Teacher concerned DS is too skinny

[confusedofengland]

Today after school, the Senco/deputy head, who works closely with my SEN DS, came up to me & said she & class TA thought DS2 had lost weight.

He is & looks very skinny & always has been. Even when he had toddler chub he looked like an average-sized child & not chubby iyswim. He is 10 & 2 months. Is 140cm (measured him last week). I have just put away 8-9 tshirts as they were getting too short. Shorts he is in 8-9/9-10, trousers 9-10. We have to pull the waist right in on most things. Haven't weighed him in ages. I'm pretty sure he grew 5cm in the last couple of weeks as he was shorter than friend's daughter but now bit taller. Even his feet are small & skinny, he has just gone into size 2 & is a D/E width.

He did have one day in the week before half term where he was sent home from school because he was so tired he kept bursting into tears. This was following a long bike ride & later than usual bedtime with Cubs & also everybody was tired as end of half term. Also it takes him a lot of effort to settle into things as he has autism. Since then he has been fine & teacher said he has been full of beans since going back.

His diet is very good. He eats absolutely everything except about 5 things (lettuce, gherkins, olives, raw carrots & brussel sprouts) & always has. He has what I consider to be decent portions. For school lunch I give him slightly less at the teacher's request because he takes a long time to eat it. But he eats plenty at home. He will often choose fruit as a treat rather than cake/biscuit/sweets etc.

I have also noticed that he has started to grow a few hairs in the pubic region, so don't know if this is the start of puberty & if so would that have an effect? Ds1 was a bit later, about 11 for the same thing.

DH (his dad) is also on the skinny side & always has been. He is 6'2 & about 11.5 stone, just gone into 32" waist trousers (at age 44) as his 30" are too tight to sit down comfortably in (he has noticeably developed a little paunch, he is studying FT & not moving about much).

So, bearing all that in mind, which is a lot, I know, what should I do? Should I start giving him more food in his lunchbox? Offer extra snacks or more fattening snacks? Something else? He has a multivitamin with Omega 3 daily. I'm wary of feeding too many unhealthy (especially processed) foods unnecessarily because I believe that they are not good for you & weight isn't the only indicator of health. But maybe I'm mistaken.

Sorry for rambling on but it has been an emotional day & this has really worried me.

OP what medication has he been given? The Paed is a fool if they’ve given him the ones that are extremely well known for suppressing appetite!

Re his ASD - my DD can’t tell when she’s hungry, or ignores it because she’s too engrossed in what she’s doing. She’s also the same with needing a wee. It’s very common.

General advice - up the fat content in anyway you can, offer him snacks.

@confusedofengland - if it's any help we have to add calories for DS. He was born with congenital heart disease. Because his heart uses more calories pumping the blood round the body than 'normal' hearts do, even when he's asleep, we've had to add a few calories here and there.

His heart consultant and a dietician said adding a little knob of butter on top of veg (even into baked beans - just a small teaspoon), full fat milk, cheese on top of baked beans or bolognese/chilli,, full fat yoghurts, a snack at school plus one when he comes home (like half a sandwich). Cereal (usually porridge, sometimes two bowls!) or a slice (or two) of toast at bed time (just packing in another lot of calories each day!) Milkshakes where possible. Doesn't help that DS doesn't like ice cream or cream (thanks for that son!)

He's still on the skinny side but now has a flat tummy (aged 14) rather than the concave one he used to have as a toddler.

I used to work with a disabled woman who was advised to gain weight, but who couldn't eat larger portions. The dietician recommended adding cheese butter and cream to mashed potato. To give milk puddings and custard made with full cream milk and to add cream to those.

I can't remember what it's called as the letter is at home & I'm at work. It's to help him concentrate more at school as he doesn't have any hyperactive tendencies.

He is very good at self-regulating, better than DS1 & DS3. He always knows & voices when he's hungry & will ask/search for food wherever he is - which can be a bit . He also knows when he is full & will not clear a plate for the sake of it, as the others (& I!) do, similarly with going to bed, he will just head up when he's tired & not desperately try to stay awake. He will ask for seconds/more food if he's hungry. Again, DH is the same, but I feel compelled to empty my plate regardless

What matters is his health and energy. If he's having a growth spurt and is already very thin, I'd consider adding a couple of high calorie snacks to his diet. DS1 was like this - naturally skeletal. I started giving him a home made banana and peanut butter milkshake every morning - just a small glass - half a banana 150ml milk and a very heaped teaspoonful of peanut butter with a dash of vanilla essence and honey or maple syrup. Adds about 200-250 cals to breakfast.

A healthy high calorie snack after school helps too - oatcakes with cheese or home made cheese and seed muffins etc. Leave cold saugages and roast chicken in the fridge to snack on. Buy full fat milk for a while and encourage him to drink a glass a day.

I think you're doing all the right things - my DS was referred to a paediatrician age about 8 because he was underweight despite eating plenty. The doctor didn't seem too concerned as he had plenty of energy but they did bloods anyway, nothing showed up.

He stayed the same all through puberty despite eating me out of house and home, and only really gained weight when he started going to the gym and was deliberately eating to gain (he would eat thousands of calories a day including protein shakes made with peanut butter with added ice cream!) I noticed the other day he'd got little love handles (I think this is from beer) which made me chuckle as he's always been so skinny.

