for thinking my dd isn't eating enough?

[helenc70]

sorry i'm posting here for traffic. she has never eaten much since she was a child and always very skinny. she's been taken to the doctors many times but they've always said there's nothing they can do. her hair is quite thin but other than this and being very skinny, there's no other health issues. when i say skinny, i mean there is literally nothing to her. i do think she's underweight but i don't want to weigh her as she's a teenager so i couldn't force her and i don't want to make her insecure or anything. she's quite short too, 5'2ish. she usually eats one chocolate brioche and a small glass of milk in the morning. usually a sandwich (no crusts), a packet of crisps, chocolate biscuit and a babybel/cheese string for lunch, but she rarely finishes everything. for dinner it's usually spaghetti bol, takeaway or freezer food (chicken nuggets, fish fingers, potato waffles, beans, you get the idea). please don't judge the bad diet, this is all she will eat. she's always picked at her food. sometimes we'll have a cooked breakfast on the weekend, and she'll eat maybe half a slice of toast dipped into a fried egg, a small spoonful of beans, a slice of bacon and a bite of a sausage. we always give her a normal size portion, but this is all she will eat. she just never seems to be hungry. when she's at school she would buy a brownie from the canteen but always always gives some to her friends. when she's had sleepovers, we'll buy doritos and she'll eat maybe 2, her friends eat much more than this. she'll have a slice of pizza and one potato wedge and her friends will have at least 2 slices of pizza, a cookie and some wedges. another thing is she eats very very slowly, always at the table at least 20 minutes after everyone else has finished eating, even with her small portions. please let me know if this is normal and i just have skewed expectations of what is normal (i'm overweight myself, always have been). her little sister is also very skinny but she has asd so that is mainly from not wanting to eat because of texture issues.

when i put in her exact details on the nhs bmi calc, it says she is 1st perceptual and is underweight i will definitely be taking her to the gp about this, and will push until we're seen about it and given some sort of help. i'm very passive so i've always just accepted that if the gp says it doesn't need to go any further, then it doesn't need to go any further iyswim. i don't think it's a control thing at all, i think it is genuinely she can't handle average portions and gets full very quickly. thanks everyone

dotdashdashdash I get her as 1st centile based on her being about 15.5 years old.

But a weight on the 3rd centile doesn’t mean she’s healthy. She clearly isn’t with such a restricted food intake.
IF she’s on the 3rd centile, it’s the very lowest that could be considered healthy. Which isn’t going to be healthy for very many people. Just as the 95th centile is also considered ok but isn’t going to be healthy for very many. Centiles aren’t the same as the adult bmi calculation.

If she was my dd I’d be very worried. I think any clinician who understands anorexia would be too.

Using the calculator all she needs to do in put on 4lbs and she'd be normal.

Can I suggest you also measure her height properly.

@edwinbear

I don't think she's eating too little, she's eating 3 meals a day. I'm 5'5 and stick to 1200 cals a day otherwise I put on weight, I also do at least 60 mins exercise per day.

From a calorie perspective, I don't see the problem, but she obviously needs more nutritious food - but then you know that.

The OP said she’s only eating a few mouthfuls of those meals though, not three full meals a day.

titchy you’re wrong, it does apply.
In a 15 year old, an ED clinic would apply that criteria. The flexibility is more that weight loss isn’t always seen, inadequate weight gain in line with height can be seen too.

Obviously in a small child that bmi might be ok. But not in a 15 year old.

I’m glad you’ll be taking her to the GP, OP. Please ignore the people on here saying it’s ok because it isn’t. I suggest contacting the Beat charity for objective advice.

The problem here is people who don’t understand Eating Disorders commenting which happens a lot on mn.

Ok, OP, so you now know how much she weighs, great start!
Don't make a big deal of it, don't stress or worry in front of her, but let her know she needs to gain weight to be healthy, and then start getting more calories into her. More butter, eggs, peanut butter, nuts, or just more of what she will eat.
Over the next few weeks, if you think she is showing resistance to making an effort to gain weight, then she does need to see the GP. If she seems to be actively NOT wanting to gain weight, then that is an issue. If she is surprised she's underweight, then she should be willing to try and gain some.
If she starts to eat considerably more and still doesn't gain weight, then you would need to see GP about potential issues such as coeliac etc.

