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.

One of my DC was way under the first centile for a long time, then crept up gradually to about the 2nd. And then the 9th. Is now an adult and completely healthy and in proportion.

I wonder if your perception is a little off too. You describe him as "an eating machine," yet he isnt eating a great deal and is one of the thinnest the paediatrictian has seen.

@chesirecat99

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.

Good point about childhood photos of you and dad. I used to worry about one of mine till I got out his dad’s childhood pics - they were identical!

The letter from the paediatrician states 2nd centile so that is what I am going on. The paediatrician did not say to put him on more calories but I am doing so of my own accord. I do have photos of both my DH & myself at similar ages- both very skinny but I have filled out since having children.

Very well done for getting seen and taking it seriously though. It can be really hard challenging what we see as "normal" just because we live with it everyday. I have certainly had some revelations with my kids!

My son was very skinny. Despite eating a lot. He was also quite reactive emotionally.

It turned out he had coeliac disease.

One glass I think blood tests will include coeliac.

We didn’t have any family history of coeliac but blood tests confirmed by endoscopy confirmed it.

I wish I had had him tested when he was little rather than him having to wait until he was 18.

I have a teeny 12 year old who is still in 8-9 year old clothes. But his dad is also 6 ft and 11 stone and naturally thin. I alas am not thin.

I bulk up his diet with chocolate milkshakes with fortified powders in them. So I know the nutrient and calorie bases are covered. Plus I keep a food diary because it makes me paranoid when HCPs point out how tiny he is. Ds also has a paediatrician and I keep him informed of my efforts to get weight on.

very best of luck.

First up, school have asked you to give him a smaller lunch and then also told you they’re concerned he is u see weight. Obviously those 2 pieces of advice don’t work well together.

If he would eat more lunch given time then they need to let him finish eating in his own time, in class if necessary.

@confusedofengland

The letter from the paediatrician states 2nd centile so that is what I am going on. The paediatrician did not say to put him on more calories but I am doing so of my own accord. I do have photos of both my DH & myself at similar ages- both very skinny but I have filled out since having children.

!I hope you get answers soon.

My ds has always been skinny, I don’t think he’s even in the 2% range. We rejected the yr 6 weigh in for him, as it wouldn’t have helped one bit tbh. Luckily, the school was sensible enough to look at me (6ft, size 10-12) and see where he was heading. I think you’re doing really well with the food plan.

@confusedofengland - you've done the right thing, you've got the help you both need and you're working on it.

My DS weighed 29kg and was 145cms tall at 10 years old. Which, according to BMI, is underweight at 13.8 (your DS's measurements make his BMI 12.2). He didn't need a feeding tube, just feeding up with extra calories which is what you're doing.

Buy some scales and make sure the weight is going up step by step. Just increase the calories as you've been told to do and add more where you can (full cream milk, milkshakes, ice cream, custards, butter or cheese on veg or baked beans).

As a few people have said fruit is good for kids but he needs a bit more calorie wise so encourage fruit with a pot of yoghurt or a bit of ice cream/cream on it or with it. Or have it on porridge/cereal or as a 'side dish' with breakfast.

And if you're giving him a small sausage roll, like you mentioned, as a snack ask if he'd like another one or just pop another one on his plate if you don't mind it wasted or add a few carrot sticks and a dip like cheese spread to the plate. Don't assume he doesn't want more. That way you can start to gauge how much he actually really needs.

DS is very good at self regulating, like your DS, but at 14 years old this is his average day...

Breakfast - bowl of cereal, fruit and a yoghurt

Cooked lunch at school (usually he'll choose pasta, fills up a soup bowl type paper bowl)

He takes a nature bar type cereal bar to school as fruit or yoghurts just gets squished with computer, books, folders etc.,

He'll have a sandwich when he gets home or some cheese and crackers or toast.

Dinner is a full plate the same size as DH now eats. Then a couple of petit filous (he doesn't like yoghurt - too runny or ice cream).

Between dinner and bed he'll usually have (I kid you not) 2 slices of toast or toasted brioche (if I've made french toast during the week) or a piece of cake then some fruit or a bowl of cereal or porridge.

At his last weigh in (in January) he was 49.3kg and 170.6cm. Which means he's now in the healthy range at 16 on the BMI.

It will go up, just keep going little and often.

If you buy some scales, check his weight and height with BMI calculator. At 10 years old, 140cms he should be 28kg to sneak into the healthy range. That gives you something to aim for but don't stuff him with food - his body needs to adjust - so little and often and added 'hidden' calories at every meal (jam on toast or in porridge instead of just toast or porridge for example).

