4 yo growth/weight/food issues

[SecondhandTable]

I'm so worried about my almost-4yo. Shes always been a fussy eater, worse and better in phases, and gradually sort of going down height and weight centiles the older she has gotten. I've been properly concerned for about 6/7 months now to the point where she's seen 2 different HCPs. The second confirmed she is dropping centiles but still said they don't need to do anything. I'm not reassured at all and I weighed her again today and she's actually lost weight again this time compared to a month or so ago. I'm going to get her seen privately by a paediatrition because nobody in the NHS is taking this seriously. She's short and has tiny feet too and meal times are increasingly stressfull for everyone and we need support.

Has anyone been through this, do you have any advice? Is there anything I can do to help? She is officially underweight now and it's so obvious looking at her. I'm worried people think I don't feed her etc. I just don't know how to fix it and I'm so worried, she's so thin now it breaks my heart to look at old pictures of her as a chubby little baby or young toddler and compare her to now with all her bones sticking out and clothes hanging off her :(

Has she had bloods taken? Or any other tests?

What does she eat on a average day? Does she have certain safe foods she’ll happily eat?

can you give her multi vitamins? Will she drink full fat milk?

I would also find this stressful and worrying

She has had various bloods done once for an unrelated reason about 2 years ago, the only thing that showed up was a high inflammatory marker. So they repeated that again a few months later and it was still high but the initial reason why she had the bloods had resolved and she had no other concerning symptoms so GP said it was probably just from a virus or something she'd had recently and nothing to worry about and no point redoing. Nothing since then. She saw the GP a few weeks ago who wasn't interested in requesting bloods (or indeed doing anything at all).

She has foods she likes and foods she never eats. However the foods she likes she often won't eat them either, it's really hit and miss, or she will eat miniscule portions. She would probably eat loads of crap like chocolate/sweets/cakes if I let her but I don't see that being a solution and the NHS webpage on underweight children says not to do that, so I don't.

There's not really a typical day as some days are much better than others. Also she is sometimes looked after by my DPs and she goes to nursery twice a week etc so it really depends. My DPs give her a lot of crap, she was there this afternoon and today she ate roughly:

Breakfast : 165ml full fat milk, 5 blueberries, half a banana, probably about half a Weetabix with full fat milk as she left a fair bit of it.
Morning snack: half a piece of medium brown toast with vitalite spread and 150 ml apple juice.
Lunch: half a Gregg's vegan sausage roll with about two tablespoons of Heinz reduced sugar Ketchup, 1/2 an M&S profiterole, 6 squares of dairy milk chocolate, most of a medium sized double choc muffin.
Afternoon snack: a satsuma and a handful of rains.
Dinner: less than 1 veggie meatball, about two teaspoons of rice mixed with refried beans.
Another 165ml full fat milk and multivitamin tablet before bed.

I don't let her eat anywhere near that amount of chocolate/cake etc at home btw but she probably does have like one day a week like this at her DGPs. She's vegetarian too I probably should have mentioned.

Have you asked for a dietician referral?
Why is she vegetarian? Will she eat egg or foods containing eggs?

I watched an episode of the three day nanny the other day and she suggested that the four year old on there (who was a very fussy eater) was drinking too much juice etc which was filling their tummy meaning they just weren't hungry, arguing that if a child is hungry they will eat. Would it be worth trialling cutting out milk and fruit juice and only giving her water for a week or so to see if that increases her appetite? I understand the idea of cutting out milk and it's calorific value might feel anxiety provoking though but if it was a short term thing might feel more manageable?

Another thought-does she get tummy pain or anything? Just wondered if there's any intolerances there which might put her off certain foods and lead to weight loss etc? X x

We are vegetarian so she is too. I think this is a red herring though as there's no reason she couldn't have a balanced diet being vegetarian and even if I were to give her meat/fish she is not going to eat it or at least not any better than anything else.

I did query the possibility of a dietician referral specifically with both the HV and the GP when she saw them and both said not necessary and no action necessary so didn't make the referrals.

She does like eggs, she likes boiled egg whites and leaves the yolk, she likes scrambled, poached and fried eggs. She also likes eggy bread, and pancakes. She generally eats eggs well but even then she is just generally hit and miss and sometimes will just refuse seemingly randomly.

Test for coeliac
She fits the profile

Yeah I can understand that, so generally I'm pretty strict with juice, she mostly drinks water. She had a drink of apple juice today because they offer it at the children's centre. She had some squash at her DGPs as well actually with lunch and later in the afternoon, I forgot about that. At home she just drinks water unless we have visitors. So for example the next two days she's at nursery and she won't have any juice those days at all.

I really don't want to cut her milk out because it's part of her routine and it's some vague comfort knowing she will get the nutritional benefits of that in at least.

She does complain of stomach pain on occasion but not particularly frequently. She does get visibly very bloated though and she often does lots of stools a day and often huuuge stools and sometimes varying consistencies. I definitely have thought of intolerances etc, raised this with GP who was not interested. I don't feel I can try elimination diets given how poor her eating already is.

