I need some feeding help for 14 month old

[stretchad]

DS is being seen by a nutritionist and GI doc for his slow weight gain, which as caused him to fall off the curves over the last few appointments. I've gotten a lot of great advice and direction from the nutritionist, but actual meal time is SUCH a frustrating time for all of us. 

DS is at daycare 5 days a week, where he eats breakfast, lunch and 2 snacks. So for most of the week we are the ones feeding him dinner. When it comes to dinner, more often than not he eats only a couple of bites of whatever I make. Usually the food goes straight onto the floor, before he even tries it. Then, in an effort to get him to eat SOMETHING we resort to trying probably 4-5 different things to get him to eat anything. For example, tonight's quick dinner was hot dogs, mac & cheese (for him, made with cream), and broccoli (coated in butter). I have witnessed him eat these foods before. Tonight he didn't eat a SINGLE BITE. I tried putting it on his tray to feed himself, and also tried feeding him with my fork. Nothing. So instead, we fed him a cup of whole milk yogurt (w/ extra calories stirred in), a Plum Organics Mighty 4 bar, a few yogurt covered raisins, and some pediasure. I'm at my wits end here. It's a battle at almost every meal. 

He is inconsistent with what he will eat and what he wont. The quantities he eats of any one thing is so small. We are doing all the things the nutritionist tells us (adding calories, fat, drink pediasure, meal times spaced far enough apart, no grazing throughout the day). Does anyone have any advice for me, so we can stop pulling our hair out and making dinnertime a struggle?

[lilac05]

How does he eat at school? Could he simply be full by the time dinner comes around? Neither of my boys are big dinner eaters & several of my friends have said the same. (Though they're both starving by breakfast & eat a ton then!) Does he appear to be a strong-willed child who recognizes your frustration & is fighting back? What do you think would happen if you just decided to pretend not to care for a few days?

Does daycare do the added fat/calories during the day? If not, would they be willing to start? (Obviously you would have to supply some of the food.)

I do almost everything in my power to not make mealtimes a battle. It just never ends well for anyone involved. I've never had to worry about weight, though, and understand that changes the game some, too.

Did your ped & nutritionist take family weight history into account when determining their level of concern? Did he drop on his curve or off of the curve completely? Is he otherwise a healthy kid?

[stretchad]

lilac05 - He dropped entirely off his curve. He started at 50th % in the first few months after being born (this is based on his adjusted age). We have a legit "Failure to Thrive" label now, which his gut wrenching. Otherwise hitting all developmental milestones even for his un-adjusted age. For the most part healthy - the usual daycare illnesses hit us hard this winter, and I think that slowed the weight gain down quite a bit. I did talk to all of his doctors about my own weight history as a baby. I had eerily similar weights at the same age as DS. However by 14 months I was about 1/2 a pound heavier than he is right now.

It's hit or miss at school as to how much he eats. I don't get a lot of detail from the teachers as to how much he eats other than "All" "Most" Or "Little". I would say that he eats all of one meal and one snack, most of the other meal and snack. I think it depends on what they've prepared for the day and whether he likes that particular food or not. I'm not sure how much of the frustration he picks up on. He seems to just ignore my pleas and continue to shove food off his tray, and then starts yelling to get out of his chair, or for something to drink, or to be held, or who knows what.

I'm going to talk to the school about the added fat & Calories on Monday. I don't know how well that's going to work, but I need to enlist their help to make a dent.

I might have to try to pretend not to care for a few days. But that will be hard!

Thanks :-)

[dcn]

My ds was/is the same way about dinner. I think it is pretty common at that age to be picky and to change day to day what they like and dont like. It is frustrating! I think you are doing the right thing, in offering different things in order to get calories into him since he needs that and you cant really just let him not eat as is the typical advice. I think adding calories where and when you can is about all you can do, unfortunately, you cant force him to eat .

I will say that ds has gotten better over the last few months as to the variety of things he will eat, but it was pretty bad around 14-16 months. He was basically on a white diet then and ate cheese, yogurt, and bread. And some days he still will only eat something like cheese.

You are doing a great job! Hang in there and just keep offering.

[lilac05]

It's REALLY hard to pretend not to care when you're screaming on the inside, but I've had really good luck with that technique. Even tiny babies can sense frustration and react accordingly, your 14 mo old can, too! (Mine does!)

