My daughter's lack of appetite & small size -18lb at 14 months. Help!

[GemmaMummyOfTwo]

I'm looking for advice as i'm at the end of my tether with my daughters lack of appetite and often sheer refusal of food. She is much smaller than children her age and has never had any of the normal baby 'chubbiness'. She was born at 39 weeks weighing a healthy 7lb 3oz, but lost more than the usual 10% after birth and dropped down to 6lb 6oz. Since then she struggled to gain weight as she suffered with quite bad reflux and would often bring up the majority of her feeds. I shared my concerns with the health visitors everytime i went to the clinic but none of them took me that seriously or did anything to help...just to advise me to add butter, cream & full-fat milk to her foods when weaning her. I've done this but it seems pointless when she hardly eats any of what i've given her. I've just been to see the doctor this morning about it, and wouldn't accept his suggestion that she could just be a 'small child' (because as far as i'm concerned she's only small because she doesn't eat enough!) and i pushed for him to prescribe a high-calorie formula as i think that might help. He asked me to find out which formula from a HV and to go back to see him.. Can anyone suggest a high-calorie formula for a child her age? He indicated that a milk designed for babies under a year wouldn't be prescribed for her. Arghhh! please help! :(

Thankyou

Well I don't know about a high-calorie formula, but I would honestly suggest that you take a step back and listen to the doctor and other hcps. I know exactly how you feel, really, and I'm not saying this to be critical. My dd was born 8lb 4oz, lost over 10% of her birth weight and took 5 weeks to get it back. She's also been quite a small eater, and at one point wouldn't touch anything but bread and cream cheese, fruit and yoghurt.

I won't say it didn't sometimes make me anxious - however, three things reassured me, and I hope you won't mind me sharing them with you in case any of them apply to your situation too.

Firstly, I'm small (5'3" and 8 stone) so initially I assumed that she was readjusting. She was born in the 75th centile, but as I'm probably in the bottom part of the 25th, and her father, I would guess, is in the 50th, I thought it likely she was just adjusting downwards to her natural size.

Secondly, I know for a fact that I used to eat tiny amounts of food as a child - I now eat like a horse and there's pretty much nothing I won't eat. My mother never used to force me to eat or fuss me about it. She just used to put healthy food in front of me and take it away again if I didn't want it. My tactic with my daughter is that if she doesn't want what I've made for her she can have bread, yoghurt or fruit, but I don't cook her another meal.

Also, it might be useful to look at what she eats over the course of a week rather than being worried if she doesn't eat much in any given day or two - if often evens out more than you think.

Thirdly, my daughter was about the same weight as yours at 14months. I figured that if she was healthy, energetic and sleeping well then that was a sign she was getting what she needed.

I really understand why you're worried, pariticularly since you had to go through the anxiety of reflux - it's really scary to think they aren't getting what they need. But really, you'd be surprised how little some babies and toddlers need.

And regular full fat cows milk has lots of calories, and will certainly, unless she's allergic, prevent any danger of her not thriving. Just keep giving her as much of that as she wants, and, honestly, she will be fine.

Sorry, that was really long!

Do you know heavy you were as a one year old? And your baby's father? A baby's weight often follows a similar pattern to the parents.

Are you worried about her development in any other way? Is she ill more then 'normal'?

All of my children have been very slim, to the point of being well under the growth curves but average height. My dd2 at the age of 17 months was just 7kg (15 pounds), and we were all concerned about her. Now she is nearly six, tall, strong and very very slim., as are all of my children.

Thankyou for the replies :)

She's always hovvered between the 2nd and 9th centile, sometimes dipping slightly below the 2nd centile. I've kept her on aptamil formula milk (moved up to the "growing-up" one) because despite the HV telling me that after 12 months cow's milk is fine, i believe she could do with the extra nutrients - that's why i'm wanting a higher calorie one. I think i could accept her being small if i felt she was eating adequately, but because she barely touches anything (it's almost like a phobia ) i can't help making a connection between the two issues :(

At the same age i was around 22lb..so not huge but significantly chunkier in photo's that i've seen of myself. Her dad is a medium to big build and 5'10" ish, and our first born, my little boy now 5, was a much chubbier baby who liked his food and he was always around the 25th centile.

