Small DS 7 and questions about his height

[Postpartumhelp]

Does anyone have any suggestions as to (a) make DS confident about his height and (b) how I can make him eat more??

My DS is the smallest child in his class despite being autumn born. He was 75th centile in weight when born but dropped down to 9th when a baby and I don't think he even tracks the 9th now. He wears M&S 3/4 years trousers. I've spoken to GP about his growth before and have been told he's fine.

This morning DS asked why he was so small and whether he would be a small adult too because he doesn't want to be small. I think a lot of kids in his class must keep commenting on it.

I was positive/upbeat about it and said he would probably be DH's height and not to worry about it, it would all work out etc. DH and I are average heights (5'9 and 5'6) so I expect he'll grow to be around DH's height

The thing is, he never eats very much and he puts on weight incredibly slowly. He's always "too busy" to sit down and eat and always jumps up from the table to run around and fiddle with something. Getting him to sit and eat is very hard work. When we do get him to do it, he takes a few bites and says he is full.

We try everything to get him to sit down for the full meal but it's like he can't help himself. we provide good meals and also provide calorific meals to get him to put on weight. A typical day is usually - cereal/porridge and fruit, or a fried egg sandwich for breakfast, lunch is at school or omelette at home, after school snack is peanut butter sandwich, dinner is usually something like salmon and rice and veg, chicken fajitas, spaghetti bol, burgers and chips and salad, roast chicken and veg etc. He'll eat a few bites and say he is done eating then say he is hungry before bed so I let him come down to have toast.

I do make an extra effort to add extra calories where I can (ground nuts in porridge for example, more oil in pasta) but he never eats a full meal. I usually never say no to treat food like McDonald's or Greggs because I know he likes them but he doesn't even finish this. I don't want to make a habit of going to these places. I gently encourage him to finish if he can but never demand it.

Any tips appreciated.

I foster a teen. He came to me at 5 1/2 on lowest 1 percentile for height and weight. He was in size 18 months - 2 years clothes. In the beginning he was often sick after eating. I saw GP and HV and was told to feed him 4-5 small meals each day instead of 3 bigger meals. I added 2 teaspoons of cream to his porridge and scrambled eggs each day. I made him berries smoothies when he said he wasn't hungry so he still got some goodness into him. I'd add a cooked egg yolk to his mashed potatoes too. I'd hand him a little pot with 6 grapes and a carrot sticks as a snack because if he saw a lot of food it put him off. I'd give him walnuts too. By the time he was 10 he had managed to get to 10th percentile for height and weight. He's now almost 20 and is 5'8" tall and very fit, lean and toned with a six pack. Your DS will get there. My foster son shot up when he was 14 growing a foot in a year. Make sure he gets lots of sleep too. I got a blackout blind for foster son because when in deep sleep his body releases the growth hormone somatatrophone.

Honestly, I’d take him back to the GP as that doesn’t sound normal. My son is 4 and wears 4/5 M&S trousers and is average height in his class. I can’t imagine a 7 year old smaller than him!

Does he look skinny for his height? Or is he in proportion? What is his BMI? You can buy milkshakes specifically for getting calories into children and it might help. But I’d take him back to the GP / get a second opinion as well to make sure there isn’t something else going on. Coeliac disease for example can sometimes present like this I believe. Sometimes you have to be a bit of a squeaky wheel to make them take you seriously.

How you described his meals is very similar what my DS eats in a day too, he’s also 7 but wears age 8-9. I know you say he doesn’t eat much, is it always just a few mouthfuls? Do you know if he’s eating in line with portion sizes for his age? Portion sizes are surprisingly small for children. You can find some visual diagrams of meals/portion sizes to give you a better idea of what he should be eating. I’m just wondering, because it’s either that he’s not eating enough, or he is naturally small which means he doesn’t require as much food as a typical 7 year old, or he has issues with his growth hormones.

I would say that my DS eats like a horse, but if he’s bigger then his stomach is also probably bigger and able to handle larger portions. I wonder whether treating his meals like you would a younger child, I.e. reducing the amount but increasing the frequency might help? My youngest has always struggled to keep weight on (below 2nd percentile) and I use every opportunity to add fat to her diet (cream, full fat Greek yogurt, milk, adding cheese to things, adding a bit of butter to any veg given). It has helped with her weight but it hasn’t made much difference to her height.

