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?

Oh I'm still slim, Handy, I just have the 'I've had 3 babies in 3.4 years and my muscles are shot' belly! I'm much happier at this weight and my BMI is only just tipping into 'healthy' now, which is a huge achievement because I've been underweight my whole life .

I think she probably has a raised calorie requirement because she has to work hard just to sit up in a chair, her walking gait is awkward, speaking is an effort, etc. It's all relatively low level stuff, but compared to an NT child she has to work flipping hard.

DS1's BMI is about 14. It has fallen over the past 2 years. He eats some toast at breakfast (inside of the slice (dry)). at lunch at school about 2 mini breadsticks and a drink sometimes. tea time its pizza or macdonalds mainly. secret to his BMI?chocolate! not that he always has it. if i give him choc in his packed lunch hes often too anxious to eat. but basically we give medication for nutrients/calcium and then its a question of calories. Has your dietician suggested this for you?

Jerbil, wow that sounds stressful. No, we haven't had that suggestion.

I have this problem with ds.
Lougle - my ds loves pasta dishes, I always make my own cheese sauce with double cream and butter and lots of cheese. I make a batch and leave it in the fridge in a gravy jug I can scoop out if during the week.
I mix this sometimes with spag Bol, use it as a macaroni cheese base and add more Phili or Boursin.
I also do porridge and weetabix as breakfast and pudding in the evenings, so if dinner isn't a great success I have a fall back.
Cheese puff pastry twists, butter caked on crackers, and Turkey rashers seem to be winners. If your daughter likes certain flavours, maybe bacon might be a winner?
I often do dinner around 4-4:30 ish if the snack after school hadn't been demolished. I then follow up with pudding as above around the 6:30 mark.

Thanks! I'll try a few of these ideas. Even 1kg would make such a difference. She literally doesn't have any fat on her ribs, etc.

I share your worry. We've just asked for a referral to a dietician for DD (4.5) as her diet is pretty much bread and croissants, yogurt and occasional fish finger - and homemade banana and carrot muffins. She has awful eczema which I'm sure is down to the gluten - but we cannot get much else into her. Its sensory with her - and she over-analyses so fish fingers are rejected if the fish is coming out, and muffins if they are too brown, or even the bread sometimes if the butter is too thick / thin. Even cereal is rejected now . She won't even eat ice cream (too cold obviously ).

Thanks zzzzz, some great ideas!