OP, my DS2 with ASD was also very skinny at 10 to 13. I used to give him Complan milkshakes after tea as a calorie boost. He was just very active, not sporty but lots of jumping, pacing and flapping. He reached puberty quite late and is actually a bit overweight as a young man. There wasn’t any medical reason, he ate well but just used to burn it all up. I hope your DS fills out a bit.

My mother took me and my sister to the doctor when we were children because she thought we were too skinny. She did not take our siblings. Doctor told her not to worry, we were eating well and he said we were fine. About 50 years later my sister was diagnosed with Coeliac disease and a few years .afterwards I was. Siblings were tested and they haven't got it. The doctor probably hadn't heard of it in those days. But more recently, my adult child asked to be tested , the GP was reluctant as he didn't seem to think it necessary. Test was positive. It is worth making sure your son is tested to rule it out

I am just home & rereading the paediatrician letter. It actually states 24.6kg weight. Also no mention of weight being a concern, although paediatrician did tell me verbally that this is what blood tests are for - letter states for developmental delays, ongoing motor coordination difficulties & processing difficulties.

Someone asked which medication he is going onto - it will be prolonged-release methylphenidate as Xaggitin XL 18mg, once daily in the morning. Means nothing to me but might do to somebody!

Also - I have noticed that DS is starting puberty - tiny light hairs appearing on his scrotum (sorry if TMI)

@Minezatea

You need to weigh him op, if you need to pull the wait in on his clothes then they are far too big for him on the waist.

I don't agree with this. My child was bang on average on the weight charts when they measured them at school but the waists are enormous on most children's clothes and that's why they have the pull in elastic things - they are catering for the more than averagely large child as the slimmer ones can adjust them down. This by itself is no cause for worry.

I don't agree either. My children and grandchildren have always had waists on clothes be too big for them. Admittedly they have all been on the slim side, but children's clothes do come up quite big, or so I've found.

It's sometimes surprising how much some children can eat and still be very slim. Both of my daughter's were on the skinny side as they grew up and one in particular could eat us out of house and home. She needed the extra calories and if she missed a regular meal or two in her teens it was obvious and she bacame too thin. She still has a big appetite now and is a size 6/8 adult.

One of our grandsons is 7 and never seems to stop eating and he is very slim too.

My son was on the 2nd percentile at that age. Skinny yes, gaunt no. Very skinny legs with sticky out knees. Though you could see his ribs and he once bruised his back due to a fall all along the vertebrae.

Also had school involvement as so thin, similar to you, which is good they are looking out for their students.

He also has ADHD, but combined type, and started on the same medication as you. He is now on atomoxitine for lots of reasons - loss of appetite was one of them.

Anyway he is 15 now, shot up recently to 170 cm and I think on the 25th percentile, so still slim but no longer hovering around under-weight.

VorpalSword your DS sounds identical to mine! Knobbly knees & ADHD.

I also think that your perception of “not that skinny” and “eats loads” is skewed. I also don’t think his ability to “self regulate” and slow eating (so a small lunch instead) are doing him any favours.

I’m surprised you haven’t been referred to a dietician seeing as your ds is BELOW the 1st centile for his height and age (according to the NHS calculator). Being underweight at this age (approaching puberty) causes short and long term damage.

@confusedofengland I’m familiar with that medication, I was on it 18mg didn’t help my symptoms, nor did the max dose and it was wearing off much faster than the usual 8 hours. So I take 20mg of the Instant Release 3x a day now.

From 36mg upwards it did affect my appetite, I wasn’t hungry and I didn’t want to eat either, and as I’m only 7st anyway, once I’d titrated to the max dose with not much improvement, I was swapped to the IR, which allows me to eat between doses.

With your sons size, 18mg may affect his appetite, it may not. The good news is that it’s not something that has to be weaned off and it can be changed to something else very easily.

The medication will curb his appetite well it does my my dd. She's exactly like your boy. On the 1st centile for weight and the 2nd for height. She's getting more tests done. Looking at her growth plates and genetic testing just to check everything is as it should be.

Without his knowledge, try noting down his calorie intake for a week. If he’s eating loads and not gaining then he may have a medical condition, especially as no one has raised concerns about his brothers. This article states an active boy between 9-13 should eat 2000-2600 calories a day.

www.webmd.com/diet/features/estimated-calorie-requirement

@CutePanda the NHS chart said below 1st for me when I put it in too ( I checked DDs at the same time as it’s never been done and I was curious!)