To not see why the paediatrician is concerned?

I don't understand some posters here. The OP's child is overweight. The advice is to maintain weight while they grow taller and that seems to be exactly what is happening here. There are obvious weight issues in his birth family and I don't think the OP needs to encourage him to eat breakfast if he doesn't want it.

One of my children was underweight on ADHD medication. We did give him a 3 course breakfast before his tablet because we were making an effort to get his weight up. That's not the OP's concern. His is still really skinny though but that's the default in my family.

You sound like a great mum who has perspective on adhd meds. It's a journey. You will adapt as he needs change. At the moment it's a plus that he is maintaining his weight if he is on the heavier side currently as he will become more healthy

And op things will change as he gets older so you adjust your patterns with meds. Mine lost weight but became incredibly active as preteens so we made sure they ate in the morning then took their meds which also gave the benefit of lasting longer through the day to get homework done.
I found ensure or fortesip were good as they come in millions different flavours and consistency such a juice or milkshake etc but you are at this point in adhd med journey.

It is important drink during the days as meds won't work properly otherwise

My son takes the meds. We try to make sure he eats in the morning. He was skinny to begin with, and he’s also a teenager. Making sure he eats breakfast means he eats breakfast and dinner but not (really) lunch. That way he’s eating two decent meals a day.

I guess if it becomes more of a concern a banana smoothie or similar is a quick breakfast.

What about one of those little probiotic yoghurt type bottles if a protein shake doesn’t work. There are very few calories but at least he won’t be running on empty and they can help gut health too.

You'd think that but my ds was born 99.8 centile and if you track that, it that is overweight by the time you get weighed at school in reception.

Op, it sounds like your ds is thriving and I'm sure it will be something you monitor as time goes by.

But he has a really good morning routine and he would struggle with this, having not eaten breakfast for over a year. School always offer him a fruit snack or toast when he gets in too and he sometimes has some. He already leaves for school at 7.15am so I don’t want to wake him even earlier to force breakfast down him when there are no downsides to him not having any!

If school provides food when he arrives, isn’t that some sort of breakfast club. He has an extremely early start for a 7 year old so it’s not surprising he doesn’t want breakfast. Was the paediatrician aware of that? If the medication doesn’t have to be taken with food, I can’t see the problem.

It sounds like you have a lot going on here OP. What I would say is that one of the benefits of protein at breakfast is that it can increase the time ADHD meds are active, so is worth doing. I would suggest protein from real food sources rather than shakes if you can as the other ingredients may be undermining your positive efforts.

@Purplevioletsherbert this is a tricky one as your going to get lots of replies that have no clue about ADHD medication or ASD children.

My DS was 14 when he started on the medication and by 16 had grown a lot taller but lost weight. It was a concern for us as he got very skinny. He wouldn’t eat breakfast, barely touched lunch and then finally ate a good meal for dinner but it wasn’t enough for him. We gave him protein shakes for breakfast and lunch and added supper (medication had worn off by then so would eat) which at least helped him at least maintain his weight.

I think your issue will be if your DS continues to grow taller but still isn’t gaining any weight eventually it’s going to become an issue and he’s probably not getting enough calories longer term. Is it the medication team that are questioning it or another consultant?

Mine - coincidentally also adopted - has never fancied breakfast. Just the least morning person you could ever imagine and I don’t think their appetite gets going before about noon. They are petite but a healthy weight and always have been.

It feels weird but it works for them.

Surely this is nonsense. It would mean that a very overweight child could never be a healthy weight!

Children should not be dropping percentiles. They should track roughly around the same percentiles throughout their childhood.

Surely that depends though, my DD is also adopted age was 3rd centile for height and weight, aged 6 she wore age 3 clothes, because she was malnourished. She’s now around 50th centile for both and is much healthier.

The OPs child is adopted with health issues in his birth family related to weight. Advice is for children to grow into their weight, meaning their centile will drop but her son will be healthier age 12 at 40kg than he is aged 7 at the same weight.

Adhd doctors don't usually want to see any weight loss when taking adhd medication - usually adhd kids are on the thinner side.
We struggle massively getting our dc to maintain weight on medication.
I'd ask for a phone conversation with the pead privately without dc; so you can have a frank conversation about weight and your concern about dc being overweight.

Children should not be dropping percentiles. They should track roughly around the same percentiles throughout their childhood.

OP this is hard. I can see what you mean.

A bit different, but my DS7 has a genetic condition that causes accelerated growth, plus behavioural/learning/low IQ problems. And Oppositional Defiance Disorder.

His diet is crap despite all effort. His is carb-heavy, vegetables & decent protein be dammed etc. Won't touch the food his family eat. I swear, the International Symbol of ND Kids should be a fucking chicken nugget.

No real advice I'm afraid, just solidarity. We're having our biannual Paed visit next week- last check he'd shot from 78th to 94th percentile for weight, similar for height. Am dreading it but hoping for some advice amongst the rest of his medical stuff.

Hang in there X

Going to post this despite no expertise as there is clearly some confusion in what the statistics around children's weight charts mean, and it may allay anxiety.

It has very little to do with BMI or healthy weight.

Simply, being 98th percentile is that 98 out of 100 children of that age will typically be that height or weight or less. 2 percent of children that age will be taller or heavier. It just shows you how your child compares to the range of different weights and heights other children of the same age are. He's bigger than many children of the same age, but that doesn't mean he is unhealthy. And he is smaller than 2 out of 100 of them.

So that is why the same height and weight is a different percentile for a different age: at the older age 88 percent (88 from 100) children will be his size or less.

You doctor will be concerned because it is normal for children to roughly track their percentile as they age - but some do drift up and down. If he was 90th percentile at birth, and has largely stayed there, then he is roughly the size you'd expect him to be now.

I thought the smoothy idea to take the medicine was a good one. If you make it yourself, you can control the sugar. Giving it with milk might also be a good start to introduce some morning calories.

It sounds like you may need to push for a dietican referral to try to help get the right balance for him with his set of needs.

if the peadiatrican remains concerned about the lack of weight gain then they may look at stopping or changing the medication which you don’t want!