DD1 is very thin

[lougle]

DD1 was born at term, average weight. Looking back at pictures, she had nice full cheeks as a toddler and didn't seem thin. Gradually as she was more mobile she thinned down. For the last few years she hovered on the 9th- 25th centile for weight. She was referred to a dietician last year, who prescribed pediasure milk shakes which I knew she wouldn't touch, but she promised the dietician she wild drink them.

I weighed her yesterday and she weighs 21.2kg. She is 127 cm tall. It puts her on the 1st centile for BMI. Her sisters are 70th and 48th centile.

She doesn't eat enough. She prefers soft textures and would live on sandwiches if she could.

She actually eats breakfast quite well and school says she eats lunch quite well, but dinner is often a disaster. I think it's because by that point in the day she's used all her energy (she has slightly low muscle tone and is malco-ordinated).

When does a child's weight become a concern clinically and what is done? What can I do to increase it?

if it were me I would be tempted to give her sandwiches for tea too. or for supper/snack.

Yes that makes sense. It doesn't seem to matter what she eats, she grows upwards but she's really painfully thin. This week she's had spaghetti bolognese, roast dinners, banoffee pie, strawberries and cream, etc. We give her good food but she eats like a sparrow.

Susan my only worry there is that sandwiches aren't really nutrient dense and she'd prefer chocolate spread which isn't too healthy.

She sounds like my dd2.

Does she have school lunches? Could you send your own? If she is eating good calories at lunch and breakfast, then I'd relax about tea and give what she will (can?) eat at that point. What about porridge made with cream, with added fruit and grated nuts for protein?

Homemade bread for extra nutrients?

Savoury muffins?

Dd1 will now eat hummous sandwiches, thankfully.

Peanut butter and banana is another good sandwich filling. My dd's think it is a sweet sandwich, but there is reasonable nutrition in it.

I had toget tough on fillings like Nutella when dd1 needed a lot of dental work. Previously sandwiches were jam, honey or Nutella. That had to change, given the state of her teeth.

I would ask for a.coeliac test

She has packed lunch - 2 sandwiches, piece of fruit, babybel cheese or sausage (dependent on filling of sandwich), yoghurt, biscuit. She's variable with it. Sometimes she eats it well, others not so. They write in her book if she manages to eat her crusts because she doesn't like to.

Breakfast is normally shreddies, shredded wheat, or granola.

She won't eat peanut butter, even if it has jam with it. I think the texture is too much like hard work for her.

I like the idea about porridge with fruit/nuts.

She had a coeliac test some time ago. She had low IgA (0.2% rings a bell?) but the other marker that they look for if the IgA is too low to be reliable was also low, apparently.

I'm sure there is something systemically different about her (if her brain is squiffy, to me it's logical that other stuff could be too) because her skin marks incredibly easily, to the point that just sitting on a plastic chair will cause lines on her skin through her clothes. She bruises terribly - her legs are just a mass of bruises, thankfully all at different stages to ward off accusations of abuse. She doesn't heal well from cuts/scrapes - she had a friction burn from going down the slide onto our trampoline and although the initial wound has healed, several weeks later there is still a big red mark where it was. Her circulation is pants. Her hands/feet are always cold to touch.

But she walks and she talks so her paed doesn't seem interested in looking further .

I've just measured dd2. She is 7, and is 122 tall. She weighs 18.6kg. She too was born a term, a good weight (7lb 12) but completely failed to put on any weight for the start - she fell right off the centile charts, and weighed 16lb at 16 months. Lots of investigations ensued, bt nothing came to light apart from a dodgy mitochondrial result which was dismissed by her then paed as it 'couldn't be right' . The test was repeated, with the same anomalous result. Paed still scathingly dismissive. But then he put her lack of weight gain down to the low-fat diet I insisted on feeding her (ie no dairy, as she was intolerant)

Then we moved areas, and dd2 was lost in the system. And then she grew out if being impossibly tiny, and is now 'just' small, rather than miniature, and so we haven't followed it up.

Dd2 is now pale, eats like a particularly small sparrow, and is the same body frame size as she was when she was a 3 year old (she can wear one of her old dresses as a tunic, and it still has room in it around the chest!). She too marks easily, and is always covered in bruises.

