Sometimes I feel like sobbing with despair that my 2yo DS won't eat enough :-( LONG!!

[Dalrymps]

This is LONG so appologies. I just feel I need to write it all down as I don't want to go over it with DH again as it upsets him just as much as me.

My ds has been difficult to feed both milk and food since he was born, I have posted about this before.

I had a period of depression which I recieved some couselling for and had antidepressants for a few months but decided against them.

It's really complicated and there are a lot of factors to consider. He is 9th centile for height which is fine, he was born 9th centile. His weight gain slowed down at 8 weeks old and went slowly off the bottom of the chart. We were referred to paediatrician and dietician (along with lots of other people who gave advice on feeding him, none of which worked).

The paediatrician believes he is perfectly healthy and there is no physical reason for his slow weight gain apart from the fact he doesn't take in enough calories generally.

The dietician's main aim is to get his weight to match his height (centile wise) so that if he were to become ill he would have some 'spare' to fall back on and wouldn't become to underweight.

The dietician prescribed him SMA high energy milk when he was under a year old and his weight picked up a bit but then slowed again. Once he was a year old she changed his milk to a higher calorie one called paediasure plus, this made him completely loose the tiny bit of interest he had in food and he would vomit on average one of his 4 bottles back up again each day, he also had very runnny poo's (all not usual for him). After 2 weeks of him hardly eating a scrap of food on this milk we decided to mix it half and half with his ols SMA and he stopped vomiting, poo's we ok again and he ate a little.

He was breast fed when younger and I had a lot of problems but he bascially ended up being mix fed till 5 months when he refused to bf anymore and went completely on to the aptamil.

He was late to sit unadied and has been quite late with getting his teeth. Hw will be 2 on 30th Oct and still only has 8 teeth (at the front) and one molar coming through.

It took ages to get him off smooth jars then ages to get him off lumpy jars. Feeding him has been the haerdest, most frustrating thing I have ever had to do. To feed him jars he required constant distractions (eg toys, books). He took ages to become interested in just eating bitd of our food and for ages would just chuck them on the floor or eat a tiny bit then leave it.

We are now at the stage where we give him fromage frais for breakfast (won't eat cereal or weetabix or readybrek), I have to distract him with a magazine or video's off my phone to get him to eat the fromage frais otherwise not one single spoon will be accepted.

Then he gets some sort of sandwich for lunch (philidelphia,tuna,cheese, egg etc) and some quavers and bits of cheese that he likes to eat. He usually takes about 2 bite of the sandwich at lunch if we're lucky then eats a bit of cheese and about half a bag of quavers. I then have to distract him (again!) to get him to eat a high cal pudding such as custard or more fomage frais or ice cream etc

Tea is bits of ours cut up which has varying success, sometimes he eats quite a bit (10 bites max) and sometimes hardly a scrap. Pudding is the same as lunchtime, high cal, spoon fed. DH usually does tea to give me a break from the feeding although I am there also as we all eat together.

He has 4 4oz bottles of milk a day as he won't take more than 4 oz a bottle ( I would love to be able to give him 2 8oz bottles or even 3 5 oz). He won't take the milk from a cup although he can drink prefectly well from a cup and he has his juice in one.

The dietician has recently also prescribed him some high calorie powder to add to his milk or food. He refused point blank to eat it in his food. I don't blame him as it was grainy and didn't dissolve very well. We therefor add it to his last two bottles of the day as to not affect his appetite during the day.

Recently we ran out of the higher energy milk temporarily (paediasure plus) and had to give him just the SMA for a week or so whilst we waited for the prescription. Ds's interest in food increased noticabily when he was on the SMA alone and he ate slightly more than when he has the paediasure mixed in. I have always believed from the begining that the paediasure didn't help matters. The dietician said to see how he is off it for a few more weeks and if still the same she will put him on a less calorie dense paediasure that is more suitable nutritionally for his age than the SMA.

I'm a little worried that changing him milk again will have some sort of affect on his eating, changing anything usually does. I'm also concerned that even though his appetite is better off the paediasure he still doesn't eat a whole lot more, just seems more willing to eat at all iyswim so he might not make up the calorie difference.

The main problem has always been the amounts he eats, he is quite good at trying a variety of foods if in the right mood but just looses interest very quickly. He just doesn't seem to get he has to eat a lot to grow, it's as if he's just not hungry.

