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?

Sorry I edited my post before I saw your reply so sorry, you might want to reread. Honestly I say protein but anything he can keep down helps slow down the meds metabolising and will stop you from having to up doses too quickly. How long has he been on meds?

Any sport with strength training will be super beneficial for him! More muscle= more calories burnt just by sitting. Once his muscle tone is better you will see a huge improvement in his handwriting too! It was incredible to see it in DD.

Theoretically they should follow the centile they are when around six to eight weeks of age as their birth centile can be artificially influenced by a number of things. However, when a child is obese, they should never be encouraged to maintain this.

I thought you were not meant to take ADHD medication on an empty stomach as it can cause side effects?

Your understanding of protein shakes is incorrect. They're used by people who exercise to get lots of protein in the least amount of calories possible. Usually to hit their macros. When you have an overweight child, or anyone really, protein is key as it stops blood sugar spikes that cause crashes and cravings and keeps you fuller for longer. It also helps build muscles which is essential for long term weight loss.

OP, is he under a dietician or feeding clinic? Sometimes doctors are very knowledgeable in their own areas (eg ADHD meds) but that can be impacted by other issues they aren’t as experienced in.

I don’t think his weight is “fine”, I fully acknowledge that he is still very over weight! He has talked small protein shake after school with my DP when they do a little bit of exercise/weight training together to help DS with his sport. It’s also to help get some nutrients into him.

I’ll post some photos in a sec.

It can cause the meds to metabolise too quickly so they don't last as long. Other than that, it's really dependent on the specific person. The most important thing is to not take them with anything containing vit C!

Please don't post photos of your child to prove this sort of thing. Imagine he finds it one day. Please just leave it.

OP if he's built muscle bear in mind that weighs a lot more than fat but takes up less space. DD weighs pretty much the same as she did 4 years ago when she was an obese 11 year old, hasn't grown but is about 1/3 of the size she was. The clothes she wore then are too big for her now even though her weight is pretty much the same! Maybe 4kg less but really not that much. Muscle really weighs a lot and takes up very little space in comparison to fat.

He has really poor muscle tone so we are working on this, and the sport has coincided with him all of a sudden being keen to write (wouldn’t entertain it at all before). Hadn’t clicked that the two might be linked!

This sounds so positive, I think I really wouldn't worry about breakfast at this stage.

Education wise its important children eat breakfast - but also if you read the small print on the ADHD meds it says 1 in 10 children can have their growth effected (well our meds packet does anyway!).

It's not about him looking good - if your son is growing taller but not putting on weight due to the ADHD meds I'm guessing there will come a point his doctor considers stopping prescribing them. Your son is only 7 - he has a long way to go to reach full maturity both physically but also mentally.

The ADHD meds are also recommended its better to take with food. We always try and take with a meal in our house as my son lost weight he didn't need to lose when he was on meds although pushed his gcse scores up from predicated 5-7s to 7-9s in the actual exams so we just give him meds for exam periods now.

@ittakes2 education-wise, skipping breakfast is having zero negative impact. And again, this isn’t an aesthetic thing - it’s a health thing. He is still very overweight. He doesn’t look as heavy as he is, but I’m not worried about people looking at him and thinking “woah he’s big”, I’m worried about his family history of obesity related health problems including premature death.

I do appreciate what you’re saying that he should take the medication with food, I wasn’t aware of this because the paediatrician has never once suggested they need to be taken with food, nor is it on the instructions. Her concern isn’t with him not taking the medication with food, it’s that he is skipping a meal. I will try to get him to eat something with them even if it’s not a full meal.

The two are massively linked. Upper body strength is huge in handwriting. In fact, in the primary school I last worked in, the handwriting intervention class was basically an abs class. They didn't do any writing!
A good exercise is getting him go lay on his back, legs straight and raised about 30cm, arms stretched straight with hands pointing towards his knees. Finally, he has to sing happy birthday to his belly button which forces them to almost crunch as their face is reaching the belly button and the singing forces them to breathe. It's hard but the kids loved this! They'd also do the barrel race, taking turns holding each others legs, as well as a snake race under the chairs. We'd make a row out of chairs and the kids had to crawl under them. It was crawling at first, then they weren't allowed to touch the floor with their knees so it was like a walking plank. We went from a row of 3 chairs at first, to creating a super long loop around a classroom made up of about 30 chairs. Some ended up with six packs at the end of term! Their handwriting was beautiful!