I've just gone back to work (i work in a nursery and she comes with me) and she is very skinny compared to the other toddlers her age and nearly a head shorter. When people ask me how old she is, i tell them and predictably i'm always met with "oh isn't she small" or "oh gosh really? Was she pre-term?" ...It gets me really down :(

no worries about a long reply, im writing essays here! Just grateful for anyones help and advice. thankyou

Don't compare her against the other children because unfortunately more and more children are becoming overweight.

It may simply be that your dd is a very small eater and will remain petite. As long as she is healthy and developing normally, I wouldn't worry.

If you really want, you could give her extra vitamins suitable for children of her age.

I have a friend whose daughter is just as you describe - small to the point of being thin, but she's energetic, fun, cheeky, sleeps pretty well - she's just very very dainty. Even smaller than my daughter, and barely on the 2nd centile. I really hesitate to say this, because it's pretty impossible I know, but do you think you could bear to try, just for, say, a fortnight, to suspend worrying and do two further things:

1. Note down everything she eats and the milk she drinks - as I say, it may be that she is eating a bit more than you think.

2. Allow her to eat what she wants (out of what you offer her, obviously - I don't mean any old rubbish!). Try varying the food, and keep a real eye on what she seems to eat most of (for example, even at her most fussy, my dd would always have good breakfast, as she loves cereal, toast, fruit and yoghurt - even if she's sometimes eat almost nothing for the rest of the day)

Actually, make that 3 things:

3. Ignore, ignore, ignore other people. Smile sweetly and say, 'yes, she's a dainty little thing, isn't she'.

I'll say it again for reassurance, too: I ate astonishingly little as a small child - literally 3 or 4 mouthfuls per meal, I'm told. I was 21lb when I was 2. My daughter was 25lb at 2, and my father joked that she was chubby! Bless them, my parents are the least anxious people in the world, but I know any normal person would be worried about a child that ate that little. And now I'm petite, slim, but certainly not skinny, and, as I said, I love my food. Food is as much about taste and texture as calories, and children don't starve themselves, they really don't. If she's hungry she'll eat.

Got no internet at home at the moment, but will check back on phone if poss, and certainly on Monday.

That sounds so stressful for you. DS also lost a lot of weight after birth and really didn't even begin to regain it relative to the percentiles until he started solids. Now I don't weigh him (he's 2y5m), so don't really know where he's at, although he certainly hadn't got back to where he started at birth. My understanding is that birth weight is more to do with the efficiency of the placenta .

But, the saving grace for me was that we did a bit of Baby led weaning, and one of the strongest messages I took from it was not to stress about precisely what they ate at each meal and trust that they would eat what they needed. Easier said than done, I know.

I couldn't spot anywhere you mentioned whether your DD is otherwise active, happy and hitting the broad developmental milestones. Because that's probably more important than how she's eating/her size.

Remember, somebody has to be in the bottom centile, it's just how centiles work.

On a practical note, what sorts of things does she seem to enjoy (I'm thinking about flavours, textures, tempatures, etc)? We might be able to suggest some things to try which you haven't already thought of.

To answer your original question, no, I can't recommend a high calorie formula.

I also have a petite baby. She's just turned 1 and we think she's somewhere around 16lb. She was teeny tiny when she was born - 5lb 40z - and was always on the 0.4 centile until a few months ago when she had a wee growth spurt and now she's on the 2nd :)

I used to stress if she didn't finish her bottles etc (although there's a longer back story here about stressful BFing and tongue tie, and a brief period when she lost weight) but I learned to chill out and go by her - she always let me know if she was hungry, and she always had what she wanted. I couldn't have force fed her if we tried.

We often got/ still get (nice) surprised looks when people asked her age etc, and comments like 'she's so tiny!', which sometimes made me a bit anxious, but you have to remember - people come in various shapes and sizes: babies too. Health visitors and doctors etc have never been concerned because they take one look at me (5'1") and say "she must take after you". And I guess she does.