When we saw the dietician the other day she made some 'helpful' suggestions on ways to encourage him to eat. She suggested reward charts/stickers for eating a bite of something or another page of his story for eating such and such. Thing is i'm pretty certian he is too young to understand this concept yet, we have tried over the last few days and he just doesn't seem to get what we're on about?!

I have watched many episodes of 'the house of tiny tearaways' to try and get answers on feeding problems. I have taken away from this that anxiety is the enemy. We spend each mealtime trying to be as relaxed as possible and basically just let him get on with playing with his food whilst we chat amongst ourselves and occaionally to him. We give him gentle praise when he eats something and clear his food away when he finally starts throwing it on the floor. We don't put too much on his tray and we always offer something we know he likes/somehthing familiar and something else for him to try. I don't know what more we can do?!

This is what has brought me to write this all down. I feel that everytime we see the dietician she makes suggestions on ways to get him to eat or things to feed him that are high calorie. I always come away from the appointments with renewed hope that we have new ideas to try and desperately hope that one of these ideas will work. Then wht happens is I get back to reality at home, try the suggestions and they don't work. This makes me sink even lower and makes me feel even more defeated and helpless than before . I always end up feeling so sad to the point that I just feel like going somewhere ds can't see me and sobbing my heart out.

We have tried so much, so many tactics and ideas over the months but the daily grind of having to feed him and progress being so painfully slow just gets me down. I try not to think about it most of the time and try to remain positive butif I stop to think about it then I just have massive feelings of hopelessness. I feel like i'm letting him down, I don't know why he won't eat more, I can't help him to eat more cause nothing works and nobody, not even the many professinals we have seen have any answers of ideas that can help us.

I don't want him to be on 2 types of high cal milk and high cal powder. I don't want to try to constantly feed him high calorie foods as deep down I feel it is unhealthy for him. I don't want to distract him whilst I spoon food in to him. I just want to be a relaxed mother who can let him discover food and feed himself. I can't be that mother though because the fact is, if I just leave him to it he will not gain enough weight and it'll be my fault. i'm crying writing this, I feel totally at a loss and I know my DH feels exaclty the same

I feel left alone to stuggle and wish someone could tell me why he is like this or at least give me something I can do about it that works.

[Dalrymps]

Sorry, got to pop in to town to drop of prescription... Will be back later though, thanks agian...

[drlove8]

if there is no allergys to nuts in your family id give peanut butter... it one of the most calioriffic (spell sorry) foods around. avacados r good too. my kids like them mashed up , sort of guacamoli type dip , but without garlic. humous is good too.

[Horton]

Everything you say suggests to me that there simply is not a problem, just a skinnier than average child which you would think in these days of high child obesity etc would not be something to worry about.

If it helps at all, this is an average day for DD who is a year older than your son (so you'd think she would eat more):

Breakfast: very small bowl of cereal, less than a whole variety pack sized portion (without milk), some kind of fruit (say, half an apple or four strawbs or a small clementine), maybe half a slice of toast with butter and jam or marmite on a hungry day

Snack: another small portion of fruit or cucumber/celery sticks with a small amount of hoummous, maybe some breadsticks or bread and butter or plain water biscuits (she loves them, the weirdo)

Lunch: a sandwich made with one slice of bread containing a little ham or cream cheese or marmite, one of those tiny pots of fromage frais

Snack: more fruit, maybe some dried fruit (like a tiny pack of raisins or a few dried apricots), sometimes a water biscuit or other carby thing

Dinner: hot meal but in tiny quantities - so maybe three tablespoons of pasta and sauce or a chicken drumstick with one bit of potato and a couple of bites of veg or half of one of those tiny child-sized pizzas (no way could she eat a whole one). Very occasionally I can get her to have another fromage frais or a bit of custard with stewed fruit or similar.

She barely drinks milk (will have maybe 100ml or 150ml of hot milk with honey in a cup at breakfast time and sometimes accepts similar amounts of chocolate milk or very weak tea and coffee).

I think this is a stupidly tiny amount of food considering how much she runs about and bounces and I am pretty sure she is not getting the recommended 1300 calories a day for her age, but she is thriving and happy and meeting all her milestones etc. My doctor, when we saw him after we'd been threatened with a paediatrician and dietician etc, said that he thinks she is absolutely fine just very very slim. Which would make sense as I am skinny and so is DH.