The FTT label has to be hard, but keep in mind, it's not literal for your child. He is on track for all other milestones...he's just a little guy. I hope you'll get responses from other moms who have been there, done that because I have no experience with it. A big part of me always wonders why we worry so much about it, though. Someone has to be in the 99th percentile and someone has to be in the 1st. If both are healthy & meeting milestones (& medical reasons for weight loss have been ruled out), why is it an issue? Some kids are unhealthy at 99th % and others are just heavy kids (my kid LOOKS pretty thin, but is consistently >95th). I'd think the same would be true for those in the low %iles, too. In a culture so affected by obesity, you'd think we'd be much more concerned about the heavier kids!

[dcrunnergirl52]

DS2 was really slow to get on board with finger foods, mostly due to his low-muscle tone which also makes some kids finicky eaters. He wouldn't pick up any food but puffs until he was 13 months. He'd just scream and scream in his chair at dinner. He'd even scream when we tried to feed him purees. Daycare reported that he'd eat some foods but mostly purees. He started to to fall in his growth curve, so we talked to our PT about it who brought in an occupational therapist.

Two things she said that were really helpful: 1) Most kids only eat one good meal per day, and for most kids, it's not dinner. By that point, they are tired, cranky, etc. and can't focus on eating. It's usually breakfast or lunch. 2) Don't make dinner a battle. By a year old, the kids can start to sense that you're nervous and trying to force them to eat, which just gives them negative associations with eating, making every meal more of a battle.

We took these things to heart, and just let DS2 move at his own pace. We gave him pediasure 1-2 times per day to make sure he was getting nutrition. We let him play in food as much as possible. When he threw food off his tray, we tried not to react b/c that just made it a game for him. We also realized that DS2 hates little bites of food. He prefers to get the entire piece of something and bite it...like handing him a whole banana and just letting him eat.

Finally, now at 16 months, he's just about caught on that eating is a good thing and is trying all foods. But, his dinner is still usually only 1-2 bites. Nothing like my older kids, who I swear were eating more than DH and me, at this age.

Good luck! I know how frustrating it is.

[smock]

I have a younger baby, but here's an idea: what about giving him breakfast at home in addition to the daycare breakfast? If most toddlers eat more early in the day that might be a better time to offer calorie-rich foods.

[gibbinator]

Ds1 was (is) really fussy like that too. He dropped from 75% at 6 months to 3% by 18 months.
Honestly we just started giving him what we knew he'd eat. Crackers, cheese, Greek yogurt... When we were referred to a pedi by his family Dr for his weight loss she also put him on a Pediasure a day diet and told us to increase his wcm intake too. Just basically to feed him whatever we could that was fattening. Make sure you brush teeth really well using Pediasure though because I've heard lots of stories of it causing cavities.
We were referred to a nutritionist as well who was really helpful in giving me ideas for improving the food he would eat. Basically he only eats beige food, so she suggested things like cauliflower and squash in pancakes with lots of butter.

We also didn't (and don't) expect much at supper time. He eats a varied diet at daycare thanks to peer pressure, so at home we just make meals we know he'll eat. Which is boring for us eating spaghetti and mashed potatoes all the time, but at least ds1 is getting calories.

In the end, after 3 months drinking Pediasure, ds1 gained 3lbs (more than he had in the past year) so he was just diagnosed as a small, skinny kid. We stopped giving him Pediasure after that since it is so expensive. He's a whopping 5% at 24lbs. At 2.5 he's getting a bit less picky now that he can understand suggestions like "why don't you just lick it and see if you like it". Helping me cook also makes my meals seem less strange (or whatever his problem is) and more likely to taste things.

[arch01]

ijack-did you deal with this at a younger age or was it just when DD was a bit older?

[redheadk]

I'm sorry you guys are struggling with this. My dd had a major drop on the growth chart at 4 months, was diagnosed FTT, and we were referred to a pedi gi and nutritionist. It was very scary but also easier to deal with since we were dealing with bottles not food.

I have no experience with your situation but I'll echo that my dd does not typically eat much dinner so it's better if we try to get more calories in her earlier in the day. The idea of 2 breakfasts is good, you could maybe make egg muffins with extra yolks, some broccoli, squash, or spinach to get a veggie in, cheese, and low sodium bacon for added flavor once a week then pull one out each morning for him.

lilac05, the concern isn't that they are at the bottom of the percentiles, the concern is that they experienced a sudden and dramatic drop in percentiles. This means that the child likely didn't gain any weight at all since the last check or even lost weight. That is not healthy at such a young age and is definitely cause for concern.

[nonsenseabound]

My daughter went through this. She was just a step away from failure to thrive. I would add a bedtime snack. A small one but rich in calories. We also gave ice cream at the end of meals and added butter to everything and cream to milk.