Could you send a hot packed lunch with your dd1? Or would she eat my favourite young child staple of mashed avocado, mashed banana and natural yoghurt mixed with a bt of fruit
Purée and ground almonds? Incredibly calorific, and actually quite tasty. Could work as a sandwich filling, or spread on rice cakes etc.

Grr, assorted typos - typing on phone.

It sucks, doesn't it, Polter?

AlarmOnSnooze, your DD2 is actually smaller than mine. DD1's BMI is 13.1, which puts her on the 1st percentile for BMI. Your DD2's BMI is 12.5, which puts her between 0.4th percentile - 1st percentile dependent on exact age.

Yes, she is small. But not as impossibly tiny as she used to be. She eats a reasonable range of stuff, just not very much of any of it!

It is a worry, but there isn't much we can do about it. I do try to ensure that every mouthful counts in calorie terms, but it is tricky to monitor what she eats at school (a couple of mouthfuls of meat if I am lucky, rarely her veg, maybe potatoes, and then pudding) and no option of packed lunch. In that respect, dd1's school is better as although I often curse having to make her a hot lunch at 7.30am, it is far easier to make sure she is having something she will eat, and decent nutrition. (Dd1 is not the biggest of children either - she is 138cm and weighs just over 26kg)

I don't think I'd worry so much if her sisters were small, but DD2 is average for height and average for weight, ish. Dd3 is 98th centile for height and 75th-91st for weight, so also average bmi.

I was super skinny as a child, though, to be fair. But I didn't bruise like dd1 or have circulation issues, etc.

Dd1 used to be really big for her age, both height and weight. But she has averaged down over the years, and is now average ish for height, and a bit under that for weight I think.

Ds is slightly on the small side, I ink, but nothing major. He is certainly nowhere near as small as dd2 was at the same age - going on the entirely unscientific measurement of him being a lot younger when wearing the hand me downs than dd2 was!

I was always reasonably small as a. Child, but not extremely so. I have always had poor circulation and bruise easily.

Would she eat soup lougle ? You could cram quite a lot into soup nutritionally and blend it if necessary. It's soft in texture and very easy to eat even when you don't really feel like it.

I don't know if it helps but ds1 is much smaller height and weight wise than his younger brothers - he's one of the smallest in his class and painfully thin (despite eating loads) - ds2 is just above average height and very slim but heavy, ds3 one of the tallest in his class and very muscular. So genetically siblings can vary a lot.

How is she with things like cheese on toast, pizza, or even macaroni cheese or pasta carbonara? - all things that can be made rather calorie laden with the right proportions, without being hard to eat. Is she OK with eggs? Omelettes or scrambled eggs made with butter and cream?

Soup is not a winner with her -takes too long to eat and she rejects it if it's not the right temperature.

She loves pasta dishes. Spag Bol/ lasagne, which I add lots of cheese to.

Ds2 lost loads of weight and it was type 1 diabetes. That was over weeks / few months though not years. He grow upwards and we just thought he was skinny but taller as his brother had thinned out in similar way. Doesn't sound like it could be that but always worth checking symptoms and ruling out. We only realised when he started wetting the bed, went to GP with suspected uti and blood sugar through roof. The weight loss is because insufficient insulin means body starts to break down fat stores for energy. They tested him for a few other things like thyroid etc so may be something there that's not gut related. But I was super skinny as a child into 20s ate loads of calories, did no exercise then rounded out after 3 pregnancies!

Will she eat more cereal before bed eg have breakfast twice, always been a hit in our house.

She might do the extra cereal before bed thing. God idea.

I was the same as you, Agnes. 7 St 10 lbs just before I fell pregnant with DD2 (5'8") then after Dd3 I rounded out and am 9 St.

Mmmmmm, just calculated BMI for dd2, is 13.8. She has always carb loaded, eats masses at lunchtimes with good varied diet. She's always been like it (was in 9 month old skirts at 18 months. HV and latterly Dev Paed never had a problem. Her sister is tall and average build, more athletic build. Their extremely tall cousin is 3yo and catching up with dd2 in terms of weight!!! Don't know at what point it becomes an issue but with her other issues I would have thought it needed flagging? Any OT input? Sounds as though she bruised incredibly easily.

You aren't very round , though, Lougle