What else can I add to DD’s diet to help her gain weight?

[Queijo]

Dd has always been on the cusp of being underweight, no matter what she eats. She’s 7 now and recently had a growth spurt so is tall, but very, very slim. I’ve got her a referral to the hospital, but in the mean time what else can I do?

Breakfast is usually dippy egg, butter and seedy bread soldiers with full fat greek yogurt, honey and frozen fruit. Or avocado on toast, or nut butter on toast. Lots of things on toast!

Lunch is a school hot lunch. At home she’ll have wraps with full fat cream cheese and smoked mackerel or salmon, then hummus, pitta or breadsticks on the sides, nuts and some fruit

Dinner is usually pasta with a creamy sauce, a fatty cut of meat with fortified mash, veggies in butter anything I can sneak some cream/butter/cheese into really.

Snacks she has nuts, crisps, chocolate, pastries, basically anything high calorie.

She the slimmest in her class by far and she’s noticed now, and I don’t want it to become more of an issue.

She sounds fine. You don’t need to fatten her up unless instructed by a GP. If any concerns book an appointment.

We use paediasure for ds5. It makes up about half of his daily calories still (all overnight...). Your dd sounds like she eats a really healthy and varied diet from that example though, and someone has to be the slimmest?

Ds is very tall and has never been a healthy weight, always at least 3 percentiles down compared to height. He's also not the skinniest in his class, though he was as a baby.

Is she under paediatrician and/or dietician?

Yes - she has a referral because I’ve been to the GP who agrees she is quite underweight. I did mention that in the op, 3 lines in. But thanks for your input.

She’s been referred to the pediatrician. I’m just worried about her, she has low energy levels and gets tired super quickly.

Plus if she ever gets ill and is off her food it almost feels catastrophic as she doesn’t have any weight to lose. I feel quite stressed with it all.

Porridge /rice puddings with full fat milk. Toad in the hole!! Macaroni cheese... Full fat cheese and blue milk. Same issue with ds 9...

Hot chocolate made with a good glug of cream.

Is she actually eating the school hot lunch? Have you considered swapping to packed lunch so you can see what's she's eating?

Pediasure is great but shit expensive if you don't have it on prescription.
Milkshakes with fair bit of added cream is a big one for us. And cheese. Lots of cheese. Would she eat babybels or cheese cubes as a snack?

To be honest OP it sounds like her diet is pretty good and very high in fat so unless your going to through in lots of takeaways I don’t think you can add in much more until the dieticians come in with shakes etc that can be added to her diet unfortunately.

Has the GP done bloods to see if she’s low in anything particular like iron or b12?

She never ate packed lunches - even if I filled it with crap! One of the lunchtime assistants keeps an eye without hanging over her making sure she has a good portion. She always had pudding and custard as well.

I’ll get some pediasure, she loves strawberry milkshake so maybe if I make it with vanilla ice cream and cream that can be a good post-school snack.

thank you!!

What is she drinking? Any way to increase calories that way?
It looks like you are doing the obvious things, and she is eating a good variety. So, eat more at each meal (pudding after every meal?), eat more often, or drink calories seem to be the other options.

How slim is she? DS1 hovers around the 5th centile. Occasionally popping upto 9th. He is also noticeably slimmer than his peers, so comparisons to others isn't always helpful, as technically he is a health weight....
But also remember dropping some centiles after a growth spurt is normal, and she may adjust back to her normal line fairly quickly.

We generally had a pattern of:
Breakfast at home, breakfast at nursery/school, mid morning snack, 2 course lunch, mid afternoon snack, 2 course dinner, supper. It was endless food!

Yes all her bloods are fine, so nothing serious underlying. She just can’t hold weight for anything.

If she was just slim it would be fine, but I can see every single vertebrae whilst she standing relaxed. It’s v worrying.

Can you just add in an extra couple of snacks a day? Maybe increasing the meal frequency will help. Milkshakes with banana, peanut butter, caramel etc might be a good shout and very slowly increase the portions.

My own dd is absolutley tiny. Incredibly thin. We've been through all the referrals and tests. We were actually told to give her aN entire large bar of white chocolate, 2 frubes and 2 cheese strings ( she was about 4 at the time) every day on top of all her food and nutrition shake by the hospital dietitians to try and rapidly increase her calorie intake as well as adding olive oil or butter to everything possible. In reality it made very little difference. She is just tiny. She is a latent coeliac which doesn't currently account for her low weight but might have an impact in the future so it might be something to ask about being tested for in your case. For us it's about just constantly offering food, not all of which might be seen as the healthiest but she needs it to keep going and have enough energy to sustain her for now.

I am going against the grain here and say don’t.

you have a paeds referral. Feed her a normal diet.

if you stuff her with calories and she gains weight, you will disguise any underlying issues.

last thing you want is to turn up at the paeds appt for them to say her weight is fine, or only just below normal, and what’s the worry. When it’s only ok because you’ve been stuffing her with an unsustainable amount of food.

feed her a normal diet, keep a food diary, and do nothing until the paed advises different.

Assuming she's been tested for diabetes?

@Queijo , @GoodnightAdeline , I did mention that in the op, 3 lines in. But thanks for your input. It wasn't mentioned other than I’ve got her a referral to the hospital

Agree with @Yogatoga1

You sound like you are doing a great job with her nutrition but I understand the worry.

When I was a child I had peanut butter in everything (didn’t work!).

I think if you are providing plenty food then you just have to assume it is her build. One of my dc is on the cusp of underweight too.

what is more concerning is her low energy. Has go not ordered blood tests? I would have thought that would be done before referral. Full blood count, check for diabetes, problems with kidneys etc can all be done very quickly with blood tests

Have you considered coeliac? Her diet sounds great. I was tiny / underweight as a child and my mum fed me custard and chocolate milk. Made no difference. I wasn't diagnosed until I was in my 20s but I put on a stone in about a month.

If she’s eating at the moment, I would try not to worry too much. (I know easier said than done). You sound like you’re doing a great job and she will be fine until you’ve seen the paediatrician or dietician.

When one of mine was little, we had to add calogen and maxijul into all his meals and additionally give him fortisip milk. This should only be done under medical supervision but what I’m trying to say is, wait until you’ve had your referral because they are options available.

Good luck.

Definitely no diabetes, she’s had blood sugars done recently when poorly with tonsillitis and they were low due to not eating but came up and stayed up with apple juice.

Yes have had bloods and no cause for concern there.

I don’t know, maybe she just is a skinny kid that needs more sleep than others but there’s that nagging thought in my head that there’s something wrong.

I agree I need to keep up with healthy diet and wait for the consultant appointment. Just hard to stop my brain being bonkers about it!

Bless her, she sounds like she’s got a really healthy diet and you sound like you are doing a great job. Honestly I would wait to see what the doctor says.

This is really sensible advice I think.

No I hadn’t thought of that. What would be the symptoms if you don’t mind sharing?

She doesn’t have digestive issues as such, no constipation or diarrhoea which is how I thought coeliac presented - but I have no idea!

To gain weight - ice cream - its calorie dense (you don't need much for impact) and I'd bet she would eat it. Scientifically it will impact because it's densely packed carb and sugar, just encourage good oral hygiene after to protect her teeth.

What weight and height is she?