To not see why the paediatrician is concerned?

[Purplevioletsherbert]

DS is 7 and has autism and adhd. He has always been very tall and very heavy. Hes quite ‘dense’ so I don’t think he ever looked very fat but was never slim either.

last year he started adhd medication and weighed 40kg at 135cm tall. He had an appointment this week and was 40kg at 142cm tall.

Loss of appetite is obviously normal with his medication, and he often skips breakfast, has a small lunch and then eats a regular meal for dinner. Not huge on veg but will eat a large portion of carrots or cucumber every day and takes vitamins. Lunch at school is a cheese toastie, dinner will be something like chicken and a baked potato. He still has a sweet tooth but we try to limit sweets.

Paediatrician is concerned about his lack of appetite and says I need to make sure he eats breakfast before he takes his medication in the morning so he’s hungry for it. 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!

Also, with such a heavy child, the advice is always to help them maintain their weight whilst they grow rather than trying to get them to lose weight. He’s maintaining his weight! And he’s actually looking really healthy for it. Is him skipping breakfast really such a big deal?

What centile weight was he born on? What was it a year ago? What is it now? You really need to look at these numbers but ultimately the doctor is a professional who will have spent at least 11 years training to get to this position.

Also as an aside, children’s BMI confuses me so much. Hes 98tg percentile so very overweight. But if I use the same weight and height but say he was born five years earlier (he’s in age 12 clothes), it says he’s 82nd percentile and a healthy weight?

As he hasn’t lost weight I would think it’s good that he’s taller at the same weight. (My son was similar at that height and looked quite overweight, then grew taller and stayed the same weight so looked a healthier size.)

I don’t understand the bit about having breakfast so he’s hungry for the medication? If the medication is supposed to be taken with food then that’s an important point.

He was 90th centile at birth (despite being born seven weeks premature) and was 99th centile last year. Currently 98.

He takes his medication as soon as he wakes up as part of his routine, she was saying as it suppresses his appetite I should give it to him after he’s already eaten. But it doesn’t actually need to be taken with food.

Then I wouldn’t be very worried. Perhaps you need to clarify it with the doctor.

Of course this is bad. And you clearly have issues with his weight so you are allowing it to continue.

He has a modest dinner and then nothing until, at best, a toastie at lunch. And you don't even know if he's eating that. This isn't about weight, it's about nutrition and about being sufficiently fueled for learning and activity.

At the very least, introduce a smoothie (add some oats, seeds, nuts etc to up nutrition) for him to take the meds with.

ultimately the doctor is a professional who will have spent at least 11 years training to get to this position

I appreciate that but doctors are notoriously not well known for their nutritional advice and forcing a bowl of cereal down him or more bread, when he’s already overweight and not inclined to eat it, doesn’t seem like good advice.

On the face of it OP, I agree with you. 40kgs at 7 seems on the heavy side. DD is 12 and weighs 40kgs, but as a girl she will be naturally lighter anyway. If he’s maintaining his weight but growing taller he sounds like he’s naturally getting a bit slimmer without feeling hungry. But, obviously if a medical professional is concerned you need to listen to him. Would your DS perhaps have a smoothie for breakfast?

Protein shake or smoothie with his meds.

Ds and I both medicated and have been told we need a protein breakfast.

He's 7, he needs breakfast. He's not getting enough food. He'll still need food for focus, energy, and concentration.

Growing 7cm without any weight gain at all will ring alarm bells for them. If breakfast isn’t an option then you need to look at ways to get a balanced intake throughout the day.

He is adopted and has a family history of diabetes (for which fasting is excellent for) and obesity related illnesses. He is offered fruit for breakfast every morning, he can have whatever he likes, but he doesn’t want it.

His birth mum is severely disabled and a lot of that is to do with her weight (over 25 stone at just over 5’). Birth dad also obese and had a heart attack at 35. So yes, his weight is a concern of mine. You say he needs “fuelling” but he has bags of energy and is thriving in every possible way so I’m not sure the lack of breakfast is having any negative impact.

ADHD medication is more effective if taken with food containing protein, I also find that side effects are less.

Overweight or not, he needs a healthy and regular intake of food and currently he isn’t getting that.

He has a protein shake when he gets back from school but it’s a good idea to see if he will have one in the morning too. Not keen on smoothies really as it’s a lot of sugar. Might see if I can get him to eat some hard boiled eggs or something.

Also not sure if those saying I need to give him more have experience with trying to get a child with autism and adhd to eat in the first place. It isn’t easy! Hes offered fruit snacks consistently throughout the school day. I know exactly what he eats at school as I get a detailed email every day from school with everything I need to know, including what he has eaten, and what food he was offered but declined.

Children's BMIs when very young should be much lower than adults. I don't know the numbers but a toddler's ideal midrange BMI might be 14, whereas as adults around 22 - to account for their completely different shapes. As they grow the middle of the ideal range moves towards the adult number, so for a 7 yo that might be 16, a 12 yo 18, a 15 yo 20. That's why he's overweight for a 7yo and ok for a 12yo.

I am not sure that fasting, when you dont have diabetes, and are only 7, is really that helpful.

I understand your concerns re his weight and family history. But I think getting some actual nutrition in him in the morning to fuel him is a better option. And of course, over time, working to improve his diet overall.

Protein shake vs full blown smoothie is fine. We do fruit, oats, linseed, yoghurt and protein powder for ds with his meds. (He eats solid food as well at breakfast but seldom has lunch).

Obviously your ds is different to mine but I can tell you that at 7, ds was hugely overweight. It was a massive concern so I do get it. The massive growth spurts, combined with improved eating and lots of activity made a huge difference. He's now 13, tall and very slim.

I'd say you know your child and if breakfast isn't an issue for him, don't make it one. He's offered breakfast so if he was hungry, he'd take it. The big problem with breakfast skippers is they tend to overcompensate throughout the day but this is a conscious thing that people who are preoccupied with food and weight do. You son isn't doing that and is eating only when he's hungry. This is actually a good thing for him to develop as he'll eat what he needs when he needs it. I worked in child healthy weigh for many years and getting a child to grow into their weight was always the goal, which is what he's achieving. As long as he has the nutrients he needs, he'll be fine. The three meals a day thing is a modern way to fit eating into our regimented lives, it's not necessarily good for everyone

@GingerIsBest thank you for understanding. I want him to be healthy, and the battles to get him to eat don’t seem worth it (he is really thriving at school and is no longer having meltdowns at all really, so don’t want to set him up to fail by starting each day with a meltdown by forcing the issue) but even a small protein shake might work.

Worth mentioning that I’m also overweight and battling it, constantly. I don’t want that for him.

@unbelievablescenes thank you, this is my thoughts also. He is much more “in tune” with his body since starting the medication, for example he knows when he is tired and when he needs the toilet (toileting was a huge issue before). I think it’s great that he’s listening to when he is hungry.

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!

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.

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

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

You say that, but the NHS also suggests that his centile puts him at ‘very overweight’ and advises that he should be supported to maintain that weight as he grows, therefore dropping centiles…