would often choose veg or carbs from his plate instead.

[delancepants]

Well that night time hunger was just a one off I think, not sure what caused it, had a vaccine recently, maybe something to do with that.

Yeah my four year old is a little small, my husband often puts him in the baby's 12-18 month clothes by mistake!  It makes me laugh because I cant imagine how he doesn't remember DS1 wearing those clothes as a toddler!  DS1 got pretty skinny a couple of times, when we first came to India around the age of two, due to diarrhea and sickness.  That really freaked me out.  Took me months to build him back up again.  I don't know how he compared on percentiles though as id stopped weighing him so much at that stage.

[~inbalance~]

If it makes you feel better my 4yo wears 3T clothes, and my almost 3 yo wears anything from 3T down to 12 mo stuff! In fact the other day he wore a 6-12mos swim suit! Lol Most of my ds2's pants are 18-24 mo.

[MasynSpencerElliotte]

In fact the other day he wore a 6-12mos swim suit!

lol, last year I bought Spencer (4) a new suit from Old Navy (size 3T) and ended up giving it to Masyn (who is 6). Spencer wears Masyn's 4T suit.