very low BMI in son

[Zanzibaragain]

By low I mean not actually on the chart.
Ds is 10 years old and been covered up in winter clothes for months now. I just hadn't been aware how skinny he was getting.
He weighs 29 kg and he is very tall far his age 152cm
He has a small appetite but does eat a mixed diet. I have never forced him to finish a plate, food is a pleasure not a chore.
A family member who hasn't seen him for a while has suggested he is too thin, so I looked up the growth charts and he is -4 bmi.
Now I am scared something is really wrong.
He does plenty of sport but does get very cold.

I think that you should arrange to go and see your GP and talk it through with them.

You need to take him to the GP ASAP, as in tomorrow! Ask for medical checks to be done including blood tests, and ask for a referral to a dietician and possibly a paediatrician. Qualified medics need to be assessing what is going on here and providing advice and management.

Sorry, don't mean to panic you. He may be naturally thin but he does sound very underweight, so do get it checked out ASAP.

He does sound very thin. However he is only about 3kg off a healthy weight. I would also take him to the GP tomorrow.

Yes GP tomorrow.
Its always been a bit of a joke that whatever he eats just makes him taller but although he is still growing taller he just isn't putting on any weight at all.
I have been looking up all sorts of charts tonight and kicking myself that I hadn't noticed.
He's at an age when he deserves a bit of personal privacy at bath time, we haven't been swimming for a couple of months with winter and colds so I haven't really seen him without jumpers and hoodies piled on.

Watching with interest as my ds is also very skinny and I can never decide whether to see a gp about it.
Has he always been slim? Has he grown in height a lot recently? What are his energy levels like?
My ds is also tall for his age and comes out at around 1-2nd centile for bmi. He has no fat on him at all anywhere and also feels the cold. But he's full of energy and seems very healthy.

Goggle is not my friend this early in the morning, now I am really worried and desperately sorry I just hadn't seen how much weight he had lost.

looking back over the last few months and weeks he hasn't been eating well. Lots of prevaricating, getting down from the table, getting his drink just so, but not starting to eat. Then clearing the plates fast, before I really notice what he has left..

Then again I am hypothyroid and on 100mg levothyroxine but never really put much weight on. 10.5 stone at 5 ft 10 . I must have been hyper for years before the thyroid packed up.

Always been more aware of Dd body image, eating and weight, just didn't notice Ds wasting away right in front of me.

I definitely think you should take him to the GP. By my calculation he is borderline on the 0th percentile for bmi and his bmi is 12.5. That along with the behaviour you describe is suggestive of an eating disorder. The GP needs to rule out any other medical reason too. If it is an ED then early intervention is key to prevent long term damage to his body.

The behaviour sounds very worrying, in conjunction with his weight loss. Hope you get some help from the gp.

Right the appointment is Thursday.
Been into school and asked if they can keep an eye on him at lunchtime.
Stocked up with all his favourites and started a food diary.

Now I can see how thin he has become, just can't believe I didnt notice.

There's not a lot of information about eating disorders in boys.
If anyone has any advice I would really appreciate it.
He is a fun, laid back boy, doesn't appear to have anxiety or problems at home or at school but something isn't right somewhere.

You're doing the right thing Zan. Hindsight is a wonderful thing. I hope the GP can reassure you and get a plan in place.

Can you make sure that he has full fat milk and yoghurts, butter rather than spreads etc. while things are being looked into?

Don't beat yourself up that you didn't notice, you're his Mum, you see him every day and you just look at him as your child, not objectively as someone from outside would.

The GP will be glad you've recognised this and should give you some advice and maybe do some tests.

If you're tall though I wouldn't panic too much. I'm 5' 10" and 9 1/2 stone, son is 6' 2 and 10 stone and both perfectly healthy, if a bit skinny. It sounds like your son is going to be tall and is currently using all resources to grow upwards rather than outwards.

I do try and encourage my son to knock back packets of chocolate biscuits - but some people are just made that way.

OP I didn't want to read and run.

You are doing all the right things now, so try and keep calm until you can talk it through with your GP.

It might be a might be a medical thing, it might be an emotional thing, or it might just be some weird anomaly that corrects itself. Step away from DR GOOGLE!

Does he have friends? Does he have an online life...I would be making checks there.

Look at what you all eat-
Whole foods- no low fat, no synthetics
Good proteins- chicken, turkey, fish, quorn, steak,
Legumes/Pules- chickpeas, lentils, rice, cous cous
Veg/Fruit
Dairy-real butter, full fate yoghurt, cream etc
Carbs- pasta, rice, potatoes,

Things to add good calories-
Breakfast,
would he eat a super smoothie with toast/cereal/crumpet/porridge, would he have eggs?
scrambled eggs are fast and delicious. 3 eggs scrambled piled on top a toasted muffin with butter and a smoothie would be a good start to the day. You make the smoothie the night before and keep in the fridge.
Smoothies we like-
Almond milk, chocolate soy milk, banana, ice, almond butter
Mango, berries, banana, almond milk, ice and apple juice

Lunch-
Soup
sandwiches, whole wheat seeded bread- tuna mayo with avocado, chicken with cream cheese, pesto and tomatoes
sub rolls with various fillings
pasta with various toppings

After school snack the French call it Goute with I love
Cereal bar- make your own or buy?
Brioche bun and a piece of fruit
Crudités with dip
Couple of biscuits and a hot chocolate/decaff tea/fruit tea/glass of pressed juice.
Handful of nuts and a banana

Dinner-
home made turkey burgers with cheese, guacamole, rice and stir fry broccoli
stir fry veg with salmon and noodles
chorizo stew with veg and butter beans served with granary bread
lasagne
shephered pie
chilli and rice
lemon chicken with rice and soy beans
chicken/steak or prawn fajitas with guacamole, rice, beans and cheese
Pesto pasta with chicken, feta and olives

Fruit/yoghurt for pudding and sometimes a proper pudding
Sponges, flap jacks, brownies, ice cream,

Light supper-
Cheese on toast, crackers with various toppings, smoothie.

