Help! Underweight toddler won't eat...

[Vinomum]

DS1 will be 3 next month. He was small for dates at birth and weighed just under 5lb. Perfectly healthy and everything formed, but just very tiny. He's carried on being tiny and currently weighs 11kg (just under 2 stone) and is also quite short. Size aside, he's completely healthy and doing everything he should be doing at his age.

When I started weaning him at 6 months, he was a good eater, but never had a massive appetite. When he's hungry, he can eat tons, but when he's not hungry he won't touch anything, no matter what it is. At nursery he eats really well (or so they tell me) but at home over the last couple of months he's started getting worse at eating. I don't give him huge portions but it's getting to the stage where I know as soon as I put something down in front of him, it's going to be a struggle to get him to eat even half of it and I'm starting to dread mealtimes.

Last night we reached breaking point. He absolutely refused to swallow the food in his mouth. It took him 2 hours to eat half a plate of food. DH and I were at our wits' end, we didn't know what to do, we ended up making him stay at the table until he'd finished his food, telling him no toys/telly etc if he didn't finish - it was absolutely horrible, we were up till 9pm with him, he was crying, I was crying, and the whole episode was just awful. The last thing in the world I want is for mealtimes to become a battleground but that's exactly what happened.

I've read all kinds of advice about dealing with feeding fussy toddlers and everyone says not to force them to eat, not to make a big fuss, and that they won't starve because they'll eat when they're hungry. I really agree with this logic and want to follow this kind of advice, but because DS1 is so small he just can't afford to skip a meal. You can see his ribs and when you pick him up he's just skin and bones and I am really worried that he's going to become seriously undernourished and end up in hospital on a drip or something awful. I know it sounds dramatic but ever since the day he was born I've been worrying about his weight and this is just making it worse as I feel completely powerless.

I just really don't know how to handle this - has anyone got any advice?

What springs out at me is the 2 hours part.... After, say, half an hour (or before), mealtimes are finished here. If DD1 really doesn't want something, then I offer pudding (which is usually accepted - I make it yoghurt and banana if she hasn't had anything else, so at least vaguely healthy), then finito. Making them sit there for so long can only be counter productive I would think. It really does sound like he's reacting to the pressure he feels at home to eat, if he's fine at nursery and is healthy and active otherwise.

FWIW DD1 is skin and bones and ribs too, has always had a relatively small appetite, and is allergic to dairy/eggs so challenging to get stuff that piles the calories into her. I think a lot of kids are really skinny at this age?

Are you sure he's actually underweight? Maybe go get him weighed to see - if he's not too bad, then that might help you take the pressure off him a bit.

Sorry - I know what its like to be worried about them being too thin. Every time DD1 is ill, its almost painful to pick her up she's so bony . But I just offer her 3 x meals, (2 with pudding) and 2 x small snacks per day (eg a biscuit or fruit), and so its there if she wants it. It has to be up to her in the end.

Reading back your post - sounds like you've answered your own question:

"The last thing in the world I want is for mealtimes to become a battleground but that's exactly what happened."

If I were you, I'd back right off, offer a meal and a pudding, and if its refused so be it. If he's just picking, give him, say 5 minutes (and a time warning), then finish mealtime. Once your DS is less stressed, hopefully he'll start eating what he needs (and it sounds like he eats well at nursery, so won't starve!). Good luck.

I feel your pain -- DS1 (same age) is v fussy, skinny and sometimes seems to live on air. But toddlers just don't eat regularly like adults ime.

You say "When he's hungry, he can eat tons, but when he's not hungry he won't touch anything, no matter what it is." Then he is simply eating to his appetite rather than your expectations I know how frustrating it can be but a toddler has no concept of eating enough at every meal to keep them full til the next one, like adults do. Also, DS1 eats progressively less as the day goes on more than me for breakfast, often just one or two mouthfuls for tea.

So I would stop trying to force him to eat. If he is not hungry at mealtime then take away, no fuss or anger. Offer a healthy but dull snack a bit later (toast and fruit is all I offer after a skipped meal but during the day I do offer other snacks, cheese is a good one for extra cals).

Some children are very very slim, you can see all their bones etc yet they are a healthy weight. One of mine is on the 98th centile for height but around the 50th for weight as an example.

You are giving your son big food issues by the sound of it. Would you feel like eating if someone was forcing you to eat all the time?

Back off he clearly will eat when he is hungry and when he doesn't feel under pressure.

Also I think you can get vitamins for toddlers if you are worried about nutrients -- or give smoothies with fruit and yoghurt.