[stretchad]

Thanks everyone for the replies. You've helped me shake off some of the frustrations. In fact, my grocery trip today was more about stocking up on foods that will help bulk up the calories for him than it was things DH and I can eat. Fortunately tonight he SCARFED down dinner, which was basically orzo made with cream, parmesan cheese, and diced tomatoes. His portion included about an extra 1-2 TBSP of butter (YES!)

redheadk, how long did it take for your DD to get back to a non FTT label?
smock, I'll probably start feeding him breakfast at home, to ensure that we're really loading up the calories that first meal of the day. Even if he doesn't eat breakfast at school, I'm fine with that. A breakfast I make will probably have way more calories than a breakfast from school.
nonsenseabound, I bought some haagen dazs vanilla bean ice cream today, and had DS eat some before bed. Kid is one lucky duck.
gibbinator, thanks for the advice! I would love it if DS gained 3lbs in 3 months! The nutritionist has advised us to swap the half and half we were feeding him (yes, you read that right, half and half. This was at their suggestion the first time we met w/ nutritionist.) with pediasure for all liquid calories. So he should be drinking at least 16 ounces+ per day. Furthermore, we add powdered calories into it as well...adds another 50 calories per 4 ounces.
dcrunnergirl52 - thank you. It's really good point that kids probably only eat one great meal a day. he's definitely tired, and cranky at that hour. I think starting to feed him breakfast at home vs. at school will help give me an opportunity to ramp up the calories in that meal vs. trying to do it at dinner.
dcn, thanks for the advice. I am jealous of your cheese-loving baby. DS will eat it sometimes, if it's mixed into something else. But I wish I could hand him a chunk of cheese and let him have at it. Just won't do it! He doesn't even like Goldfish or Annie's bunnies!

[redheadk]

stretchad, we started seeing a bit of an improvement after a few weeks and by her 6 month appt (so 1 1/2 months later), she was trending up again. She never did get back entirely on her growth curve but she sort of started a new one and the dr was not concerned. We were able to discontinue concentrating her feedings (I pumped and added formula powder to my milk) at some point, I'm fuzzy on when. I know we had to do it for a few months at least. DD's issues were tied up with her reflux so once that fixed itself, things leveled out for us. She's still on the smaller side but she was 15% for her height/weight ratio last time, a vast improvement over hovering at the bottom of the chart, sometimes off, sometimes on.

I wish you lots of success! Issues surrounding feeding are stressful and lots of work for the parents. Sounds like you are doing a great job!

[speckledfrog]

ditto PPs, dinner is the pits for most people. I agree that doing breakfast at home will probably work better and hopefully make you feel less stressed about getting him to eat at dinner.

[origami]

In addition to the helpful advice you already got... My feeding tip - which I know is terrible advice but we do it and it works so I'm sharing it in case it works for you too - is giving him a smart phone or tablet while you feed him. He might be too young for this but it worked for my overly picky 2-3yr olds. We had to break the habit and it was rough but I'd do it again if I had to.

[nonsenseabound]

Good luck! I hated it because I felt like a mommy failure but it really does get better. These ladies have given great advice and your little one will catch on soon.

Fwiw, my son did not have any of these problems. We can't decide if it was a genetic thing, personality or he watched his sister eat and joined in. Kids are a weird little mystery.

[ijack]

Ugh, big hugs for you, I know how frustrating this can be. My 6.5yo has had feeding issues since birth (she was a preemie) and 14 months was about the worst. She's still not huge (just hit 40lbs), but we've come a long way!
My tips
Let him eat whatever the hell he wants. If he's really not gaining weight then throw out all the traditional advice on how to feed toddlers and let him eat whatever he'll eat.
Try to think of his intake on a weekly basis, not a daily or meal by meal basis, it's more important.
If he's eating well at school then it's really possible that he just might not eat at home. Most toddlers eat ONE good meal a day.
Try not to stress about it. I can only say this because I've been in your shoes and was there for years, but he knows you care and he's a toddler and he's going to play that up.
Does he have any sensory issues? or food intolerance?
One thing they teach you at feeding clinics when you're really trying to get them to eat (and eat what you want them to eat) is to put the TV on and as long as he takes a bite the TV stays on. If he doesn't take a bite the TV goes off until he takes another bite - rinse, repeat. I can find you a better explanation if you're interested in that option.

ETA- just read a response. I wouldn't switch to pediasure quite yet. And I wouldn't feed half and half. I would do whole milk with milk powder in it (nido is the easiest one to get, it's usually in the hispanic food aisle), it has more actual nutrition than half and half.
If he's hungry when he gets home from school, feed him then and don't worry about "spoiling" dinner. I would make sure it's a nutritious snack, but a lot of kids can't wait until dinner time to eat. My girls are a million times more hungry at 4/4:30 than they are at 6.