Definitely demand z coeliac blood test

www.coeliac.org.uk/information-and-support/coeliac-disease/about-coeliac-disease/coeliac-disease-in-children/?&&type=rfst&set=true#cookie-widget

Dd was diagnosed after poor growth losing centiles and being super fussy eater

Apart from the weight loss she sounds like she actually eats a fair amount? Unless what she had was unusually a lot today?

I was shocked at how small nhs portion size guidelines are for kids.

Probably today was unusual in the sense that obviously all the crap she ate in the afternoon at her DGPs was very calorific. Whereas most days she wouldn't eat all that super sugary calorific stuff all afternoon (cake, chocolate etc).

I agree that you are describing a child with a fairly classical coeliac presentation, potentially.

If she has now actually lost weight, rather than merely gaining slowly and dropping down the centiles, you have good leverage to go back to the GP and say, she needs to be seen by a paediatrician. Don't ask the GP to organise tests, just to get a rapid paediatric assessment done. There are often "short notice" clinics that she might be suitable for, not sure what they are typically called or how effectively they are running at the moment of course!

Don't try cutting out wheat or other things until she's tested.

Good luck.

Don't remove gluten from her diet as needs to be present wheh testing but do push for a celiac blood test

also a stool test given the high inflammatory marker and loose stools it couid be Chrones or similar which would cause weight loss also

Thanks everyone. I am going to call the private hospital tomorrow to arrange an appointment with a specific pead who is consultant paed and also a consultant paed endocrinologist. My DPs are also very concerned and have kindly offered to pay for us to go private (wouldn't be an option for us otherwise). I will also submit another e consult to the GP practice about the weight loss and our ongoing concerns. I'm getting DC2 weighed at the HV's clinic on Wednesday so I will also raise DC1's issues there too in case anyone there can help as well.

Probably not relevant but just to add some further context wrt her health she is suspected to be asthmatic, she also has hay fever and eczema too.

Look up the asthma - allergy - eczema triangle. Not all allergies are life threatening anaphylaxis and the fact she has 2 out of the 3 would indicate a higher propensity to food allergy or intolerance.
If it helps, my youngest DC was a lot like this and it loathes me to say he did indeed “grow out of it”. It took years but he’s now a healthy weight and you’d never know from the variety of food and portions he puts away now.

State in your e consult that you would like a coeliac blood test

I agree with other posters to request coeliac investigations then OP with those other symptoms xx from my understanding of autoimmune conditions that would link to the inflammation too I think? X

Just to add I'd start a food diary too and on there note down any other symptoms including poo consistency and any bloating/tummy ache etc x

So I put another e-consult in to the GP practice who responded with a text saying a clinician had viewed it and I need to call tomorrow at 8am to book a face to face appt for her. (Why can't we just book one today for a later date?!)

After a palaver I also finally got through to someone at the private hospital who said she needs a GP referral before I can make the appointment with the paediatrition I want her to see.

We are doing a good diary atm btw but a good idea to list any accompanying bowel symptoms etc. I also meant to call nursery to get the calorie info from them about their meals as it's my understanding they have to have that info? But I've been sooo busy arsing around calling a million places that I forgot about that one in time for today's.

Hi OP my son has gastro issues (IBD) and now possible delayed puberty and we are seeing a endocrinologist, she didn't ask what he ate.

just take a note of what she eats on a typical day - they will do their own testing, blood tests etc

When i spoke to our GP I literally requested a direct referral and he wrote the letter that day. You shouid get an appointment in next couple of weeks if private.

Saw a GP. He was reluctant to do anything, but after a lot of pushing has agreed to refer DD to a dietician. He is also going to do the private referral letter for me to take her to a paed privately and said this should be ready to collect on Monday. I also saw a HV at the baby weighing clinic for DC2 who has made a note for my HV to review my DC1's GP records and give me a call to discuss her too.

Glad you got your referrals

I know you've said you don't agree with loads of cake and biscuits but given she is loosing weight, I'd be inclined to increase the amount of junk/pudding.
Both mine have been slender. DS1 hovers around 9th centile. Aged 3, he'd have breakfast1, breakfast2, snack, lunch, snack, tea, dinner. It was endless. And, yes, there was cake, biscuits, custard, ice-cream. He's naturally dropped meals as time goes on - second breakfast disappeared when he went to school, and we finally got to 3 meals a day in lockdown, when his activity dropped. He's 13 now, still skinny, still eats, and still probably has too much sugar. But without it, I don't know if we'd get the calories in him.

Pursuing the private referral is probably your best long term solution tho.

I agree with you OP about keeping the milk if she drinks it happily. It’s a brilliant source of nutrition.

I’d want that inflammatory marker investigating. Gut problems can affect your appetite.

The bloating does point to an intolerance and these are worth investigating. My DD has a mild dairy allergy that she’s nearly grown out of. She can eat well cooked dairy products but even a teaspoon of milk makes her bloated and funny poos.

Insist on the coeliac test. If that comes back negative I’d ask the dietician for skin prick tests for other common allergens.

I had a ‘mild’ intolerance to soya as a child but no one realised. It led to bowel inflammation and I now have IBD.