Hi, My DD1 was off the graphs from 1 year old she was so small (and still is). What were referred to a child nuritionist with her and the advice we were given was to put her food in front of her, but to take it away after 20mins, so she could eat what she wanted and not to worry if she didn't eat much. Also we were prescribed a special milkshake (Nutrini) which was packed with vitamins, minerals, iron and acted as a food supplement. She would have these at night after she had eaten, so we didn't worry about it affecting her little appetite.
She is now 7 and still very small, but we think her size is genetic, her appetite isn't great, but her dad was the same at her age, all we do is try to make sure everything she eats is healthy as it can be.

Thanks all for your advice, I really appreciate it. I just find it so hard, being someone who's always had a healthy appetite, to understand how a person can not enjoy food! And it's soul destroying when I've spent ages making stuff from scratch that just ends up in the bin.

He is underweight for his age, I had him weighed about 4 months ago and he's not on the centile chart at all for weight and is on the 4th for height. HV didn't seem worried though, I think because in all other ways he's developing completely normally.

Tonight he's come home from nursery (where he had seconds of everything apparently) and polished off 2 bananas and 3 bread sticks, which is good.

I will do what people have suggested and give him a time limit to eat what he has and not fuss if he doesn't finish. This is normally what I've been doing, last night was an exception and not something I want to repeat. Another thing he does is guzzle drinks with his food which I think might be filling him up, so I'm going to limit the amount of drink he has with meals too and see if that helps.

DS1 is like that with drinks too -- won't eat anything if juice/squash is available. So he is only allowed water with meals.

Today we went to a party and while everyone else tucked into pizza, chips and sausages, he ignored these and had half a dozen grapes for tea instead!

hey vino. i feel your stress! my ds was exactly the same....

firstly, back off!! you've already identified it yourself, but give it a few days of backing right off and forget about formal mealtimes for now...make eating fun again.

when he eats, give him high cal foods...mash with loads of added butter, cheese cubes for snacks, few crisps with his sarnie, full fat butter, not spreads etc, choccie for treats/afters, extra creamy posh yogurts etc...the complete opposite of anything you would do if you were dieting....

try him with different food to usual, or in a different form...try baking with him..make pizzas where he can put on his own toppings, put his food into little bowls ie..bread and butter in one, grapes in another, meat in another etc... it might excite him into trying...what about cheesea nd crackers? cheese on toast cut into shapes...or give the choice of squares opr triangles when cutting...give him back a choice.

its easy to say all this i know when you watching every morsal that he eats and being relieved when he does eat, but honestly, he won't allow himself to starve, and you need to forget and move on from the other night.

good luck. hth. x

allow him to have plenty of fruit, of course, but try giving him higher cal snacks too...

oooh. it came out all jumbled and in the wrong order! you get the gist though!

Firstly, it's a myth that you shouldn't be able to see a child's ribs. Most children who have visible ribs are a perfectly normal weight. Ds1 has visible ribs. he's fine, I have never worried a second about his weight.

Secondly (and I shan't push this as I'm sure you already know) sitting him at a table for two hours and threatening to punish him if he doesn't eat is cruel, and will give him a behavioral eating disorder.

Instead of trying to force feed him, make his food extremely calorific, with cheese, peanut butter, fatty meat, and plenty of butter and olive oil. Then don't worry about how much he chooses to eat, and CERTAINLY don't worry about where he eats it. Sitting at the table for 2 hours being threatened and diapproved of?!! Of course he hates mealtimes at home!

Vinomum - very good point about the drinks. DD1 has milk first and last thing, but just water apart from that usually. Ribena and OJ etc are treats rather than usual drinks. If she had them regularly she wouldn't eat nearly so much.

Oh, and the usual rules about no cakes and stuff don't really apply. Provided DD has had a stab at something vaguely healthy (and to be fair, she does eat a reasonable amount of fruit and veg), I then positively encourage her to have whatever bad-for-her calorific crap she wants. Something is better than nothing!

MegBusset, your story about the party rings so true, exactly the same thing happened on Saturday at a birthday party, he picked at a couple of crisps while everyone else was wolfing down cake and biscuits.

I do make sure that everything I cook for him is laden with fat, calories and carbs so he gets the most he can from the little he eats. I just think - bizarrely, given his parents - that he's just not bothered about food particularly, I've tried to engage his interest by baking muffins and biscuits with him but he doesn't really get into it. I think he sees eating as a distraction from playing with his toys.

I also think that perhaps his appetite decreases through the day as the one meal he really eats well at is breakfast, he can regularly get through 2 weetabix and a banana or yoghurt. Perhaps that's all he needs to see him through the day.

if he's eating 2 weetabix and a banana or yoghurt for breakfast, then a big lunch at nursery, then a snack when he gets in, he's eating enough. Please get off this kids case.