Whatever you do, don't make it a big issue. Keep it down to earth and jolly, and factual. No hand wringing or anguished 'pleaaase start eating more'. Keep it low key.
You can do this!

@InSpaceNooneCanHearYouScream thank you for all the advice. i will definitely try giving her eggs for breakfast as i know she likes them (only the yolks though ) but the problem is she takes so long to eat them they start to dry up (not envy) and she only likes runny yolks! i will definitely buy her some nuts as i guess even if she is too full for her next meal, they would have a lot more nutritional value than her meal she would've had! i don't think she'll resist against weight gain, as long as i don't try and force too much food down her and make her uncomfortably full! she does ask for takeaways a lot so i definitely know she wants the food, she just can't manage a lot of it. i think she likes the idea of food, but her appetite is so small she just can't manage much, and doesn't think about it a lot. is there any ways i can load her up with calories without adding much more food to her diet iyswim. if there's just things that won't make her too full or overwhelm her, that could work.

In a 15 year old, an ED clinic would apply that criteria.

Well given that a bmi of 17 is well within the normal range for a teenager I'm surprised that an ED clinic would choose an adult measurement to assess a child....

OP google low volume high calorie foods for more ideas. Any oils, butter, mayo, cream, but butter spreads you can add into her food as all high calorie but will not add extra bulk to her meals.

I've had an underweight teen, luckily with no ED issues, and like your daughter he'd been eating tiny portions for so long his appetite was tiny. With a bit of effort he now knows a lot about 'calorie dense' food. So where he was having a bowl of weetos for brek, now he makes himself porridge with peanut butter and banana, sprinkled with flax seed. For lunch he might have had a sandwich and crisps, now he makes himself three slices of toast with butter, 3 scrambled eggs, half a tin of beans and a whole avocado!
So there is hope!

My advice is leave her be food wise. But I'd try to make high calorie smoothies for a snack. Forget the powders, they are disgusting, all of them. Fruit smoothies can pack in a lot of vitamins and calories in a small volume. How about a healthy chocolate milkshake, you could add peanut or almond butter into it, it has a lot of good fat and calories, cocoa, banana, hemp seeds (lots of good omega fat and protein). Or just fruit smoothies, banana, berries, hemp seeds, some spinach (can't taste it), yum. Make one in the morning and leave in the fridge, she can drink it when she feels like it. You could give her trail mix for snacks, can pack in a lot of calories in a small amount, or are there any nuts she likes?

I was also very skinny as a kid and still very fussy. I sort my calorie deficiency by consuming home made baked goods which is not ideal, lol. Eating real food is always a struggle, I just don't care about it. I also don't like cooking and wish my mum involved me in it from an early age, as I went through a very unhealthy stage after moving out, had no idea how and what to cook, let alone how to cook healthy meals. Still would rather eat grilled cheese for dinner than cook a real meal, but having a man in the house forces me to be more creative, lol.

Maybe some foods to tempt her Appetite ? Some slices of ham or Chicken breast . Home made Popcorn is also surprisingly healthy as well, and Bananas in a milk shake perhaps if she will take it. My DD loves Tuna and mayo sandwiches .Maybe cut up small into squares so doesnt look too much at once .

Cant believe posters here saying 1200kcal is enough for a growing teenager ffs. She might not increase in height but she is still growing and devloping. I am glad you are taking her to the GP

It sounds like its more that she has a small appetite than shes actively restricting her intake. In which case salads and things are not a good idea as you dont want her to fill up on something with little calorie. I think she needs to see a dietician really

Hi OP. We have just come out of 2 months in hospital with our 12 year old .
He lost weight running at the start of lockdown and ended up in the ED.
They were horrified by how thin he was .
He is under the care of a medical team and a dietician.
His heart rate went down to 27 ( we were nearly in ICU) , his blood pressure was very low and also his body temp .
His bloods were all over the place .
I am not trying to scare you but this is what can happen when weight is too low .
Even if NOT caused by an eating disorder . My son does not have an eating disorder, he was just too thin.
I don’t think your child is eating enough and they can have very serious consequences for every organ of the body .
The low calorie intake and the low body weight both have an impact .