I think height issues have to be looked at slightly differently from weight. I know that sometimes there’s a growth hormonal issue that can hinder a child’s growth. It’s when the pituitary gland in the brain doesn’t produce enough of the growth hormone to the body. I think this hormone can be given artificially, but it’s most effective when given earlier. Children with growth hormone deficiency do often have a reduced appetite and their growth slows significantly from around age 2 - 3. If you could find his old ‘red book’ from when he was a baby could you check to see what his height percentile was when he was a baby (not from birth but closest to age 2) compared to now? Maybe this is something you could raise with the GP? You could ask for a referral to a paediatric endocrinologist to make an assessment if you think it could be related to this.

I believe it would be classed as failure to thrive due to falling off the centiles. The GP needs to do some blood tests to try and establish whether thwre is a medical cause that requires treatment.. One friend's son was diagnosed coeliac and put on some weight after cutting out wheat whereas anither friend's son was given hormone treatments at around 10 y o and has grown a little more. If foods or food intake is limited the gp can refer to the dietician who can prescribe nutritional drinks to increase the calorie intake or look at what supplements might be needed. I definitely wouldn't ignore it when looking at your heights.

Monitor closely. Ie measure at gp now and in 3 mobths to check growth rate.
Test for coeliac. Which can cause failure to grow

I second the thought of Coeliac Disease. I wasn't diagnosed till University, and despite a late growth spurt then, which caused me some physical problems, I'm still several inches shorter than my siblings. ( Luckily they are tall!)

Thank you everyone. I've got a GP appointment booked for him but might go without him to discuss my concerns as I don't want to give him a complex!!

That’s helpful.

My ds was exactly like this. Age 7 and wore 4/5 trousers. Smallest in his class. Perfectly normal and he’s grown up just fine.

We have the same. Was 75th, now 2nd. Its very stressful, but on top there is arfid and allergies. We now do whatever he wants which is basically crisps. Finally weight is stabilising but height isnt coming yet. Tests all normal. Just calorie deficit. It sounds like you arr doing the right thing with flexibility on food. Maybe more snacks between meals and feeding when busy running around so doesnt notice. The stomach will need to get bigger to increase appetite and thats hard.

This is lovely, what a brilliant foster mum you are, you’ve taken such great care of him.

What an amazing nurturing job you have done with your foster child. You sound like you more than live up to your user name! Sounds like your commitment to him has really paid off ☺️

When my dd needed to gain weight I added double cream to everything, also thinks like milkshakes made with ice cream and cream and fruit are really calorie dense. I’d also add in old school puddings after dinner, rice pudding, sponge pudding and custard, ice cream, bananas and custard etc.

You're a good person ❤️

DS1 was small... still is as an adult... he had other health issues, frequent ear infections, low energy, frequent other illnesses, poor digestion. Not celiac but was gluten intolerant... we saw many people who dismissed this but I put him on the GAPS diet (or a close version of) and I can vividly remember when he first started to say he was hungry... he had never said he was hungry before..

I think he is 5'7 now.. but strong, fit, active and eats loads!!

Going through similar with my daughter right now, although she's now 12. She was a big baby and toddler, but just seemed to slow growing around age 6, and now is a foot shorter than most of her class. Was back and forth to gp for years who kept saying she's fine, it's only when I persevered and took her red book with me to how how many centiles she'd dropped that they referred her to paeds. A year wait for an appointment, but finally she's been seen and we're waiting for blood results to determine if she has an issue, or if she's just small. It's tricky to navigate as you're constantly reassuring them they're perfect and fine, but then advocating for them at appointments means you're really having to press the point that you're concerned there may be an issue. All you can do is keep on and on at the GP as depending on your area, the wait times for paeds can be even worse than ours was. Failing that, go private. We were going to go private at the point we finally got a referral, as over the past 18 months her slow growth has become even more obvious. Fingers crossed they're just slow growers, but if there is an issue, it's easier to sort out the earlier it's found.

We came et it from a different angle. DS was premmie. Age 2 clothes at 5. At primary he was oldest in year, smallest in school. Very slow to catch up. By Yr 8 he was 3 sizes smaller in tops, 2 in trousers. By Yr 9, it looked like he would be less tall than us parents. Yr 10 he caught up. But never wore his age in school trs, extra long age 14 at 16. Filled out a bit at 20.

