1 year old on 9th centile but parents 5'7 and 6'2

[artisanroast]

Hi,

I'm looking for some advice...

My daughter was born 4 weeks early and corrected weight had always followed the 25th centile for weight.

Her first height was between the 50th and 75th centile - this makes sense as I am tall and skinny.

My daughter has had a diarrhoea and vomiting bug for a week and then immediately after had a cold for 2 weeks.

During her diarrhoea and vomiting she returned to being exclusively breastfed as she refused food.

Her diet now remains poor and seems to be living on pasta and white toast. She is refusing everything else.

She still has diarrhoea but the GP has now asked for a sample to be sent off.

Oh, I should mention that she had an ear infection with her cold so was on antibiotics too.

I think all of this would affect her weight but not her height.

I have checked her height 3 times now so it is correct and marked correctly on the 9th centile.

She was refusing multivits so she is now having them forcibly syringed into her mouth every morning.

I still breastfeed evenings and during the night but should I stop in favour of cows milk or formula milk?

I'm worried she perhaps hasn't had adequate nutrition since weaning and that's why her centile point is so low.

Any thoughts would be appreciated because I have been up all night worrying.

My husband is coeliac so I have a GP appt to discuss the centile points, diarrhoea, and if she may be coeliac.

My first thought was coeliac and then with a family link the chance goes up to 1 in 10 and isn't being helped any by only eating pasta/toast.

I wouldn't switch to cows milk as if it is coeliac there's a chance of lactose intolerance as well.

Ds2 was large at birth but after a gastrointestinal issue he failed to thrive staying in the same height percentile for months until I got him diagnosed.

Go to your doctor and get her checked for coeliac stating the 10% chance of it being inherited.

Don't remove gluten until tested as the blood tests will only show positive if she's being eating gluten in the weeks beforehand.

How old is she now?

I think the coeliac thing is worth following up on, and a general gp appt to discuss your worries.

Keep up with the bf, always going to be better than cows milk. Until 1 year breast milk is a complete food source and will provide most of their nutrition.

Some children do grow in "steps" rather than a nice convenient centile line. Huge growth spurt, then they settle down for ages while they focus on developmental stuff and weight gain.

However forcibly giving her vitamins? That sounds horrible for everyone, and is probably not much benefit. Leave off that until she's seen a GP.

thanks :) will do

I did so much reading when I was pregnant on how to reduce the risk of her becoming coeliac and the advice was breastfeeding and slightly earlier weaning with introduction of gluten. Longer bfing. I did the lot!

I even went to an allergy conference to make sure I was doing the right thing!

It may just show there is nothing you can do!

Thank you.

I really appreciate your post :)

xx

You poor DD. She has been poorly. I think you're doing the right thing to get her checked out. They grow a lot in height between 1 and 2 years, so it's good to keep and eye on it. If you are worried about celiac, maybe see if you could get her off pasta and bread? I know that's hard though and she needs to be eating gluten before she's tested, if they do a blood test for celiac.

They might just say wait and monitor, but trust your gut feeling and insist on a referral to a paediatrician if you don't feel happy.

We are the same heights and my DS was always on the lower centiles for weight and height. He's six now and still skinny but just starting to get nearer 50th centile for height. Also, he went through a fussy stage aged two of only eating cereal, pasta and toast. It passed. If you are slim yourself, your daughter is likely to be too but I would ask the GP if you are worried about coeliac.

My dcs were full term & over 8lbs but dropped down the centiles. They were all the smallest in their school years for a long time but have gone through puberty late and are now back where we'd expect. Were either of you small children/later developers? Just worth bearing in mind, I don't have coeliac experience .

I know a very very tall couple. Their first 2 dc are also very tall, as expected. Their last dc was born tiny and at 10 is still really small. They of course had all sorts of tests done butt there is thing amiss, it's just one of those things.
Sorry your dd has been poorly. Please don't get obsessed with weighing and measuring , you'll drive yourself bonkers ( I have been there and it drove me bonkers)

While coeliac is possible, it isn't also common to get transient intolerances to lactose, wheat etc after GI bugs, can persist for a few weeks while the gastric mucosa repairs itself properly. And this can also cause the ongoing diarrhoea. Growth halting while unwell like this is usual, once recovered you would expect to see catch up growth back to their usual genetic centile line, can take a few months. Hope the results are all good xx

thanks ladies.

I needed some reassurance this morning.

My daughter is a year old.

I'm going to keep her on gluten until after she has seen the GP because if they test her for coeliac disease I want a true result.