I would definitely see my GP and a dietician also . I would not be happy if the GP said she was ok . My own GP described my son as ‘ a bit thin’ and five days later he was in the ED , hooked up to an ECG and they were extremely alarmed by him .

On a practical note Scandi shakes are fantastic . 600 calories, 250 mls and not heavy at all .

Your daughter needs help to reach a normal weight . Best of luck !

How much caffeine does she have? It acts as an appetite suppressant. It also gives people 'fake' energy which they wouldn't have without it. If the only thing you can do are to get her to start taking an multivitamin and some calcium supplements that would be a good start. If she will take a probiotic or drink a probiotic drink that would be helpful too, because sometimes issues like this are to do with gut bacteria.

You could ask for an autoimmune screening and her b12 and iron to be checked at the GP too. They might say no initially, but push for it. It could be she has any number of issues going on, but that would be a good place to start. A GP can ignore "skinny, low appetite" they can't ignore "low iron levels."

I think you should be less focussed on her calorie intake and more focussed on her nutrient intake. For a non-fussy child, her diet is pretty awful! Almost no vitamins/minerals, minimal protein and a lot of sugar so most of the calories she is eating are 'empty'

Hi OP my dd is under dietician and ED team having lost a stone through low mood, ibs, sensory issues and just not feeling hungry. They advised that the stomach shrinks when dietary intake is reduced so could be why she’s feeling full easy. Milkshakes are a quick and easy way and as pps suggested smoothies and flax seeds. I would contact GP and I hope things get better. Good luck

Will she drink slimfast shakes. They are recommended as a meal supplement as well as a meal replacement and the ready made chocolate shakes are actually quite nice too.

@GracieLane she has a cup of coffee after her breakfast - i don't let her have one before as i don't want her to have anything sitting in her stomach before eating iyswim, and maybe 2 cups of tea during the day (without a biscuit usually, unlike me ). @WaltzingBetty as i've already said, this is her diet when she isn't eating much of what i've presented to her, because i know she's more likely to eat more of it (and it's still never all of it, so she's not just having me on). @FoodieToo thank you for the shake suggestion, and i'm sorry your son was in such a bad way , i hope he is better now. i will definitely try to get to her to drink a smoothie as some posters have suggested, the problem is i think she gets fuller quicker from 'heavy drinks' than food in a way, as they lay heavier in her stomach (this is what she's told me), but i'll definitely try and tempt her and pack as many calories in as possible. she's just eaten lunch (even though she only ate a small breakfast of a 120 calorie brioche roll and a small glass of milk ), which was 8 nuggets, and a small glass of coke, she ate about 4 of them, and because the other dc and i were eating some ice cream she asked for some, and ate a few spoonfuls, and then said she felt really full. i'm making macaroni cheese tonight, so i'm hoping she'll manage some of it, i might make it with full fat milk and more cheese to pack it out with calories

My DS was the same, to the point that we saw a paediatrician when he was about 10. They did blood tests which showed nothing amiss, and the doctor basically said as long as he had plenty of energy, it wasn't a problem and he would rather see kids skinny than overweight! Does she have plenty of energy or do you feel her diet is affecting it?

Would she drink more milk? I was advised to give him full fat milk, cheese, peanut butter etc if I felt he was losing more weight. Even now as a young adult he cannot hold on to any weight, and to gain any he has to eat about 3500 calories a day. I assume he just has a fast metabolism (unlike the rest of the household who have the opposite problem!

OP, just because she is saying that she ‘feels’ full, that the shakes etc ‘feel heavy’, doesn’t mean that this is a physical problem rather than a psychological one. Speak to the GP, speak to BEAT too.