I really feel for you in how you've been made anxious by what sounds like very very bad practice from people who really ought to know better. I felt much better when I stopped going to HV etc, personally. DD hasn't seen one since she was 8 months old.

[alypaly]

Dalrymps ........had the same problem with DS1 ...he was only eating quarter of a sandwich for lunch and not much more at tea time. He was in the lowest 9th centile too.

THe suggestion i had from the doc WHICH WORKED was to stop drinks as they are empty calories.
Not altogether.
What doc said was to give him his food ,make no fuss,if he asks for a drink,just say you can have one when you have finished your food. You may get a few tantrums and a few meals that they play with...but it worked really quickly.
So try just giving a drink when meal is finished and then a half sized drink in the sfternoon. They will soon get to learn that a drink is a reward for eating.
And it is true,drinks are empty calories and a stomach full of juice or water tells the brain that it is full. Try it..its worth a go..
good luck

[Dalrymps]

NC - I just get him weighed now when we see the dietician or paediatrician, stopped getting him weighed by hv quite a while ago. He now see's paed every 6 months and dietician every 3 months so usually gets weighed at least every 3 months...

I am curious as to his weight to check his progress but I can usually tell by carrying him every day and how his clothes fit as to how he's doing really.

DrLove - Not sure, it jsut has less calories than the paed plus, probably the one you mentioned. I'm unsure about him going on it though, I really don't think it suits him.

The SMA suits him but they're trying to get him off it as its only 'suitable' until 18 months nutritionally. They think the doc might stop prescribing it once they realise he's too old to be on it. I don't really feel he needs milk with loads of extra vitamins etc in it anyway, other 2 year olds survive pretty well on normal whole milk after all..

Iwantachick - He's on the SMA as it's SMA high energy, the first high cal milk he was prescribed and he still gets it mixed with the second one he was prescribed (the paediasure).

I know the distraction isn't good and i agree with you it will give him the wrong attitude to food. We need to change that somehow.

Horton - It's reassuring to see other children to eat loads and loads. Ds has 2 cousins that love to eatand it makes me feel so jealous!

I feel this has all been concentrated on too much and made us worried sick as a result.

Alypaly - Interesting suggestion, he doesn't really have much juice though. Not really more than half a tommee tippee cup a day... It might be the case that he gets full from his milk though. I do feel sometimes he likes to wash his food down with a bit of juice as he doesn't have many teeth yet. I'll keep that in mind though, thanks

[IWantAChickAndADuck]

Horton, you give your 3yo coffee?

[Horton]

DD hardly drinks either! She might have another 200ml or 300ml of liquid in addition to the breakfast milky drink, which would be very very watered down apple juice.

[Horton]

Er, yes. Very very weak coffee and often decaf. She gets a dribble of coffee in a cup topped up with a lot of warm whole milk so it is 95% milk at least, maybe 98%. It is one of the few ways to get her to be enthusiastic about anything milky and she gets v little calcium as she won't eat much cheese or yoghurt. She feels very grown up drinking her 'coffee' and I would rather she had the liquid and calcium.

[IWantAChickAndADuck]

Ok... I thought you meant a proper cup of coffee

My DS thinks it's hilarious when I ask him if wants a cup of coffee in the morning!

[LilianGish]

Haven't read entire thread so sorry if repeating. Neither of mine were particularly good eaters and certainly not at two. I remember despairing with dd who sometimes seemed to eat nothing at all. Best advice I had came from another mum who said don't look at what she eats day by day, but look at it over a fortnight. It helped me to relax and instead fretting that I hadn't managed to spoon enough into her I let her follow her appetite. Hesitate to go against your dietician as I am certainly no expert, but my own instinct would tell me that stuffing him with high calorie milk will only serve to kill his appetite for anything else.
Also you say "He is an absolute delight (most of the time) apart from normal toddler tantrums. Lots of energy, great at talking and moving about." It doesn't sound as there is much wrong with him. Why don't you give yourself a couple of weeks off and just see what happens? Resolve not to stress about it - offer him food and snacks and let him eat as much or as little as he wants.

[CookieMonster2]

Having just read the whole thread I don't think there is a whole lot more I can add, but wanted to post as I have a dc who is nearly 4 and weighs about 23 lb so I am familiar with some of this.

What shocks me is that you are being given high calorie milk. We were told to keep milk to a minimum as food is more important.

Reward charts are a really bad idea as well. To me thats just asking for eating problems in the future. You should eat because you are hungry, not because you will be rewarded for it.

