hmm, not sure this is the right place, but dd2 (15 months) is having dietary issues and I need advice

[silverfrog]

well, title has said most of it

dd2 is 15 months, and weighs 16lb 4oz. she is tiny. She also eats like a horse.

She is on a gluten and dairy free diet (family associations) but eats just about anyhting else. She is still bf (twice a day, was on 3 times until a couple of weeks ago when she lost interest in the afternoon).

so, today we saw a dietician, referred on from the paed we saw a coulpe of months ago.

overall, dietician was ok with dd2's diet, but has mentioned a couple of things.

she said that dd2 should be on vitamin supplements? A, C & D specifically. are these necessary? dd2 eats loads, and has a very varied diet with loads of fruit/veg/meat/pulses and lentils.

she also mentioned iron levels. dd2 eats meat almost every day, probably half the timeit is red meat. And again, she eats lots of green veg etc. And I thought that there was iron present in breastmilk, so I thought she'd be ok there?

we did talk about ways to get more calories into dd2,as obviously without dairy there's quite a lot of fat missing.

I do add cocnut milk to stuff, and she eats things like avocado, but any more suggestions?

the dietician suggested upping puddings, and I will do that a bit, but not sure I want to encourage lots of pud in one so small...

bump

Are the family associations close ones? Don't mean to pry - just as you say, dairy is a very good way of upping calories. I don't think there's any harm in her having a vitamin supplement but I wouldn't have thought she'd need iron unless a blood test shows she's anaemic. Iron supplements can be very constipating - I'd avoid them if at all possible.

yes, the associations are close - dh is dairy intolerant, and on top of that dd1 is autistic and on a gluten/dairy free diet. It is recommended that siblings follow a similar diet in early development to avoid known autism triggers, and so the dairy/gluten free bit is non-negotiable for dd2

but, it does cut out a lot of calories.

Those were my thoughts too re: iron. dd2 has never had a constipation problem, and I don't really want her to have one now.

hmm, I suppose there's no harm in a vit supp., just not sure i see the point if it's not needed...

dd2 is small all over, btw, so is in proportion, not tall and skinny etc. She just seems to be growing ever more slowly (started out life on the 25th centile and has slid ever since. Now below the 0.4 for weight, and between 0.4 and 2 for height)

For fats try using olive oil - just stir a spoonful in her serving of pasta sauce, stir into rice, drizzle over all vegetables etc. Also things like hummous as quite rich fat and protein wise (and calcium rich), especially if home made, plus you can alway drizzle extra olive oil over the top of that.

If you have not issues with nut allergies then ground nuts and seeds stirred into porridge/weetabix is a quick and easy way of getting extra nutrients and calories in at the start of the day. Also, you can make "creamy" sauces using ground cashews or almonds. I'm not in agreement with upping her puddings, it's an easy way out and doesn't promote good eating habits long term.

My DD is also tiny - at 13 months she weighed 8k - but has always eaten like a horse. However, her paed is not worried as she is obviously healthy, bright and growing nontehless.

The dietitian sounds like she wasn't listening to you. Dairy product have very little iron in so it's not like by cutting them out you're missing out. Maybe she meant calcium? If so by eating lots of green veg and pulses she should be getting a fair amount, you could always up her intake by adding things like ground almonds and tahini to her diet. Your DD certainly seems to be getting a large amount of iron, mine eats no meat whatsoever yet she is certainly not iron deficient.

yes, could put extra olive oil on rice/pasta, will give that try.

she already eats hummous etc, and nut butters (although she could eat more nut stuff)

she has ground nuts in porridge etc (and the porridge is a rice/buckwheat/quinoa mix so fairly nutrient rich)

calcium came out ok intake wise (although she spent a fair whil calculating) as dd2 has a fortified rice milk, and is still bf too (plus chick peas/pulses in most things, and veg etc)

The dietician was mostly concerned with vit A & D due to the lack of cow's milk.

I am happy to supplement if dd2 needs these extra, but do wonder whether it's standard advice given to everyone she sees, and not based on dd2's quite varied diet

agree re: the extra puddings - that's exactly why I don't want to give loads of them (and not so keen on soya yoghurts etc - have you seen the list of ingreds on most of them?!)

If you are BF then why is the dietician concerned about vitamins A and D? Is there sufficient in cow's milk but not in breast milk? No. It does sound like you were given quite a lot of pat advice not really taking into consideration what you said. Your DD diet sounds very healthy to me.

My 20m DS is dairy intolerent (though he does tolerate butter) and vegetarian so we have to be careful with his diet too. When I saw a dietician I was not impressed with his advice to put fruit juice on his cereal instead of milk, and lots of other things he said.

What works for us is stirring extra olive oil into his food, though I have been recommended flax oil as it is rich in omega 3s etc. We also give him lots of nut butters and pumkin seed butter is a big winner for us. I do give my DS extra puddings but they are of the fresh fruit based variety and not very sweet (eg a banana wrapped in 50% wholemeal pastry with cinammon). Most of these wouldn't work for you though as a lot have pastry/crumble topping. I agree with you about the ingredients in soya yogurts but you can make your own if you want to be sure of ingredients.

