Underweight 9 year old - is this a bad daily diet?

[Stripyseason]

My 9 year old has always been slim but more so the last few years, she’s now dropped a centile so I’m trying to get her to put weight on but seem to be failing! she doesn’t naturally like dairy or cheese.

breakfast
grapefruit with honey
1 slice white bread
2 x bacon rashers

snack at school
crisps

lunch at school
hot meal- today was spag Bol. Never convinced she eats much of school lunch.

Snack after school
3 oatcakes, handful of pomegranate seeds, bag of crisps

dinner
tuna and sweetcorn pasta
Carrot sticks
fruit frozen pole

supper before bed
potato scone with butter

shes eating as much as her older brother but just not putting on weight, often needs a poo after eating with some tummy cramps but been tested for coeliac/ chrons/ IBD and all bloods fine so gp not doing any further tests,

for reference she hovers around 24jg but goes up or down by 0.1 and that’s it ☹️

My daughter was like this. I give her fruit, sandwiches, dinner or what she wants in a beautiful way. Also lactose free milk has made a difference to eating cereal, hot chocolate etc. It’s no fun to struggle to eat bit she is a healthy weight.

Kids often move around centiles a bit as they grow - those smooth curves on growth charts are averages, but an individual child would typically show a bit of variation around those curves as their growth isn't steady.

I fully agree with previous posters that many people have no idea what a typically healthy weight child looks like. Unfortunately a lot of children are far from optimally healthy, with inferior diets (nutrient-poor, high fat/sugar/salt, low fibre, lots of heavily processed foods) and far more sedentary lifestyles than a typical childhood would have had a few decades ago. A peer group comparison may not be a good benchmark, and many children and parents are surprised by how lean a healthy child can look, e.g. one of my children is on the 60th centile for BMI but gets ribbed by their friends for being 'skinny', 'two dimensional', and a 'beanpole'.

Your nine year old is only 120cm? My 5 year old is 121cm he is taller than average but she's 4 years older.
The BMI people are giving will be wrong if she is taller than that

Are you sure about her height OP because 122 seems short for a 9 year old to me. My 6 year old is 122, he's tall but not mega tall. If she's, say, 132, that will make a difference to how we are seeing her weight.

Why is she eating so many crisps? She's eating a lot of ultra processed foods which won't help her stomach issues. I've cut ultra processed foods down to a minimum and my son's stomach issues have decreased significantly and he rarely complains of abdominal pain any more. Our school doesn't allow crisps and I've taken him off school lunches to avoid all the crap he was eating. He's much better for it.
If the height and weight you've given us is accurate then she's not underweight.

You don’t need to have chrons to find that wheat doesn’t agree with you and she’s had bread and two lots of pasta in one day and a potato scone for supper. There’s not a lot of fruit and veg and it’s all quite beige.

Please remember there's a lot of overweight kids out there. She seems a healthy weight to me. My dc got stomach pains a lot but they settled at puberty, no health concerns

Even using inputs of turning 10 tomorrow, 24 kg, female, 130 cm, the BMI centile would calculate as 5th centile, i.e. towards the lower BMI end of the healthy range. If only just turned 9, this would be 9th centile.

The NHS calculation uses 2nd to 90th centile for kids as the healthy range. The National Child Measurement Programme uses a slightly different range for healthy weights of 2nd to 85th centile.

Yes, 120 cm would be at the lower end of the height centiles for a 9 year old girl. Some kids are small.

National Child Measurement Programme, England, 2022/23 School Year - NHS England Digital

My child dropped to the underweight category and we had a dietitian assigned to us. For comparison they were a similar height but under 20kg and dropped to 18kg at one point.

Easy ways to add in extra calories are adding butter and cream into foods. I would stir butter into soups / pasta before serving up. Cheese as a snack with grapes and peanut butter is another good one. Milkshakes or anything high calorie without filling them upto much. You can get special meal milkshakes but I doubt they would give you them without being a lower weight.

For the tummy pains did they do any allergy testing? You can pay for a private allergy test or you could ask the GP if they could run a basic food allergy panel

I can't see if you've said what her activity levels are?

