To be really worried about my malnourished daughter?

[WorryWizard]

My daughter had some medical issues which resulted in her being underweight. During this period, she had an aversion to milk, yoghurt and cheese, but more broadly, eating was a challenge. She underwent a multitude of tests but for around 3 years, was struggling. She is doing much better now thankfully, but at a recent appointment, I mentioned her not having the same strength she did a few years ago and that I am hopeful we can build on this. The consultant has arranged a blood test to check for bone density and since I heard this, I’ve been feeling really worried. Her bone density being affected would make perfect sense, especially with her aversion to dairy. I am so upset with myself for not thinking to give a supplement for this, but my whole focus was on trying to ensure DD was eating. She did take a multivitamin, but this didn’t contain calcium.

I have had a look online and, if this has been affected, it looks like it could impact her for life. I am so upset with myself that I could have done something so small to have prevented this. I am feeling very alone with my worries, and just need someone to offload to. I hope that’s okay.

Is she still underweight? Have they checked for anaemia too?

maybe she had an aversion to dairy because she couldn’t stomach it- some people can’t easily break down lactose. So please don’t beat yourself about lack of dairy intake. You just needed her to eat whatever she could

How old is your daughter? Try not to worry until you know more, it may not be a bone density issue. You can’t be blamed for not anticipating something you didn’t know about. I’m sure you did your absolute best for her just as you are doing now.

DD is 12 and her weight is now restored thankfully. Sorry for missing that bit out.

She was underweight for 3 years

Yes - she couldn’t stomach dairy but lactose intolerance tests came back negative.

Speak to your GP,get blood tests done,a dexa scan to check bone density. I was very sick as a small child (ie vomiting) premature in 1950) I was put onto what was then called "The Gastric Diet", which was fat free,no milk or butter...I was given Cod Liver Oil, and Viral daily,it was a malt extract thing. I became veggie in the 1970s, early menopause,so paid for bone density scans every 5 years, and everything has always been normal range. I have a bird like friend who eats like a horse, and she has osteoporosis. You have time to sort this out, don't blame yourself.

The doctor has arranged the blood tests, but DD didn’t want to have them done at the appointment, so she will be having them done in the next week.

Don't be hard on yourself. You made the best decisions to help your DD at the time. She is still young and her body is growing so there is time to rebuild her calcium levels and build strength.

If her bone density has been affected, she can have an infusion which will help her absorb calcium better and it should return to normal with supplements and sensible eating.

Normal rules don’t apply when you’re just trying to survive. Cut yourself some slack mama.

Please don’t beat yourself up - it’s hard to remember everything all the time, particularly when going through a stressful time. And try not to worry until you actually know if there’s anything wrong.

My daughter is autistic and had long covid so didn’t eat properly for months (the post covid inflammation thing). Then she wouldn’t eat loads of things out of fear of feeling sick. It’s amazing how resilient children’s bodies can be so you might find everything is okay.

My daughter is dairy free and on a restricted diet due to other food allergies. There are calcium supplements that you can get alongside a multivitamin.
Ask for a dietician referral, my daughters dietician checks her calcium and iron intake at each appointment to ensure she's getting enough. As she approaches puberty we will probably have to be more mindful about calcium but the requirements at her age (5) are the moment are manageable even with the limited diet. My mum and grandmother have had osteoporosis so we are keen to ensure she goes into adulthood with good bone density. You have about another 10 years to improve on bone. Look at the scan as a way to snapshot what is going on at the moment and whether you need to do anything differently over the coming years.

My daughter can't have dairy because of the milk proteins, lactose intolerance is something that affects more adults, children are more likely to have trouble with the proteins. The lactose intolerance test would have only looked at the milk sugar (lactose) and not the proteins.

Thank you for the reassurance everyone. I really have tried so hard to help DD. It has been such a long road and I naively thought we might come out the other side without any lasting impacts on her health.

@Superscientist so can bone density increase all the way up to early 20’s?

My mum had a total hysterectomy, including ovaries, at age 41, pre menopause. This was in the mid 1990s.
As she got older, she was offered nothing in the way of HRT or any sort of supplements.
She hit mid-60s and had two bone fractures in quick enough succession to trigger further investigation. She was diagnosed with fairly severe osteoporosis, which she was told could have been prevented if she'd been put on HRT following her hysterectomy. Basically, her complete lack of hormones from a reasonably young age, did a bad number on her bones.

She was really angered by the whole thing, but also appreciates that she could have/should have done more of her own research. It just never occurred to her, or any of us.
Now she's focused solely on what she can do now, moving forward. She's now militant about her supplements, focuses on bone-related nutrition, and gets yearly infusions at the hospital that are something to do with bone density. She's currently early 70s and doing well.

The same applies to you OP. There's no point beating yourself up about things from the past. Now you know better, you can do better.

Yes. See this article from the royal osteoporosis society page. Also, diet is only part of bone health - vitamin D alongside the calcium is important as well as exercises. If she does turn out to have low bone density look into load bearing exercises that can help with bone growth alongside diet and supplements.

https://theros.org.uk/information-and-support/osteoporosis/causes/age-and-bone-strength/

I had anorexia and bulimia as a teen and given my family history I have been very mindful of my diet and exercise as an adult. I ensure I take a good calcium vitamin whilst breastfeeding and stay active. I was dairy free when breastfeeding my daughter with a dairy allergy and since I stopped feeding her I've been mostly dairy free as we keep most of our diets compatible with her diet. I am trying to hopefully minimise any bone loss as I age.

Her previous diet is in the past, there's lots that can be done from now on to mean that any longer term consequences are minimised.

I have a DC with eating issues and it is just exhausting to struggle to feed them and worry about them getting enough nutrients. It sounds like you and your daughter have made amazing progress and I agree with PP that all you can do now is focus on getting the best supplements and it sounds like you are getting advice and support from the consultants which is great. Also you don't know what the results will show - hopefully the bone density is fine. My DC has ARFID so eats incredibly restricted but somehow nutritional bloods have always come back fine

Coeliac disease?
Dd has coeluac and bone density scans each year . Improvement on prescribed supplements

Thank you. I’m so pleased she is doing well in other ways. Getting her weight up was a huge task and required so much determination on a daily basis. It’s reassuring to hear that supplements will hopefully help to replace anything that’s lost. I just want her to be strong, fit and healthy.

How old is she? Peak bone mass is achieved in the adolescent years so she should be able to build on what she has. Bone density continues until age 30 so she can make huge strides!

Try not to worry. If she didn’t get rickets then she likely wasn’t majorly deficient and she can get back to a healthy normal.

Also dried apricots are a rich source of calcium if tha could be added to her food?