And people's appetites are different too. Some people are gannets and eat all the time (my husband!) and others don't eat much. My DD has days where she's happy to eat a lot, and other days when everything gets chucked on the floor. But she's alert, happy, drinks, poos, sleeps - everything a wee baby should do.

Please try not to stress, and please don't compare your beautiful daughter to everyone else - 'chubbiness' is not a necessary part of being a baby! And you never know, those parents of chubby babies are possibly worried theirs eats far too much!

Trust your baby - if she's happy, pooing, peeing, sleeping, alert etc then all is well. She'll eat when she's hungry and what she wants.

theborrower - just wanted to add that you're so right about the parents of bigger babies also worrying sometimes. A friend has a beautiful 23mo girl, who is much heavier than my DS despite being 6mos younger. She definitely worries about her being too big.

We are parents, it seems to be our job to worry...

I could be way off the mark here but is it possible that all this anxiety you feel about your daughter's size is simply putting her off her food? Learning to explore new food is challenging for small children. It tastes of lots of things unlike milk, it smells odd too, it may feel hard or sticky or lumpy. For the first six months after introducing solid food children still get most of their calories from milk because nature has intended them to take their time learning what is good for them before solid food becomes the mainstay of their diet.

When you introduced solid food did you fret about how much your DD ate because you wanted her to be bigger? Did you sit there hovering at mealtimes hoping she'd have another bite? Imagine how you would feel if you pitched up in China and were served food that was completely new to you. It might be healthy and delicious but it is going to take you a while to get used to it. Then imagine your host is a truly wonderful person whose feelings you care deeply about. And she obviously wants you to eat it all. She is sitting there telling you to eat more at every mouthful. Would you feel a bit anxious and uncomfortable? Would it be hard to enjoy the new flavours and textures? Might mealtimes start to feel rather daunting? Would you play for time and perhaps try and distract your host so as to get her off your case?

The HCPs are telling you your daughter is OK. And believe me if they had concerns they would raise them. Extra high calorie milk won't support her to eat more solid food.

And some kids are small. My daughter (15m) is currently on the 9th centile but was between the 0.4th and 2nd from 3-6m. She eats like a horse 3 times a day and spends all the remaining time hurtling round and round in circles. Since her Dad is also tiny, also greedy and spends all his time fell-running I think there may be some connection...

I can completly understand why you are so worried, I have twin girls han is 22lb and fifi is 16lb at 14 months. Fifi is not on the scales for her hight and her weight is just on the 0.2 centile and sometimes she isn't on the chart. She has reflux and doesn't eat much, her reflux is still bothering her which makes her not want to eat. :( We have so many people coment about the size differance, it does bother me but what can you do.. She did have a powder called duacal which gave her more calories, she couldn't have it as it made her have a tummy ache.

I wanted to ask has her reflux gone? Even if she isn't being sick it still could be hurting her, it could be silent reflux. This would stop her eating as it might hurt her, it might be worth her having some reflux meds to see if she eats better. The biggest tip is try to be relaxed with her when eatin and make it fun, give her foods to play with sorry it does get messy but fifi enjoys it. If she has the high calorie formula it will fill her up and she will eat less, so if poss don't give it to her. Can you aks to see a dietion and see what she says and maybe a ped doc to check out the reflux.

Please don't worry, all babies/children grows at differant rates. I bet in a few years time she would have caught up.

I've a petite little girl as well - nearly 11mths and about 15lb having been born full term weighing 4lb 10oz.

Feel surrounded by like minded mums reading this thread as it's a stress I have often too - DD will often eat really well on 1 sometimes 2 meals a day!

I find that as she's not needed as much milk, her eating has often worsened until I've realised and reduced the milk feed.
I don't think a high calorie milk would help the OP's DD situation as it would fill her up even more and make her less likely to want to eat.

Something that has reassured me is advice given by a speech therapist friend (who specialises in helping children with swallowing/eating problems) who says that so long as a child eats a portion of food equivalent to the size of their fist per meal will be ok.

