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?

Adhd doctors don't usually want to see any weight loss when taking adhd medication - usually adhd kids are on the thinner side.
We struggle massively getting our dc to maintain weight on medication.
I'd ask for a phone conversation with the pead privately without dc; so you can have a frank conversation about weight and your concern about dc being overweight.

@Hankunamatata thank you, that’s good advice. It just seems so single-focused of the doctor to be concerned that a very overweight child isn’t gaining weight! Especially since I don’t have any major concerns about his nutrition. He eats quite a varied diet for a child with his difficulties!

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

Surely that depends though, my DD is also adopted age was 3rd centile for height and weight, aged 6 she wore age 3 clothes, because she was malnourished. She’s now around 50th centile for both and is much healthier.

The OPs child is adopted with health issues in his birth family related to weight. Advice is for children to grow into their weight, meaning their centile will drop but her son will be healthier age 12 at 40kg than he is aged 7 at the same weight.

Surely this is nonsense. It would mean that a very overweight child could never be a healthy weight!

Mine - coincidentally also adopted - has never fancied breakfast. Just the least morning person you could ever imagine and I don’t think their appetite gets going before about noon. They are petite but a healthy weight and always have been.

It feels weird but it works for them.

@Purplevioletsherbert this is a tricky one as your going to get lots of replies that have no clue about ADHD medication or ASD children.

My DS was 14 when he started on the medication and by 16 had grown a lot taller but lost weight. It was a concern for us as he got very skinny. He wouldn’t eat breakfast, barely touched lunch and then finally ate a good meal for dinner but it wasn’t enough for him. We gave him protein shakes for breakfast and lunch and added supper (medication had worn off by then so would eat) which at least helped him at least maintain his weight.

I think your issue will be if your DS continues to grow taller but still isn’t gaining any weight eventually it’s going to become an issue and he’s probably not getting enough calories longer term. Is it the medication team that are questioning it or another consultant?

It sounds like you have a lot going on here OP. What I would say is that one of the benefits of protein at breakfast is that it can increase the time ADHD meds are active, so is worth doing. I would suggest protein from real food sources rather than shakes if you can as the other ingredients may be undermining your positive efforts.

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!

If school provides food when he arrives, isn’t that some sort of breakfast club. He has an extremely early start for a 7 year old so it’s not surprising he doesn’t want breakfast. Was the paediatrician aware of that? If the medication doesn’t have to be taken with food, I can’t see the problem.

You'd think that but my ds was born 99.8 centile and if you track that, it that is overweight by the time you get weighed at school in reception.

Op, it sounds like your ds is thriving and I'm sure it will be something you monitor as time goes by.

This makes sense and I agree that if he was still 40kg in two or three years time I’d be very concerned. It’s his medication team questioning it.

This makes a lot of sense too, but he takes the medication at 7am and it generally lasts until about 5pm. It’s 6pm we notice it’s definitely worn off, just in time for bedtime 😂

What about one of those little probiotic yoghurt type bottles if a protein shake doesn’t work. There are very few calories but at least he won’t be running on empty and they can help gut health too.

It’s not a breakfast club, he gets to school for about 9am (depending on taxi) and as they’re aware that he doesn’t eat breakfast they make sure they offer him something when he gets in as part of his settling in for the day. It’s an independent special school so they’re very adaptive. The paediatrician is aware of the time he leaves as that’s why he’s prescribed the XL medication so it doesn’t wear off by lunch time!

My son takes the meds. We try to make sure he eats in the morning. He was skinny to begin with, and he’s also a teenager. Making sure he eats breakfast means he eats breakfast and dinner but not (really) lunch. That way he’s eating two decent meals a day.

I guess if it becomes more of a concern a banana smoothie or similar is a quick breakfast.

Thank you.

