Underweight 12 year old

[Rainingdogsandcats]

DD is 12, she'll be 13 at the beginning of May. She has Asperger's.

She weighs 5 and a bit stone, she's around 153cms. That makes her over a stone underweight. Less than the 1st centile.

She has a limited diet of salad, chicken, Nuggets, pasta, fruit, veg, baked goods such as tea cakes, croissant for breakfast.

She doesn't like to eat sugary foods.

She doesn't like any type of potato or rice but will eat plain pasta with cheese. Shell eat a roast without the potatoes.

Doesn't eat foods like lasagne, etc but will eat spag bol. Doesn't really eat bread but will eat wraps, bagels.

She's in age 11-12 clothes but you can see her bones when she's undressed or in thin clothing.

On the NHS website it suggests doctors but I don't want to give her something else to obsess about. She's lively, acts, dances, sleeps ok.

Would you be concerned?

I would be. Girls with ASD are more prone to anorexia. It's one of my biggest fears for my girl. I am so super careful to never mention weight with her.

I would speak to an anorexia specialist to get advice. Not saying she's anorexic but forewarned is forearmed.

56marshmallow it's the first thing that comes up on the NHS website. Do you think I could seek advice without her to start with?

I think we have the same DD.

I am not overly concerned about her weight, or her limited diet, but I am aware she restrict her eating and drinking when anxious and stressed (she says it's because she feels sick and then can't eat) so I keep an eye on her mental health and take swift action if I see it deteriorate.

My DD had similar stats at the same age. She is also ASD with a limited diet.
My GP told me to just feed her what she ate from her restricted list and add in extra milk to drink and vitamin tablets.
This didn't help with putting on weight, but it kept her healthy.
However, we found that her anxiety levels from the ASD made her appetite virtually zero. It was only once the anxiety levels were sorted that she discovered that feeling of hunger and began to eat...her stomach was no longer in knots.

Oh and DD drank a lot of Slimfast type drinks...lots of nutrients, decent calories and something she enjoyed the taste of. It added a few extra calories to the day.

What sort of build are the rest of the family?

She doesn't drink milk and doesn't really like cheese or much dairy. She likes mozzarella pearls with baby tomatoes and pesto.

The rest of the family are pretty average, myself and DH carrying few extra lbs but nothing much, average sz 14. DH is 6ft 3, I'm 5ft 5. Other DC pretty average, both older dd's sz 10/12 ( 14 year old) eldest is Pg at the moment but normally around a 12/14 at 5ft 5.

She's only just grown a little, she can still wear 10-11 jeans for the fit although now they'd start to be a little short.

She's enjoying school but has been having episodes of zoning out that were waiting for a gp appointment for.
She

My 11yo Asd DD is similarly small, and always has been. Has your dd always been small, rather than a recent weight loss? That seems like it would be less concerning.
With mine, it's more a case of making sure she gets the calories in, even when she's stressed. We've found that in those times, it's better to take away any 'demand', like giving a choice, or an expectation of eating a certain amount, but making it easy for her to eat, so 'safe' foods, maybe away from the dinner table?
When she feels better, she eats better, so we focus on feelings over food.

Has she started puberty yet?

Can you build in more good fats to her current foods. Things like olive oil and avacado on the salad. Just to try to bulk up her calories a bit?

Yes, I would seek advice without her in the first instance.

Also what others have suggested, give calorie rich foods that she feels happy to eat. No stress, no pressure.

I never pressure her to eat. There's always food in the fridge, fruit bowl is always full. She doesn't eat junk food beyond chicken nuggets, her salad consists of cherry tomatoes, cucumber, rocket, pepper and some roast chicken.

Kids are allowed to graze healthily if they're hungry between meals, I make her breakfast smoothies and throw in a few oats but I make with juice as she doesn't drink milk.

She has breast Budd but no periods as yet.

She's always been slight yes so as pp says perhaps less concerning.