I'll speak to my GP about potentially removing gluten/lactose until her bowels settle.

MIL can't have gluten or lactose and follows a low FODMAP diet.

DD is very like her Dad so I wouldn't be surprised if she had his coeliac disease too. I really really didn't want her to have it if we could avoid it.

xx

It should be relatively easy to get a test for coeliac and as they can do it via a blood test it's not too bad for the child.

I have a DD with a growth delay issue - she has no endocrine IGF-1 but doesn't have typical IGFD or Larons. IGF-1 is basically the ignition switch for the body to use growth hormone - she has tonnes of growth hormone but no way to use it.

I come from a family of giants and DD was born at 97th centile. By a year she was at 25th and by 24 months she was at 4th centile. We were referred to the endocrinologists and had a battery of tests done which showed the IGF-1 issues and a delayed bone age. It was incredibly obvious that there was something wrong by the time we got as far as the hospital.

DD is now 7 and we are still on watch and wait as she is growing, albeit nowhere near her genetic curve. We see the hospital once a year.

I stopped breastfeeding when she was 3.5 years and the hospital were very clear that breastmilk is much, much better for her than cows milk or formula or many foods that she could have had instead, so please don't feel that you have to give that up.

Vitamin drops are great, and there are also gummy sweets that are often more acceptable to children. DD was totally uncooperative and we struggled even with the syringe so well done on that count!

I was very worried that DD's growth issues were because she ate so little and only about 4 things, but hospital said that she was not malnourished. IGF-1 has huge influence on things like hunger and so she just isn't ever hungry. I probably look like a dreadful mother as we try to get her eating high fat and high calorie rather than worrying about carrot sticks etc.

Try not to get too stressed with the measuring - even when hospitals are doing initial 'urgent' investigations they only measure every 3 months. Any period of ill-health will often result in low growth and then they will catch-up. Often you get a big catch-up at the end of a nice summer - running around in the sun seems to help. For that reason they discount any measurements that are too close together.

Makes it very stressful for parents when you are worried and it takes such a long time to get any clear picture or answers.

How is her weight centile compared with height?

with the history of parents/grandparent it's worth investigating.

If she has had diarrhoea for an extended period then giving her a probiotic may help - all that runny poo can flush out good bacteria. You can get Optic from the pharmacy. We found it helps.

Optibac that is...spell checker...

Hi,

Thanks I have her on probiotic yoghurt and the bowels finally became normal again yesterday and today.

My DD is on the 9th centile for weight and height but previously was 25th for weight (that was constant) the height has only ever been taken twice - birth and one year. This appears to have dropped from between the 50th and 75th to the 9th.

Thank you Elf for taking the time to tell me about your daughter. It's reassuring to know that maybe I should be proactive about this

xx

elfonshelf I wondered if you have been in touch with the Child Growth Foundation? I know that some children are prescribed growth hormones when IGF1 is low as they can't grow to their genetic potential otherwise and might not get the growth they need in puberty to reach normal adult stature without some help.
I assume your DD's bone age is being monitored as bone age can increase rapidly from 7-10 which needs to be managed for children around the bottom of the charts.
I know from bad experience that the quality of growth monitoring and advise varies from very poor to excellent.

I was in touch with them, but we see the European expert in IGF-1 disorders at the hospital (reason for selecting that hospital), and DD is in all sorts of research things they are doing.

We've just seen the Endo and her latest bone age has come back over 2 years delayed which is an increase on the last one. She grew nearly 9cm in the last 18 months which is brilliant and is tracking the 9th centile (way off genetic but tracking is something).

We're seeing them again in 18 months and doing a new x-ray and set of bloods beforehand.

Current thinking is just to keep tracking her until she stops growing in her 20's. Strong family history of constitutional delay of growth and very delayed puberty on both sides so that is being factored in as well. We agreed that further testing at the moment would be because it's intriguing rather than in DD's best interests and the next lot of tests aren't much fun, so they are now on hold. If her growth drops or anything else happens then we will rethink. GH wouldn't work in her case, it would have to be be IGF-1 replacement which is a huge step and with the whole crappy situation over the patents, I'm relieved that we're not having to do that at the moment - v worrying for parents who are.

I was very lucky that my GP took it very seriously at the start and we spent a lot of time finding a good consultant - you are right that it makes a big difference if quality of advice and monitoring isn't good.

I found the Magic Foundation in the US helpful initially, especially as given DD isn't GHD or IGFD, she doesn't fit in any of those groups easily.