If your DD is growing well along her own lines then I would only give supplements if shown to be necessary by blood tests. Otherwise you could overload her system and potentially cause damage. I wonder why prescribing vitamins is done so casually, especially for children?

Apparently bm isn't very rich in Vits A&D as I got advised to supplement when excl bfeeding (it's common practice where I live). Re the vit D she should get enough from regular, normal exposure to sunlight, the only worry would be if she was particualrly dark skinned and lived in a very northerly clime. Vitamin A is easily obtained from fruit and vegetables that are rich in beta carotene - carrots, apricots, tomatoes, oranges, melons, pumpkin etc., as well as from nuts and seeds.

It soundes like this dietitian did a correspondence course with a fake university if she still believes that the sole source of these vits is dairy. What on earth do the large swathes of the world population who don't consume dairy products do for their vitamin intake, I wonder?

the dietician said it was standard for bf babies to be given vit drops at 6 months+, and that these would be given until cow's milk was introduced at 12 months. (apparently used to be given until 2, but now 12 months) if ff, then no need as formula is fortified.

this wasn't ever suggested to me, and I do wonder where the advice has come from. Pre-formula, surely our grandmothers weren't routinely giving babies vit supplements?

the problem is that dd2 is not following any known growth curve - each time she is weighed (and they are nicely spaced apart weighings, so not single week fluctuations) she is still slipping down the charts. I'm all for babies finding their own centile to be on, but at some point she should have reached a level (and preferably before she dropped off the charts altogether!).

She was 7lb 13oz born, and barely double dher weight in her first year. Her height was also 50th ish centile, and is now in danger of dropping off the bottom of the charts as well. She has never actually lost weight, but her gains have slowed and slowed, hence the referrals in the first place.

oh, what to do. I obviously want to do what is best for dd2, but I'm not convinced that the advice I was given is for the best... the dietician thinks I'm a loon anyway, as the whole gluten/dairy free diet wrt autism is in its infancy (but cutting it out has worked for dd1, and so I trust the recommendations to steer clear for dd2. It's just not a risk I'm prepared to take.)

x-posts, Brangelina

silverfrog
Are you memeber of AiA. I would post this on their forum.
If you are not let me know and I will see if I can paraphrase your query.
DS2 is on a multi vit and min. I have always avoided iron for him as children withhis gut often don't process iron well and can store it quickly.
Aia membership is £30 but the forum has recipes etc and membership includes all info pack etc.
is this an egg sucking type answer?

right, so vit A&D recommended when excl bf, fair enough.

I reckon she must get enough vit A from diet, but when I queried the vit D advice (sure I've read that "false" (can't think of a better term!) vit D is not effective anyway, and that the best source is sunshine) she pooh-poohed that and said that as dd2 only went out when I did that it couln't be enough sunshine for her (I know I don't have a glowing tan, but I don't look like I've never seen sunlight either! )

As it happens, I'm quite comfortable with the amount of time we spend outdoors, and dd2 gets enough sun exposure...

I did wonder whether I should ask her about Asian diets for example (re the non dairy), but dd1 was wreaking merry havioc by this time so we had to withdraw gracefully!

Oh dear. It might be 'standard' HV recommendation to give vitmain drops to BF babies, but this is not because BM lacks vitamins. It is because formula is artifically high in vitamins/iron because they are not as bio-available (ie readily absorbed into the system). This makes some Hv and other HCPs think that the formula is 'better' when it isn't. Your dietician clearly isn't informed about BF and I wouldn't take any advice on it from him alone.

Silverfrog, if you want information about the vitamin A and D content of BM you could try posting in the breast/bottle feeding topic, where I am sure TikTok will have a full informed answer for you.

ooh, yes ,pagwatch, i am (d'oh! sometimes the obvious answers just don't come easily!)

I will try asking there.

I have dd1 vits & minerals sorted (nutrilink nutritionist) but dd2 is NT so far, and don't really want to start on that route if not necessary for her. Just the pesky calorie count would appear to be a problem (although, dairy aside, is there really that many more calories in wheat pasta than in GF pasta?!)

Silverfrog - apparently (depending on your skin tone) 2 x 20mins a day in the summer and 2 x 30 mins a day in the winter is sufficient exposure for average white children (the fairer skinned you are, the more efficiently you process sun source vitamin D, hence the difference in skin tones the further north you go in the world).

It just dawned on me that you eat fish (we're veggie, so it's out of my sphere of recognition). Well, if you eat any fish, esp oily fish, you'll be getiing A & D aplenty (remember cod liver oil being recommended to stamp out rickets?), so you don't need dairy. Maybe you should point that out to the aforementioned dietitian. And while you're there, mention you'd like a second opinion from someone who doean't work for the milk marketing board.