I agree with what other people have said as well regarding the charts. People are different builds, we aren't all expected to be on the same centile for weight and height. My ds is a centile higher for his height than he is his weight but he still looks really chubby.

My advice would be:
a) Ditch the special milk and just have cows milk for breakfast and supper.

b) Offer a variety of foods. There is nothing wrong with high calorie foods as long as healthier food is being eaten as well.

c) Don't make a fuss at meal times. If it doesn't get eaten then it doesn't get eaten and there is nothing you can do about it.

It sounds to me as though he doesn't have an eating problem at the moment, but will have in the future if it continues to be treated in this way.

I would also say that if you refuse to follow any advice that is given by hcp not a lot will happen. At the end of the day its just advice.

[Dalrymps]

Lilian - Good advice there, if I focus on what he eats each day it gets more stressful. Sometimes he has a bad few days or even few weeks then picks up again. I think we are going to have to try him without all the supliments for a few weeks to see what happens.

Cookie - I agree with your advice, that's basically what we want to try doing.

Interesting that you were advised basically the opposite of me, to keep milk to minimum. I feel like the milk has become the main focus and the main source of his calories.

Was it a dietician who advised you on the milk thing or some other hcp?

[CookieMonster2]

Dalrymps, we were given advice by a dietician from the hospital, who we thought was brilliant. She gave us loads of help and advice, and reassurance that we were doing the right things.
The reason to cut down the milk is because:
a) If you want to increase calorie/fat intake you can do this much more easily through food, just by mixing butter/cream with other food as other people have suggested.
b) It isn't just about putting weight on, its about learning to eat, and its difficult to do that if you are being filled up with milk.

[Dalrymps]

That's it exactly, I feel it's affecting his ability to eat as he's all filled up.

When she said to keep milk to a minimum what amount did she suggest and what age was your dc then?

Ds has 16oz a day...

[CookieMonster2]

I was trying to remember what milk she had before I read your reply.

We had prescription milk until we started weaning her, when we went onto a normal amount of normal formula milk (I also partly breastfed). I can't remember what the normal amount was but it was just whatever it said on the tin. She had water to drink with meals.

When she was 1 we went onto full fat cows milk, but just with breakfast and for supper unless she asked for it. Water during the day is fine.

We were always told you can get calories much more easily from food, and on the suggested menu was croissants (sp?) crisps, icecream, chocolate, and all sorts of stuff you wouldn't imagine feeding to a toddler. Ofcourse, she also had more 'sensible' food as well.
If you don't describe things like chocolate as a treat they won't become a treat, she ate so much of it she doesn't eat it now, and when offered it will choose fruit instead.

Sometimes easier said than done but we have slowly learnt to not worry or make a fuss. Beyond offering suitable food there isn't much else you can do.

[whelk]

Most two year olds I know don't have much milk at all - my own dd (2.6) has a small cup for breakfast and a small cup at bedtime- sometimes she drinks it all and sometimes a few sips. Think this is pretty normal amongst her friends.

Having as much milk as your ds is supposed to seems very likely to be putting him off his food especially if its a high cal one.
If it is disagreeing with him and making him feel nauseaous or similar he will want to eat even less food.

I think deep down that you want to stop the milk and give him a chance to have a normal go at food. You sound like a mum who is very much in tune with your little boy so trust your own judgement.

If it doesn't work out then you will have to go back onto the milk but you aren't going to know unless you try.

[CookieMonster2]

Sorry to post again, but can't help wondering if he really needs to put on more weight, or whether the issue is just that he needs to get off the milk to help him eat like any other 2 year old.
Would it be worth asking your GP for a referral to someone else (maybe at a different hospital) for a second opinion?

[meltedmarsbars]

Based on our experience, I think the 9th centile is the trigger the Paeds and Dieticians use for intervention.

Its just a number but its hard not to take notice of it. You are sometimes better to use your eyes and common sense.

Unless like drlove8's situation, you suspect an underlying cause.

[CookieMonster2]

The 9th centile is normally the point where they want to check there isn't a medical problem, but there is nothing wrong with the 9th centile. In a class of children there will be 2 or 3 that are on or below the 9th centile, and someone has to be the smallest. Better this than being the fattest 2 or 3 in the class!

Its also worth remembering that no matter what size your children are people will always comment on it. Sometimes I think people can't thing of anything else to say. With my ds someone can comment on how you forget about how small they are when they are young, and then 5 minutes later someone will comment on how big he is for his age!

