Nutritional shakes

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My child has just turned 4. He’s always been small, born on 10th centile, but having just measured height and weight he’s dropped to 3rd centile. 2nd is classed as underweight. He is a very fussy eater at home and doesn’t eat much, but I’m told at nursery he is excellent, one of the best eaters and will ask for seconds and thirds! I am not a bad cook and even make the same meals he has at nursery to entice him but he wants the usual, McDonald’s, fish fingers & chips etc.

Can anyone recommend a good shake like paediasure, but more organic and with less crap in it?

Does anyone think we should speak to GP now, or give it a couple weeks of trying to actively get him to gain weight ourselves?

Do you have dietician support?

If he is on the same for both he's not necessarily underweight. Usually it's a concern when the weight is much lower (more than 2 percentiles) than the height. Especially if he was small at birth.

For upping weight I would first look at adding hidden calories to beef up the number of calories per mouthful. Add cream in to mash potato or put peanut butter on apple slices instead of giving an apple for example.

My daughter is on the 1st percentile for height and her paediatrician and dieticians are happy with this as she has always been small and I'm short. I was only ever on the 2nd percentile for height and weight and my sister didn't reach the 0.4th percentile until she was 1 and stayed there until 2 when she started to move up a bit. I am from a family of small people!

My daughter goes through phases of only eating plain pasta with olive oil at home and it's only when she also stops eating at nursery we get worried. Peer encouragement is a wonderful thing and nursery can work magic!

We don’t have any professional involvement yet as we’ve only just weighed and measured him again. Would you suggest we speak to the GP or wait a couple weeks to see if our dietary changes (like you’ve mentioned) make a diffference?

I just put his height in to the WHO centile calculator and apparently he’s on the 58th centile, so nowhere near in like with his 3rd for BMI.

Also, the WHO centile calculator states he’s on 17th centile for weight but the NHS BMI states 3rd.

You probably won't notice a huge difference in a few weeks so I would book something now and get proper measurements. My daughter gets measured every 3ish months at the hospital and depending how well she stands there can be a few cm error in height measurements which can have a big impact on where she is on the percentiles. When she was still having length measurements she lost 4cm in 6 weeks...both measurements were probably slightly wrong the first too long and the second too short.

The difference shouldn't be that significant. I have a copy of the 2-18 charts and at 4 is when the UK charts stop following the whole guidelines but the difference in the 2nd percentile at 4 between the 2 charts is 0.5cm (95cm for who and 94.5 cm for UK90) and for weight 2nd percentile is 12.5kg for who and 13.2kg for uk90. Do you have your red book handy that would be the best place to look for the right charts.

For the 50th percentile figure. Was that a BMI calculator? If so that will be right if they are on the same percentile for height and weight.

You could also contact your HV. They can also make dietician referrals

I would make your own "milkshakes" for him.
Protein powder, banana, Peanut butter, full fat milk, chia seeds if he'll tolerate them (my 4yr old will but 6yr old won't!) all whizzed up in blender.
Also increase calories in ordinary foods such as cream in mash potatoes, anything you can think of to increase calories at this stage.