I'd be extremely concerned in your shoes. My d is recovering well from an ED and your story is familiar with a lot I see in various support forums.

All people have a daily calorie requirement to be able to live a regular life and malnutrition can occur at any weight too.

There are some great ARFID groups on Facebook where you are on there where you can seek some advice

She sounds like my son. It's not an ED, he's not controlling his intake in any way, he just doesn't like most foods. (Eats only wholemeal bread, no cereal, spag vol but never lasagne, drinks only water or milk, eats croissants, salami, apples, yoghurt, no other fruits, no veg other than peas that are still frozen).
He is very thin- born on 50th %ile for height and weight, and has dropped and dropped over his life.
Some children with ASD just cannot eat because of taste, texture etc.

It probably is time to see a gp if she's dropped to 1st %ile. DS is 10, and on 4th for weight.
The periods thing though, isn't abnormal not to have started yet at her age, but menarche is linked to weight, so there will likely be a further delay.

She was 9lb 5 at birth. Born at 36+6

Yeah I was pretty average, just 14 with my periods as I recall, her older sister started at 14, she's a very average weight although my eldest dd started at 9!

For Christmas lunch today she had peas, about a tablespoon of stuffing, a few carrots, 2 slices of turkey and a small Yorkshire pudding. She left some of it.

Does she not like milk? You could try complan, plenty of vitamins and calories

Ds is 15 and just been diagnosed with autism. He is on the cusp of being clinically underweight.

He saw a community dietician a few weeks ago. Dh went to the appointment with Ds and she seemed to suggest that he should eat as much sugar as possible. Ds does not eat sweets or hardly any chocolate. She suggested he put extra sugar on his cereal and drank full sugar coke.

Ds has mental health difficulties and on weeks that he is very low he doesn't really eat at all. She said we could put milk powder into whole milk to add calories when his food intake is low.

He doesn't get a follow up appointment though. That was it, a one off appointment for advice. She did apologise and say she wished she could give Ds a longer appointment and more time.

More sugar? Crikey, his poor teeth.

DD doesn't like milk, and eats very little high fat/sugary foods. She will eat dry cereal sometimes. She just never appears hungry, never says she's hungry.

My DS1 and DS2 both have had issues with their weight. With DS1 we were advised to add a bedtime snack to get some extra calories into him. Along with higher fat foods, adding butter to vegetables, etc. DS2 was prescribed PaediaSure shakes to increase weight gain. Both are still slim but back in to the percentiles on the weight chart.

My DS has very high pain threshold (feels virtually no pain) thus I think he doesn't ever feel hunger pangs.
Would she eat peanut/nut butters? Avocados are calorific too. Perhaps guacamole would be palatable as it's blended?

Mine has finally acquiesced to eating a multivitamin, which I am so thankful for. He had sores around his mouth, but they are beginning to clear up.

He had a toblerone in his stocking yesterday, ate one piece and couldn't eat another- I think those that are hypersensitive to taste just can't handle the sugariness of many foods. He had jelly beans too, but only managed a couple.
At least he ate meat/roast potatoes/gravy for lunch!

Rain I thought the same thing about the teeth. The only other advice she gave was if he was eating something different to us (which he always does!) was to put a small amount of what we were eating on a plate next to him. A bit like you would with a younger child. She said he may eventually agree to try something different.

Ds's eating difficulties seem to be a mixture of selective rigid/sensory eating and not eating when he has very low mood.

If I were you I would keep a close eye on her eating (but try not to worry her) and seek advice from the gp if you feel that some intervention may be needed. Ds's dietician referral came about as he was seeing a physio and she was very concerned about his food intake so contacted our gp. Unfortunately one dietician appointment is not really going to change a huge amount when the eating issues are long term. Ds also has a camhs referral but I'm not sure if that will help.

Will she eat ice cream? You can get some that really pack a punch!
How about nuts/nut butters?