Switch to gluten free diet and give her pro biotic tablets from Holland & Barrett. Add oat or plant based milk/yogurt/mousse puddings to her diet and include richer fruits & veg like bananas & avocado's.

Reduce the ice poles as that's just water and give her a dessert, let her choose but from the gluten/diary free range.

I was like your dd for many years and it's only now that I've managed to put on a decent weight. The gluten free and prebiotic tablets really helped to settle my tummy eventhough I wasn't diagnosed as IBS or coeliac.

Don't go gluten free without a clear medical reason from a doctor. It seriously restricts your choices and makes it harder to get a healthy varied diet

Does your DD like nuts? Anything with nuts in are good for gaining calories and healthy. My skinny child lives on Kind Bars that are mostly nuts.

It sounds like from what previous posters have said she is a healthy weight and you are doing a fab job of providing a healthy diet.

I think you probably need to take some of the pressure from yourself and her and relax.

Perhaps just a 6 monthly height and weight. Just for fun. Easy breezy 😀 Growth in height is a bigger indicator of health in this age group anyway. Weight will often fluctuate.

Tummy aches can often manifest from anxiety in children.

She’s not underweight, you should be able to see the ribs of pre-pubescent kids.

Can I recommend you stop weighing her? It fuels anxiety. Trust your instincts - does she have enough energy, is she growing, is she eating healthily enough?

You could try and swap out the at least some of the crisps for a different savoury snack, but overall her diet doesn’t seem appalling.

My dd stayed at 15th percentile weight and 75th percentile height for most of primary. I only weighed her if I thought her eating habits were shifting negatively (ie reducing).

She is now a teenager and 5 foot 4 and 1m65 and she weighs herself from time to time. She has a fantastic athletic figure and absolutely loves the fact she has a tiny waist and small boobs (she’s very sporty and likes to wear flattering clothes). On the whole she is skinnier than your average teen, but that’s just her and it’s fine I think.

Not weight-related but I would rethink bacon if it's daily unless you are buying nitrate/ nitrate free and unsmoked? There is a clear link between processed meats and colon and bowel cancer and people are developing these cancers at a much younger age i.e 20s.

Sorry, I know you didn't ask about that but I have cancer in my colon so am a bit passionate about it.

@TwigTheWonderKid that’s a good point about bacon.

It mostly looks good, I'd swap out the white bread for brown and ditch the bacon (too much salt)

Oh yes, totally this! No ham or sausage either

@LetItGoHome there's nothing healthy about bacon, supermarket bread, ice poles and crisps. There's little in the way of fruit, veg or whole grains. Some grapefruit and sweetcorn are the only fruit and veg. Bacon is a class 1 carcinogen.

I’d get her checked out , as per PP comment i’d prioritise thyroid (DS had undetected issue with this )

if you’re worried about not enough calories add ghee on toast or food generally and good quality high protein powder in cereal or water

i did these ^^ for DS who’s on adhd drugs so doesn’t eat much and his height increased by 20cm in 1.5 years (he was tiny before)

good luck x

Could you try to increase the protein content of her diet. This would increase the nutritional content of her diet, and give her fuel for growth. So less of the crisps biscuits snacks and fruit ( fruit is great but maybe she needs protein!) and more types of protein added from whatever she will eat. Meat, fish, eggs, cheese, milk, beans, nuts, chickpeas.
Add a source of protein to her oatcakes … slice of cheese/cottage cheese, hard boiled egg, turkey or chicken, tuna mayonnaise, hummus. Give meat and vegetable casserole for dinner ( batch cook if you can?) or salmon and roasted vegetables and baked potatoes, or lentil or bean stew with rice or pasta.

Yes cut out pork related products because of the intestinal parasite risk. Have you checked your dd for worms?

There was an article on BBC website not long ago about a woman who had health issues and severe headaches for years. They eventually found a parasite in her brain which made its way from her intestines. She had a pork/ bacon/ ham heavy diet so it's worth checking.