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 :(

Oh my god, it's just never ending. The GP I took her to see last week said he'd do an NHS dietician referral, and write a private paediatrician referral letter which would be ready to collect on Monday. I went in to the practice today and neither had been done. The receptionist was very apologetic and did me a print off of the consultation where the GP has just added a sentence about the private referral but the receptionist isn't sure the private hospital will accept this. She said if they don't, I need to call back and request a proper letter. Also the GP's note said about the HV doing a dietician referral which is completely not what he said to me! The receptionist then said she could do the dietician referral for me today. She's then just called me and said the GP in clinic today (different one from the one my daughter saw) has reviewed it and said there are no concerns on their side so they won't do the dietician referral and if I want one I will need to ask my HV to done. I'm sorry but WTF?! So frustrated and upset.

It is frustrating. I have to say that although it's annoying that the GP didn't do as they said they would, I'd arrange to see your health visitor.

DD's health visitor arranged DD's initial NHS dietician appointment. We were then referred onto the allergy clinic by that dietician.

The health visitor also spotted an issue with DD's eye that no one else had picked up on and was able to refer us to the hospital eye department herself.

If the GP isn't proactive about referrals, the health visitor could be a really useful ally for you.

Have you asked then to do a stool test as that needs doing

GP practice have reiterated they won't do anything at all and that our options are asking HV for input and/or private paediatrician.

Apart from finding out the cause of weight loss if any, having a dietitian does really help.
My dc is very very skinny. He has chronic illness and multiple food allergies. So, I was always worried, but luckily we had dietitian since he was a baby/toddler, who look at his diet regularly and reassured us.
He is a teen now, and still skinny, but quite healthy otherwise.

Could it be just a very bad diet more than a health condition.
The lunch menu you presented is quite horrendous from a nutritional point of view
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.

She is a fussy eater, is getting wore on that front, no wonder she has growth issues.

@SecondhandTable Your focus maybe should be on removing the ultra-process, nutrient-void food even the vegan ones, such as the vegan sausage , the veggie meatball and focus on real food. Make a bean burger, tofu slices, home made hummus , homemade falafel, a Dahl soup made with red lentils...

To me, it seems her issues are more linked to a processed diet, with lack of fresh food. with the exception of a satsuma, all her food comes out of a packet or can.

I agree it should be possible to be a healthy weight and vegetarian. However I would say it requires a wider palate than a meat based diet. Without resorting to a lot of processed vegetarian alternatives.
In this case, with your daughters health and growth at stake I would suggest you try including some meat. A lot of children will eat meat more easily than vegetarian alternatives. And this means fresh, good quality meat cooked from scratch, not processed/pre-made.

100% agree with you @Sparkl it is not unusual for vegetarian kids to be malnourished if they are not eating a balanced diet, and a fussy kid by definition will mostly eat processed food, sweet or savoury, and refuse real food. IN fact the OP says it herself, her child would happily eat sweet , cake and chocolate.

Malnourishment is most likely the cause of the stunted growth and should be addressed before making assumption about rare diseases such as coeliac .

I don't disagree with that really about the processed food, although in my defence that lunch was at her DGPs, she certainly doesn't eat that much rubbish when she is at home, I don't allow it. I am really finding it difficult to cook as much good stuff as I used to since we had DC2 though (8m) as he is very clingy and just cries if you try to put him down. I do regularly make things like bean/veg based curries, vegetable/bean pasta dishes, bean/veggie stews, tofu stir fries etc but she just picks out the bits she wants to eat, so she doesn't actually eat any of the beans or veg. And tbh even when you make things she likes and has eaten well one day, the next time she may just refuse to eat it or hardly eat it anyway so there's nothing I can make that she really reliably eats either so that makes it harder too.