I know how stressful it is when your baby is so much smaller than others the same age and isn't keen on eating. I too have a teeny 1-year-old. He's 12.5 months and weighs 7.7kg, which I think is just under 17lbs, around the 0.4th centile for boys I think. I got asked if he was prem the other day. No - he was a week late lol! Does your dd do any better with finger food? Our ds pretty much refuses to be spoon fed anything except for a few favourites (avocado, breakfast cereal and yoghurt!) - this started around 9 months and was very stressful for a little while - but he is pretty good with finger food so now we just do that for his 'main' meals - stuff like cheesy pasta, homemade pizza, stirfried noodles and chicken etc etc and he will happily feed himself a moderate sized portion plus yoghurt for dessert. If we focus on spoon feeding he will generally refuse to eat anything! I've also noticed he'll refuse to eat if he's had milk too close to meal time, and also if he's had a lot of milk during the day, so I suspect focusing on formula might not help the eating situation, though I imagine the high-calorie stuff might be a band-aid solution for her weight.

Did your dd see a paediatrician for her refulx or for her dislike of feeding? If you are really concerned, perhaps you can ask for a referral and see what a specialist thinks? Our ds had (still has perhaps, not sure) reflux and was referred to a paed for it because we suspected it was affecting his intake of food and weight. We asked a gp to refer him - the gp wasn't convinced it was necessary but we wanted to make sure he'd been thoroughly checked by an specialist so she agreed. The paed wasn't too concerned by his size and basically just said he needs to eat a little more and is also probably naturally small. Not particularly helpful, but reassuring that she didn't think he was going to fade away! She adjusted his reflux meds a little too, which may have helped a bit with the eating. She also referred him to the hospital feeding clinic in case they had any suggestions to help him eat a bit more - we're still waiting to see them, but I'm not sure there's much they can do. Another thing you could try is seeing if there are any drop-in sessions with dietitians at Sure Start centres near you. I know the ones near us have them from time to time; I think they offer tips on encouraging fussy eaters to try out foods etc. Might be worth a try?

Hi guys, sorry not been able to get back on here for the past week, but thankyou very much for all your kind comments and advice.

I asked a HV to come round which she did this week, we discussed my concerns and she advised me to go back to my GP (pillar to post syndrome) however she did weigh my DD and discovered that she's lost weight - nearly half a lb in 6 weeks. It didn't come as a massive shock to me because im with her day in day out and see how poorly she eats. Although I did decide that the high-calorie formula wasnt the right route to go down (nothing to do with what any HCP said - more to do with what you've all commented!), I instead have put her onto high fat channel island milk and am only offering it in the morning and in the evening, to avoid filling her up too much. But the problem continues and i don't think i mentioned this in my other comments but she doesn't drink either which really, is even more concerning. For instance today it's been pretty hot, we've been out and about all day and i went out with her beaker full of juice...having only taken a couple of sips on two occasions and having refused it on every other, she actually barely drank an ounce of fluid. Assuming she must be gasping for her bottle when it came to bedtime, she went on to refuse her milk! So i spent about half an hour dripping it slowly into her mouth while grappling with her in my arms (managed about 3 ounces) - only for her to vomit it straight up. So like i said before, it's too much of a coincidence that she's so small and hardly eats or drinks anything. There's definately a link and fortunately my mum was with me today and saw first hand the difficulty my daughter has with feeding and was shocked. She's insisting we go down to the doctors again tomorrow and not leave until we're taken seriously. Or we'll go direct to the hospital and demand she see's a skilled paediatrician. Enough's enough! :( :(

I'm sorry this isn't what you probably want to hear but i feel you are worrying too much. Babies/toddlers do just find their natural weight and sometimes its much higher and sometimes it much lower than the birth weight. Weight/hight also gains in jumps.

What percentile is you child on? My child was born about 7lbs but has just turned three in August and is now 24lbs. Just at the bottom of the percentile chart but I have no worries developmentally. Bean is all there mentally and physically. Is your child doing OK developmentally apart from food? That is how HV and GP's will often measure things

Is there any chance that food and drink has become a control issue for you and child? What ever you do don't turn food into a battle. Be laid back and act like you aren't bothered how much she/he eats. Chat about non food issues while eating.