@confusedofengland

Just adding an update. We went to see the paediatrician yesterday - mainly for ASD/ADHD assessment & DS also got measured while we were there. He is currently 140cm tall & weighs 24.5kg. This puts him on the 2nd centile, according to their calculations. This is in line with what I thought really.

The paediatrician said she has never seen a skinnier child & that because of his weight & his delayed development, she wants to run some blood tests. I still believe it is just a case of DS taking after his father, but I am happy to have any tests done. She has also put him on medication for inattentive ADHD, which will increase his concentration. We are to start this as he goes back to school. The trouble is that it can suppress the appetite, so I'm hoping that won't happen with DS.

For now, we have switched to whole milk & I am making sure to give him extra & larger portions. I am also trying to introduce extra calories where I can, so thinking of trying peanut butter or honey in milkshakes, cream in sauces etc. Plus I am keeping a careful eye on what he eats. Today has been:

B - 2 crumpets with butter & marmite. Bowlful (approx 2 serving spoons) raspberries, blueberries & strawberries. Banana milkshake ( 1/2 banana & small cup whole milk)

S - milk. Small hm sausage roll.

L- 2 slices tiger baguette with Clover, 1/4 yellow pepper, 4 small slices cheese, 1 large slice ham, 2 slices courgette (DH thought it was cucumber 🤣), bag Wotsits. Squash to drink.

I'm at work now so not sure what snack DH will give this afternoon

D - will be hm battered haddock & hm wedges. 1/4 tin rice pudding with teaspoon hm raspberry jam.

Milk for bedtime.

So hoping we're doing ok but still feeling nervous about it all!

I am glad you finally had him weighed and realised that he’s incredibly underweight. The latest meal plan sounds good. Just make sure he eats it all and doesn’t move food around his plate to pretend he’s eaten more than he has. Maybe you could add Pediasure drinks in between meals as snacks. Berries are really low cal so maybe you could give him Greek yoghurt with a few berries? Or a banana smoothie with lots of whole milk (more than a small cup which you mentioned).

He definitely doesn't pretend to eat, the boy is an eating machine & always has been Same build as he's always been too!

I came on to ask about medication, we have a child at school who is currently having their medication adjusted, combining that with a growth spurt has led to quite an alarming change in appearance - very angular and gaunt looking. Everyone in school/home/gp/camhs is keeping an eye on it and shakes were prescribed while the meds settle.

I had this on different occasions when mine were at school. We are a tall and slim family.

My reply was to explain that as long as they are eating well, have plenty of energy then there is no problem.

You would never have had this during the 60s/70s as almost all children were slender.

He is currently on no medication & will not start until September. We do give him Equazen Omega 3 capsules, which the paediatrician approved of.

DS doesn't look gaunt, I wouldn't say. Very skinny but not gaunt. His arms & legs are like little sticks, but you can't see his ribs unless he breathes in deeply, let alone count them like some DC I have heard of.

I’m struggling to imagine how he doesn’t look skinny when he’s only 3.5 stone and is 10 years old

And 4ft 7-ish?

He looks skinny but I don't think he looks gaunt.

My 5YO is 3ft 8inches (to my 5”2, so bloody giant to my eyes!) and weighs 3 stone, is skinny to the point I have to buy her leggings and shorts custom made because she has no bum and no thighs.

Your DS is a foot taller and twice her age.

I guess they look different to each other then. I'm aware DS is skinny & technically underweight & am acting accordingly. I am also saying he has always been like this, as has his father & I don't think he looks gaunt.

DS doesn't look gaunt, I wouldn't say. Very skinny but not gaunt.

I think your perception may be of, especially since you said you thought he had put on weight. The school have expressed concerns about weight loss, and the paediatrician said she had never seen a skinnier child.

I feel your perception is massively off.

DDs Dad is 6ft 4inch, and weighed 10st after an illness (was 12st before) and looked very gaunt.

If the figures you have said for weight and height are accurate then he must be very underweight.

Ds was the same weight but 5cm shorter when he was fitted with a feeding tube because he was so underweight.

I am acting on all the medical advice I have been given & also working on his diet. Nothing has been mentioned about any kind of intervention including feeding tubes. It could be that my perception is skewed, but there you go.

I always had to pull the waist in on my DC’s clothes. Children’s clothes sizes are way out of kilter - they’ve lost sight on what should be a normal waist/weight for children. That in itself is not a good indicator if your child is underweight.

@daisypond

I always had to pull the waist in on my DC’s clothes. Children’s clothes sizes are way out of kilter - they’ve lost sight on what should be a normal waist/weight for children. That in itself is not a good indicator if your child is underweight.

OPs DC is 10, 4ft 7inch and 3.5 stone.

That puts him under the 1st centile.

If the paediatrician is recommending more calories, the meal replacement shakes like paedisure made with a scoop of ice cream are good.

Do you have photos of you and your DH at the same age? Genetics plays a part too and needs to be taken into account.

@confusedofengland

He is currently on no medication & will not start until September. We do give him Equazen Omega 3 capsules, which the paediatrician approved of.

DS doesn't look gaunt, I wouldn't say. Very skinny but not gaunt. His arms & legs are like little sticks, but you can't see his ribs unless he breathes in deeply, let alone count them like some DC I have heard of.

Sorry, I misread. I thought you said he was on medication.

One of my dd’s is 136cm and 3stone 10z . She saw a consultant for a non weight related issue and he commented on how in proportion she was. We have lost sight of what healthy and slim looks like. She has stayed in the same centile since birth.