[MamaChris]

dalymps, our ds is skinny (but tall), although only 20 months. have avoided all HVs since he was about 10 months. he is a super-fussy eater and I struggle constantly to stay positive, so I do understand how awful it is to watch your dc not eat. the list of foods he totally refuses is growing daily (and now includes milk and cheese, which I do worry about). all I can offer are tips I have found help him eat something, hope they may help you:

when he's really thin (and I'm worrying about calories more than nutrition), if he enjoys eating anything, he can have it in unlimited quantities. this can mean a packet of rich tea biscuits in a day (suggested by an A&E doc as high energy, low fibre, easy to digest - he loves them ). also spoonfuls/finger dips of peanut/nut butter. my friend lets her dd eat butter direct, but ds won't touch it.

when I specifically want him to eat more than his "core" diet (fruit, marmite sandwich, yoghurt), I try any/all of the following:

• avoid the high chair/table that have been the scene of too many stressy mealtimes
• don't force him to eat anything
• let him feed himself (fingers or spoon)
• let him help with cooking something quick (short attention span), eg omlette
• smother savoury food in ketchup
• picnic together in the garden/front room - blanket on the floor, one plate of finger food we all share
• eating with other kids (and adults)
• eating away from the house

I have noticed, the more effort we put into making him eat, the less he seems to eat. if we manage to back off, he does better (though it can take a few very stressful days of almost no eating before things change).

your dietitian doesn't sound particularly helpful, though. why is her focus on high energy powders rather than high energy food?

[CookieMonster2]

I will second everything MamaChris has said. I think we have been advised everything on that list in the past, and it does help. The only problem is, that at some point, you will be sat in a cafe whilst your toddler eats a sausage roll and a packet of chocolate buttons for lunch, and then goes round the table eating the individual portions of butter, and other people will look at you in total disgust .

Things really changed for us when ds went to nursery. Peer pressure can sometimes be a wonderful thing.

[MamaChris]

@ CookieMonster2

I look forward to that day. at the moment ds is more likely to be found trying to eat bits of fluff/hair he spots on the floor

[Dalrymps]

Whelk - Yes I do want to stop the milk, suppose i'm worried people will think i'm a 'bad mother' or something...

I didn't spoon feed him today, toast for breakfast which he ate just over 1/4 o a slice of, good for him. Lunch was a bit rubbish, he just ate a handfull of quavers, I offered him his pudding to feed himself but he just left it after dipping his finger in. Must stay strong.

Going shopping later, might get some whole milk and start 'the experiment'.

Cookie - Well I don't really know, his weight has never dropped suddenly and he always gained weight even just tiny amounts. He did look quite skinny before going on the high cal milk but I guess that's cause he wasn't eating much food.

Melted - I don't think there's an underlying cause, he's my first lo and seems normal to me. Dh and I have gone over all causes we can think of to rule out but nothing has come up yet. He has an obsession with wheel spinning which I posted about on here wondering if it was an autistic trait but other mums reassured me it's just a normal part of development.

Mama - Thanks for the tips, yeah we try lots of things, frustrating when no one tactic consistantly works though isn't it?!

Back when we started seeing the dietician at the first appointment she advisd all the usual food things such as adding butter/cream etc etc but at that same appointment also prescribed the sma high energy. He was doing quite well on that for a while but his weight gain started to low a bit when he was just over a year so she then swapped him to the higher cal paediasure. I think the difficult bit was that even though we can add allsorts to his food he won't eat very much of it. How am I to know if he'd have eaten more food without his milk swapped though? I'll never know. When he went on to paediasure he ate hardly a scrap for 2 weeks, was sick every day and had runny poo's .

[MamaChris]

yes, very frustrating Dalrymps! the key is to have lots of tactics and rotate them.

around a year, it's natural for babies to start cutting back on milk (I think). Certainly, ds now (20m) has very little milk, but we do offer lots of full fat yoghurt, which he likes. I think it also takes up less space in his stomach than milk (per calorie), leaving more room for a wide variety of other foods marmite sandwiches

[Dalrymps]

I think it's just the never ending battle and not knowing when things will get better that is annoying.

I am plagued by feelings of guilt whatever I do. Right now i'm worrying casue he had naff all for dinner and i know he would have eaten piding if I had of fed it to him but I don't want to feed him that way anymore...