Sorry just read that your child is between the 9th and 2nd mostly. Mine tends to move between the 2nd and just off the bottom of the chart. Also a head shorter. DH is 5-10 and I'm 5-6. Both solid but we have the odd small and skinny relative. Try not to compare your DD to others - instead take an objective view of how healthy she seems. Kids can be small but reaching all the targets. Try ignoring all the comments (I've had them all too) and just enjoy the little one without food pressure.

Agree . dd is 10 next week and still weighs less than 21kg and is petite at around 130cm. She also had reflux as a baby but suddenly she started eating properly, with less choking, at around your dd's age. Be wary of offering milk , it will only suppress her appetite further and create a vicious circle. Try small amounts in a bowl , which you can top up if she clears it - pasta, yoghurt etc - and maybe do little and often so she has 5 "meals". If you get anxious about how little/much she eats then so will she. Let her sit with her brother and eventually she may copy. Also agree with not comparing them. ds was smaller at birth but grew much earlier than dd has.

And if the gp isn't concerned then nor should you overly be.

This sounds awful I was going to say as long as she's putting on weight (no matter how small) I wouldnt worry but with your latest post saying she has lost weight I would be taking her to the hospital until you are listened to.

I would avoid comparing your DD to other children (even siblings) I have 4 dc's and the 3 girls were 10 lbs + but my DS was 7lb 6oz although 4 weeks early (so off the centile chart) he then dropped to 4lb 6oz in 10 days and has hovered over the 2nd centile. He is now 5 eats like a horse (he eats the same as me) and he is only on the 9th centile, he will either wake up soon an be 10 stone or 6 ft.

Hope you get this sorted - my DB had bad reflux and after much badgering he was admitted for observation and need a small operation to fix it. He's now 22 6ft 3 and 13 stone.

I was a horrendous eater as a child and my mum was constantly fretting. The GP said 'no child ever starved themselves when food was available'

now i am fretting about my 13m old who is very tall and slim and doesn't eat a huge amount. And my mum reminds me of the GPs words and says 'he was right you know'

step back - you are going to make her have food issues. My DD eats so much better when I ignore her or with our nanny. I can see know that she is taking on my anxiety.

DD is a similar weight and age to your daughter.

Don't worry about it. The doctors right, some children do just have a smaller build.

If she seems healthy (sleep,alertness,happy etc) then I'm sure she is. You can tell when a child's weak say if they have a tummy bug or something.

I think you really do need to try to relax, although I know its hard. I had similar problems, DS had reflux. He was always sick a lot, and when he was weaned he got so bad he would eat nothing but yoghurt. I remember getting so wound up and frustrated with him. I tried everything to get him to eat, including almost forcing food into him. He is another tiny one, which makes it so much harder. I felt as if the world would end if he dropped off the charts, (he was always at or around the 2nd centile)

Eventually he was given Gaviscon, and it was like magic. Within 2 weeks he was eating a complete range of food quite happily and he hasn't looked back since. Despite that he is still on the 2nd centile, even though he eats far more than other bigger children. I would echo what others have said and look more at how she is developing. If she seems bright and healthy then she almost certainly is fine. If not, then you do need to push for something to be done.

My dd was born at 8.4lbs. At 14 months she was 18lbs. Now she's 3yrs, 1 month and she's 27lbs.

So basically she was born on the 91st centile, by 11 months she had dropped down to the 9th and has stayed between the 2nd to the 9th ever since.

She is very petite (wears 9-12 month clothes) but is perfectly healthy. Some days she eats 1/4 piece of toast, 1/2 piece of bread, 1/4 apple, 3-4 crisps, a couple of spoons of pasta and as many vegetables as she can shove into her mouth. This is at 3yrs old and compared to other children she barely eats but it is enough for her. She runs around (never stops!) and teh doctor is perfectly happy with her. I had concerns as dh is a 6'4 rugby player and I am 5'6 and fat not petite but the doctor says that she takes after other family members who are small.

Sorry to waffle on but I wanted to let you know that my dd matched yours for weight and has just stayed small with no hidden issues. Fingers crossed your dd is like mine - it's bloody cheap on clothing