He just doesn’t seem to need the ‘fuel’ as some others are suggesting. He’s just having a cheese and ham wrap for lunch with lots of cucumber and an apple on the side, and a glass of milk. He has spent the morning jumping around whilst playing with his cousin and has worked up quite a sweat but is by no means tired!

And op things will change as he gets older so you adjust your patterns with meds. Mine lost weight but became incredibly active as preteens so we made sure they ate in the morning then took their meds which also gave the benefit of lasting longer through the day to get homework done.
I found ensure or fortesip were good as they come in millions different flavours and consistency such a juice or milkshake etc but you are at this point in adhd med journey.

It is important drink during the days as meds won't work properly otherwise

You sound like a great mum who has perspective on adhd meds. It's a journey. You will adapt as he needs change. At the moment it's a plus that he is maintaining his weight if he is on the heavier side currently as he will become more healthy

I don't understand some posters here. The OP's child is overweight. The advice is to maintain weight while they grow taller and that seems to be exactly what is happening here. There are obvious weight issues in his birth family and I don't think the OP needs to encourage him to eat breakfast if he doesn't want it.

One of my children was underweight on ADHD medication. We did give him a 3 course breakfast before his tablet because we were making an effort to get his weight up. That's not the OP's concern. His is still really skinny though but that's the default in my family.

Thank you @Hankunamatata and @Yellowroseblooms

I’ve been watching him this morning just so full of energy and looking so healthy, for the first time in his life, and wondering why on earth the paediatrician is encouraging me to pump him full of sugar/carbs first thing in the morning. He’s doing so well in every possible area at the moment so there are no downsides to him skipping a meal that he has no interest in eating.

I don't see the issue as long as he's able to focus in school and his behaviour is ok (for him I mean, as in not significantly worse than the afternoon). It's surely positive for his long term health to slim down a bit. Also (I'm just speculating) maybe as he's become a bit slimmer he's a bit more active? My middle child who is also autistic is very overweight and unfortunately does even less exercise than before because it's more tiring for her.

Worth adding as well that school have no concerns. I do wish they’d provide healthier food for him but the majority of pupils really struggle with food so their approach is very relaxed, which makes sense. He did ask last week if he can start taking a packed lunch so I think he’s finally bored of the toasties, after Easter I’ll start doing that and can vary his diet a bit more.

His headteacher commented last week that she couldn’t believe the change in him and how healthy he is looking.

He’s doing so well at school, fully engaging in learning and not having meltdowns or needing to be restrained any more. He’s academically working a year above in maths and English and is FINALLY thriving socially too. He’s a good friend and role model according to his teachers.

The only reason I'd insist on him having some protein with him meds is because it helps them last longer in my opinion, obv depending on the dosage and type of meds he's on. ADHD meds helped my previously overweight DD get to a healthy weight and start to enjoy exercise, she was previously so self conscious and would refuse to run as she'd find it so embarrassing. She's now a competitive swimmer and much more confident. I agree with you on the nutrition advice too, Drs are notorious at being bad at this!
What I'd suggest if you haven't already, is get him into swimming or any other sport, if he's not already. It's brilliant for self esteem and his appetite will increase. The appetite does return after a number of years on the meds in my opinion but the weight he has lost will probably mean he's a bit more confident in himself. Sports is tough when you're chubby, it's embarrassing to take part! So him looking well and healthy, it's a good time to utilise that. Esp as at his age as lots of sports still see beginners as "acceptable". It gets harder to find a sport suitable for older beginners.

Good advice, I wonder if I could get him to eat a little bit of cheese first thing in the morning? Or some ham, he bloody loves ham.

Interesting you should say about sports as he’s recently got into a new sport and has been attending weekly, it relies a lot on his upper body strength and ability to hold his own weight so he is actually doing really well!

This is confusing. He is over weight, but the doctor is concerned about him not eating enough. You think his weight is fine, yet are giving him protein shakes (my understanding these are used by body builders to gain weight?). Just by looking at the kid is he chubby or scrawny, or in the middle?