It may not be an ED, there could be many things going on.

Talk to him, not about not eating though unless he brings it up. If ED is the eventual diagnosis then you will do lots of talking about it with support from specialists. Take time each day just to ask him how his day has been, hang out together, you may find out a lot that you didn't know that way, kids often open up if you just spend time doing everyday stuff with them, no pressure. I also agree with checking his browsing history, mobile phone if he has one, diary even, and his bedroom may reveal things if you look. Do this without him knowing you are checking on him, he may hide things if he thinks you are watching him.

If ED is suspected by GP after blood tests and other investigations then F.E.A.S.T is a good place to start to find out about Eating Disorders. Website here.

This is a good article on E.D, here.

These videos explain E.D well along with issues to do with treatment.

My advice would be to do the food diary for a week and get the school to record the lunch. This will be helpful for if you are referred to an ED specialist. He needs to be observed closely at meal times to make sure he is not hiding or throwing away food.

Once the week is up start a food plan and he has to eat everything you put in front of him, no bargaining (ie swapping high calorie for low calorie items). You need to build up the calories gradually because of the risk of re-feeding syndrome which can happen in people who have eaten very little over a long period, it is advisable to do this with specialist help from a paediatric dietician who can help you work out his required daily intake. A boy his age should be on 2032 kcals per day, but in order to gain weight he may need up to 4000kcals eventually for a period of time. He also needs to have multivitamins daily to ensure that he has enough trace minerals and vitamins to convert food into energy in his body and avoid refeeding syndrome, which doesn't only happen in cases of ED.

Let us know how you get on at the GP, push for a dietician referral at the very least whilst awaiting test results.

If it does seem to be an eating disorder when your DS is seen by the GP, OP, do make sure that the GP refers your son to CAMHS (child and adolescent mental health services) - that is the correct service to treat eating disorders in young people. But it is an IF....it may not be an eating disorder (although it does sound from what you say that there is some avoiding of eating going on).
Do let us know how you go on.

Thank you so much for all your advice.
Doctors tomorrow first thing and then see what comes next.

I have had time to have a long hard look at the whole family attitude to food and just how much of an Orthorexia View I have.
I have denied Ds perfectly decent after school snacks in favour of a bowl of vegetable soup, full of organic, nourishing blah blah blah but no calories.
Scary thought that I may have slowly been starving him.

Tonight it's chicken, peanut sauce and rice.

That's an interesting point - but you really shouldn't beat yourself up about it. It's such a difficult balance and we're so bombarded with healthy eating messages for adults that it's easy to forget children need a very different diet, calorie-dense, plenty of fat and protein. I went through the same sort of realisation when we decided we had to try and feed my DS up, so now instead of say, an apple as a snack, he has a block of cheese, some ham or a few mini sausages etc. we've switched back to full fat milk and I put cream in puddings, things like that.
Let us know how you get on at the gp.

No definitely don't beat yourself up.

As Lizzie says we get so focused on the 7 a day rule that we forget about the other elements kids need for a balanced diet and that their needs are different to our own.

The good thing is you are noticing things now, he is young and can quickly recover.

So been to Dr, lovely Dr as it wasn't easy to hold it together.
Food, weight and your child is very emotional.
I will never ever judge anyone on how they feed children ever ever again.

Ds actually weighs 28 kg, even less than I thought, but interestingly he is tracking exactly as he did when 6 and 4 years.
I had taken him to Dr at 6 for tests for milky white poo, everything came back normal then and it seemed to get better but now he's 10 I don't know if his poo has changed and he doesn't say it has.

Got bloods done and Dr will call me as soon as results back then see what turns up but also agreed referral to eating clinic as I am seeing some eating disorder signs(cutting food up into tiny pieces)

Wait and see, meanwhile fish and chips which we get once in a blue moon tonight.

Well done, OP. You are doing all the right things.
In the meantime perhaps keep a closer eye on his eating without making it a big deal or a battle, but up his calorific intake overall e.g. whole milk instead of semi skimmed; full fat yogurts etc.
Chase the referral to the eating disorders clinic if need be, and did the GP offer a further appointment for review? If not this would be a good idea, to monitor weight and overall health.
Try not to beat yourself up. I had this with DD when she was 15...went very skinny before I had even noticed. She improved with time and support and now has no issues, but it can be easy to miss.

Great! You are on the right track now! Well done and your rights its so hard to see our kids in pain or see something not be as lovely and rosey as we might hope.

Fish and chips sounds good- mushy peas and a pickled onion that all
Important veg! of all the fast foods fish and chips is head and shoulders above the reat as its real food.

Selks so glad to hear your Dd is well, its wonderful to hear there is a light at the end of the tunnel.

nilbyname the rose tinted glasses are now off, its been a shock to see the truth in my Ds, in myself, in my family and the way we thought we all appeared to the outside world. Full 180 degree turn around.

Glad the doctor was lovely. Hope you get done answers soon