He's a ball of energy, not sporty but gym fit. I think you should get your DS checked out OP, but the big growth spurt is likely to be awhile coming yet so tru not to worry

Our third child was on the 7th percentile, which was way out of sync with her siblings at the same age. We were encouraged to essentially let her eat anything she wanted, whenever she wanted, and to start having her drink calories. It worked a treat. She is now above the 75th percentile. She just wasn’t getting the calories in to support growth. I would focus on increasing calories and sleep. You say he doesn’t eat much as he is too busy… is sleep also an issue?
Lots of smoothies and milkshakes, ideally with a bit of extra protein could help. Even fresh juices will have calories. I’d also recommend a blood test as low iron can contribute to low appetite!

My boy is 6.5 and wears about size 4 around and 6 in length. He also has trouble sitting through a full meal. I have started making his dinner more like a buffet instead of me dishing his food. I let him choose, if it's a new food, he only has to take a small portion. He also has several small meals throughout the day. I keep a snack drawer He can access whenever he likes. It holds granola bars, goldfish crackers, veggies stick crisps, apples, bananas, etc. Mostly healthyish foods that can be grabbed on the run.

How tall is he? And is he just seven, or nearly eight etc? I had two that were falling off the growth chart, they turned out to be gluten intolerant and have clawed their way back up to 25th centile. Really is worth investigating. Are his feet growing?

If he’s not eating enough then that’s going to impact his growth. Could you offer smaller meals throughout the day?

Good to go back to the doctor to push for tests to check for any underlying medical reasons. But for general techniques to try to get more calories in him, try looking at what gym bro body building types do when they're bulking. It's easier to drink calories than chew them - full fat milk, milkshakes, yoghurt drinks, smoothies. You can mindlessly drink one of those while doing something else and barely notice. Oil is one of the most calorie dense foods going - if you can hide a tablespoon of flavourless oil in a tasty smoothie or milkshake, that's an extra 100 calories. There are loads of foods these days with extra added protein as well, things like fortified yoghurts. Add butter, add cheese. Little and often between meal snacks. And try to distract him to keep him sitting at the table longer - screens aren't the best habit to get into, but maybe playing games of some kind, and posting an extra few spoonfuls of the meal into him while he's still sat there doing something?

You are truly so wonderful 💐

So I should clarify the M&S trousers 3-4 is more to do with waist size rather than height as anything about that falls down but the 3-4 does graze his ankles.

His sleep isn't great either, he's up at the crack of dawn and goes to bed at 9pm (despite being in his bedroom ready for bed at 8pm). He doesn't really stop from 5:30-9pm either. Always needing to do something.

Thabk You all for your suggestions. He loves a chocolate milkshake and a pasty from Greggs so will maybe do more of those things. His 4yo sister is average height/weight for her age and a baby DD too who is 7 months old and is dropping centiles just like DS was as a child so perhaps whatever happened with him is happening with her.

I'm going to pump as many calories into him as I can. I am slightly worried about building bad eating habits/future heart health but will try with the good fats first!! Hopefully GP will listen to me

I had this worry with our third child, and I won’t lie, it has been difficult to shift to healthier eating habits, although your son is older so may be able to understand it better. However, being on the 7th percentile for life would have had a bigger impact, so I don’t regret if at all. I would say sleep is as big a problem. I’d start with some melatonin, in the hopes that better sleep will support other processes. If the blood test comes back clear, ADHD can also cause issues with sleep and being unable to sit and eat.

Where was he at his reception measurements? And where is he on this centile chart? https://www.rcpch.ac.uk/sites/default/files/Boys_2-18_years_growth_chart.pdf

i have a small girl. Tracks between the 4th and 9th percentile depending on when she grows. Still fits in some age 4 items. Picky eater and always on the go… being referred for adhd. I keep an eye but don’t make it too much of a thing. She’s definitely one of the smallest in her class and kids 2 years below are bigger. She’s tracking along the chart though and although I’d like her to eat a bit more protein I’m quite chilled because of that. If he’s not on the charts though then it would be worth pushing GP for dietitian referral.