The snack issue is another problem. Is it better to let him have snacks (I give him Organix cereal bars, Babybels, yoghurt raisins etc) as at least that way he eats something, or is giving him snacks making it worse because he then doesn't eat a proper main meal?

He doesn't need 'proper' meals - the only thing he needs is food.

a babybel, a couple of pieces of apple and a cracker is as much as my children ate for lunch at 3. If he's eating a big lunch, then this supposed 'snack' when he finishes nursery is probably his meal, IYSWIM.

If that's what he will eat, let him eat it.

Also i would get him weighed and measured, to reassure yourself that he is healthy for his height.

Coldtits, I've had him weighed and measured as I said before, he's not even on the chart for weight and only just on it for height. There is no question that he is underweight. He's not emaciated, but he's so skinny that he looks fragile. He's still wearing 18-24 month clothes. He was on the 9th centile for weight when he was 1 and has slowly slipped off the chart over the last 2 years, so this is clearly a problem that is getting worse. I don't rely on centile charts alone, of course common sense comes into it, but visible comparisons with other children of the same age draw the same conclusion.

With a child of a healthy weight, I wouldn't even be posting on here, because I wouldn't be stressed about it. If DS2, (9mo) who's a 91st centile baby and weighs the same as DS1, skips a meal, I'm not bothered in the slightest. But DS1 is a different matter altogether, hence the draconian measure last night. Which, I want to stress, was done out of genuine concern and worry, and not cruelty.

Feeling your pain on this issue OP. My DS sounds v similar and its taken me a while and a lot of angst to get my head round the fact that his not being bothered about food is my issue and not his. He eats a variety of small bits and bobs some days, some days fresh air with milk and some days loads. I was advised by a peadeatric nurse to keep a 2 week food diary and then review and I realised that over that time period things balanced out. You may find that helpful to do.
I think you have realised that your approach last night (although it sounds like you were at your wits end) can only lead to more grief in the end. Your child won't starve himself and the main issue here seems to be how you get to grips with your own feelings.
On a practical level I think it might help if you had him weighed and measured as well.
Good luck.

x posted with you OP- sorry

one more thing - my DH chipping in - if your DS eats well at breakfast wonder if fried eggy bread or savoury or sweet pancakes or more of a cooked breakfast might help get some more calories in ?
You could also consider seeing if you can get a referral to a peadeatric dietican via your GP or HV.

I think you've hit the nail on the head sazlocks - it's my issue, not DSs. Just have to stress less about it but easier said than done.

Yes that's a good idea re a big fried breakfast. I should probably make the most of the one opportunity during the day that I know he will eat well. Good thinking by your DH!

I wouldn't be too concerned that your DS is still in clothes for a smaller child. DD is 3.5 - she is on approximately the 2nd centile for height and between the 9th and 25th for weight at around 32lbs so not that much bigger than your son at 5 months older. She is in some 12-18 month clothes, 18-24 and 2-3 years. She is also still wearing several pairs of tights for a 6-12 month old and some fleecy trousers sized 9-12 months! It means we get our money's worth out of her clothes! As Coldtits says if he's eating a large breakfast, lunch at nursery and a snack - that's 3 meals a day and more than my DD will tend to eat. She seldom eats breakfast, will have a light lunch then sometimes eats all her dinner and sometimes she'll barely eat a few mouthfuls. It is difficult not to get stressed - I do myself - but they won't starve and will eat when hungry.

I'd second the advice to get your DS weighed and measured again - he may well have grown in the 4 months since you had him done last.

Re: snacks, I know some people follow the 3-meals-no-snacks format, personally I think it is fine to present food in whatever format he will eat it as long as it's healthy! Eg DS1 won't touch pizza but will happily polish off a Babybel and some breadsticks, or some sliced cheddar next to (not on!) toast. It's all bread and cheese IYSWIM!

vinomum, I could have written your op, not the 2 hour dinner but the issues you mention. My ds will be 3 in April, he is skin and bones and barely eats anything and it does stress me out, how can it not. I try so so hard not to get wound up and have the 'eat if you want' attitude but it is very hard.

Interestingly my ds still has milk morning and evening too and eats a huge breakfast, 2 weetabix or a big bowl of porridge. He is also still in size 18-24mths trousers and 2-3 tops, but they are a little big but the smaller size too small IYSWIM.

I haven't got any advice really, just empathy, sometimes it helps just to know you're not alone.

I've started my own thread on her about ds' eating habits and the answers were all the same as yours. Don't worry he is eating something. So I am trying my best not to.