I was a size 4 till I was 35. Even now I’m a size6. My children are also very small. Both on the 0.4th centile. We’ve seen all sorts of drs.

Is your family slim?

Difference is I eat like there’s no tomorrow. I just have a stupid metabolism. I also have to take lots of painkillers if I ever need them as a normal dose DOESNT work. Same for anaesthetics. Same for sedatives. Same for most medication. I once had to have a procedure where they were meant to sedate me. But the dr had given me the max dose and I wasn’t even sleepy. I also once took the wrong dose of a sedative as a child. We read it wrong. The drs told my mother my breathing would stop. My heart was also in danger of stopping. (The dose was 20mgs of something. I thought the tablets were 1mg each. But they were 20. So I took 20 tablets. Instead of 1!). I didn’t even fall asleep. They wrote about me in medical journals!

I would stop buying the bad foods. The salad thing is good. Baked potatoes.

So they told me to do this. Hide dats in foods. So olive oil on fish fingers etc. You could easily hide a bit of olive oil in the burgers. Butter on stuff. Baked potatoes. Cheese. Honey into foods. It’s really hard as shops rarely put high fat foods in supermarkets. So it’s about having the fat. As such. Pate is another high fat food. Avocado. Basically look up the keto diet. (However don’t follow it. Just look to see what good fatty food is. That’s what the dietician told us).

Fruit is a healthy option to sugar. You don’t want sugary foods. But don’t limit the good sugars. Pasta. Complex carbohydrates. Hidden fats.

Or you could just not buy the food. The bad food.

There’s quite a few options. Though I wouldn’t let her eat bad food. Just so you get food down her and this brings about bad connotations. Just announce that you think the whole family should eat healthy. Etc

Also sleep. She’s 14. She needs a really decent amount of sleep. We do a lot of growing when asleep. I would probably try to curb the on her phone at 2am. Just because the screen can effect your circadian rhythm which in turn means you don’t get quality sleep. Teenagers are renowned for sleeping a lot. Yet they actually need those lie ins till 12pm. It’s good for their body and brains. But she also needs to sleep earlier. Knocking out the circadian rhythm means that the influx of hormones that will be coming into play become unbalanced. Most female hormones run along the circadian rhythm meaning that once that’s gone. That’s why acne CAN come about. Why periods can stop. We need quality sleep.

The other thing if she won’t get off her phone is blue blocking glasses. These do work. As blue light blocks the melatonin production. Which is also a hormone. Meaning that the system gets knocked out.

@Happyheartlovelife my family are not slim, i've been overweight since i was a child, my mother isn't fat but not particularly slim, probably higher end of average, my husband is overweight, her little sister is very skinny like her but this is because she has asd so has texture issues, her little brother is probably on the high end of normal but nothing to worry about as he's going through a growth spurt and usually sits in the normal range. thank you for the long message and all of the advice @HelloDulling i don't think this is a psychological one because she asks for takeaways most days (not that she gets them everytime she asks!) and shows an interest in food, it's just her eating enough of it that's the problem. she does like drinking milk, @yearinyearout, she has it every morning with her breakfast but it makes her feel very full very quickly, more than eg orange juice, getting her to drink it and still eat her meals would be a struggle. she does play around with her siblings so she has some energy, but her brother has adhd and her sister has asd so i haven't got much to compare it to as they're both restless constantly, can't sit still.

My two dd's are small eaters and always have been they are now 17 and 27. Youngest dd will eat toast two slices no crust for breakfast and then a small portion (on a side plate) of whatever I have cooked for dinner. She never eats lunch and rarely has anything after dinner. She drinks water. She is four feet ten which wasn't unexpected as her Granny and aunt are the same size. She is slim but not skinny although soon looks skinny if her appetite drops because of a cold for example.
Eldest dd is five foot two, she similarly eats small portions in her own home but she has a sweet tooth so will have tea and biscuits at some point during the day.
I find if I try and feed them up it generally backfires so if for example I bought a treat it would knock their appetite for dinner so I tend not to bother. They are fit and well both take vitamins daily to make up for any shortfall though.