@Purplevioletsherbert what about a rollito (supermarkets sell loads of varieties) - a piece of cheese wrapped in ham? Lots of protein in that. And if he loves cucumber, a piece of cucumber AND a piece of cheese wrapped in ham. Even one or two before his meds might help.

You sound like you work very hard to provide him with the best possible life / chances in life.

You mentioned he has poor muscle tone - can I recommend you google infant reflexes not going dormant. When a child's infant reflexes have not gone dormant this can affect their brain development and they can demonstrate autistic / ADHD traits. This happened to my children.

For infant reflexes to go dormant a child needs to do some physical movements (as an example like moving down the birth canal, their shoulders touching either side triggers the development of crawling, later the crawling helps them get their bottom half and top half of their body working together - if this doesn't happen you see kids who bring their heads to their plates to eat rather than bring their utensils from their plates to their mouths to eat and they have trouble both sitting still and sitting up straight).

So I have noticed children with poor muscle tone or hypermobility tend to have their infant reflexes not go dormant more than other children.

Ah but the cucumber must not ever touch any other food ever, or even be on the same plate as any other food 😂 but cheese and ham rolitos is a great suggestion, thank you!

These are incredible suggestions thank you so much!!

He sees an OT for retained primitive reflexes :) it’s bizarre that it isn’t more commonly known isn’t it!

The paediatrician is concerned because the weight loss (which is what this is) is unintentional. Purposely changing his diet to help reduce his weight is one thing, but when it happens as the result of a medication side effect, it needs to be monitored if the medication is going to be for long-term use. If he continues to fail to maintain his weight (or gain in a child), they might decide to take him off that med.

Sorry but I agree with the paediatrician (after much personal experience of this). For a number of reasons.

You are effectively putting him on a very low calorie diet to achieve weight loss in terms of centile. In fact if you look at the charts for what his weight would be if he’d maintained centiles and subtract his current weight you will see how much he’s “lost” and why she’s concerned.

What do you think will happen when he reached an average bmi but you’ve allowed him to skip meals for such a long time?

Given that he’s consuming quite a bit less calories than needed to maintain his centile spot, can you see that his body and brain may not have enough nutrition to function properly? You can’t see all of his struggles from the outside, especially as they will be somewhat masked by the adhd meds.

I would suggest that you go maybe half way. Give him breakfast before the medication. This still won’t be sufficient to maintain his centile but will help to maintain good eating habits and good internal health.

They might also decide to refer him to a dietician or eating disorder clinic (since there isn’t a more suitable service available to help with this problem)

Does he drink in the morning? Glass of full fat milk, hot chocolate (made with milk and cocoa so limited sugar) and a peanut butter or ham sandwich on the side with his meds might work. Maybe introduce the drink first, then a tiny stamp size sandwich, then grow the sandwich?

Egg muffins are good too- ham and cheese to start with! They can be mini muffins, or even a chunk off a bigger one.

Protein would be better than fruit as it’s less of a sugar spike.
Protein drink at bedtime may help, if bedtime liquid isn’t an issue

I fostered, and had DC with ASD/Dyspraxia/school refusal type things. We always had a protein breakfast after a great video about brains and serotonin. It increases happiness hormones and something or other.
In practice, I cooked a pan of sausages at the weekend, and they microwaved one and stuck it in a cob to eat while they walked. Now I’d worry about the processed sausages, but I was happily ignorant then!

Ha the good old days of scoffing processed sausages!

You are effectively putting him on a very low calorie diet to achieve weight loss in terms of centile.

Hold on, I’m not putting him on a very low calorie diet at all?? I don’t control what he eats at school, but have already said I am going to be giving him a packed lunch after Easter to support a more varied diet.

He eats a healthy-ish dinner most nights (chicken and potato with veg, or spaghetti bolognese, or fajitas, or chilli con carne, and once a week or so will have nuggets and chips). If he’s hungry between meals there’s always fruit or yogurts he can eat, and he has a protein shake when he gets home from school. So please don’t accuse me of putting my child on a low calorie diet just so that he can lose weight.