Older toddler failing to thrive

[textbookcase]

B is 4, almost 5, and had her yearly physical yesterday. She has only gained a lb in a year, bringing her up to 33 lbs. she has always been tiny, always in the 5th - 10th percentile for weight. This time she was in 75th for height and 16th for weight. She is also borderline anemic, not quite there yet but he said to start pushing more iron rich foods. He also said to give her pediasure after dinner. We have done the pediasure before and it didn't seem to help with weight.

She isn't a picky eater but she doesn't eat very much and if I try to get her to eat something she doesn't want to eat she works herself up into a frenzy and vomits up whatever it is. Getting her to eat is like pulling teeth.

Has anyone dealt w this? Advice?? How do I make her gain weight?

[thebuddhagouda]

I haven't dealt with it with a toddler, but my go to for weight gain is always smoothies. When Ethan had GI issues and dropped too much weight, we went that route and it helped when Amelia was almost FTT this year. I'll throw a whole avocado and a giant scoop of PB in there and some cocoa powder and banana and whatever milk they can drink or use pediasure instead of milk to really load the calories (and usually some loose spinach because why not get in some extra iron and vitamins).

The avocado makes it creamy and the cocoa and peanut butter and banana made it taste fine for my kids, and it's super super calorie dense.

[TR]

Sneak healthy fats into things she'll eat? Like oils, butter, etc.

[kris356]

Have you tried getting referred to a feeding specialist? I know our local children's hospital has a Feeding and Swallowing Clinic and also does therapy. I had a friend whose son went to them and he is doing great now.

[textbookcase]

Sept 9, 2016 9:56:49 GMT -5 thebuddhagouda said:

I haven't dealt with it with a toddler, but my go to for weight gain is always smoothies. When Ethan had GI issues and dropped too much weight, we went that route and it helped when Amelia was almost FTT this year. I'll throw a whole avocado and a giant scoop of PB in there and some cocoa powder and banana and whatever milk they can drink or use pediasure instead of milk to really load the calories (and usually some loose spinach because why not get in some extra iron and vitamins).

The avocado makes it creamy and the cocoa and peanut butter and banana made it taste fine for my kids, and it's super super calorie dense.

Awesome, I'll try that for sure!

[textbookcase]

Sept 9, 2016 9:59:08 GMT -5 kris356 said:

Have you tried getting referred to a feeding specialist? I know our local children's hospital has a Feeding and Swallowing Clinic and also does therapy. I had a friend whose son went to them and he is doing great now.

I will talk to him about that at her follow up, thanks!

[Que?]

Sept 9, 2016 9:59:32 GMT -5 textbookcase said:

Sept 9, 2016 9:56:49 GMT -5 thebuddhagouda said:

I haven't dealt with it with a toddler, but my go to for weight gain is always smoothies. When Ethan had GI issues and dropped too much weight, we went that route and it helped when Amelia was almost FTT this year. I'll throw a whole avocado and a giant scoop of PB in there and some cocoa powder and banana and whatever milk they can drink or use pediasure instead of milk to really load the calories (and usually some loose spinach because why not get in some extra iron and vitamins).

The avocado makes it creamy and the cocoa and peanut butter and banana made it taste fine for my kids, and it's super super calorie dense.

Awesome, I'll try that for sure!

I had to load my kid with calories and I did the same thing. I went to the health food store and got all kinds of things to add, protein and greens powders etc., under the advice of the people there so it's all good for kids. We have this powdered chocolate peanut butter that has 9g of protein in a tbsp, plus an avocado and some fruit and it's a full meal.

[jeaniebueller]

Sept 9, 2016 9:59:08 GMT -5 kris356 said:

Have you tried getting referred to a feeding specialist? I know our local children's hospital has a Feeding and Swallowing Clinic and also does therapy. I had a friend whose son went to them and he is doing great now.

I was wondering that too. Does she seem to have sensory issues with tastes and textures?

[hopecounts]

Agree with all the above but wanted to add.
Look into Division of Responsibility (DOR) and see if it might help.
We have used it very successfully to help DD eat better.
Basic theory is picky or limited eaters develop anxiety around food (the freaking out and throwing up you mention is one example of this) so you remove the stress.
Your job as parent is to provide 2 safe foods (foods she is comfortable eating) as part of the family meal (for example chicken (nuggets) and French fries) and then let them fix their plate and eat what they choose to, no nagging no pushing them to eat just provide it and let them take over.
Kid responsibility is to fix their plate and join the family for the meal.
It helped DD so so much.

[ijack]

First off, hugs! FTT is an awful name and it often makes parents feel like shit, but you shouldn't.
Since weight gain is the goal I would serve foods that you know she'll eat and add extra fat/calories to them. Whole fat dairy products, smother things in butter and cheese, add butter/oil/cream to cereal or soft foods, etc. I don't think pediasure is always the answer, but if she'll drink smoothies it's super easier to get calories in those. You can also add a scoop of vitamin powder or give her a multi vitamin to help with the iron. However you might run into the problem that if you make her food too calorie dense she might not eat as much, which then backfires, so play around with it.
Did she grow in height?

[themysteriouswife]

Myles will be 15 months next week. He is considered FTT. I have to hold him down and pour food into him. He is super picky and has a lactose intolerance. I cook his eggs in real butter. He eats nut butters on waffles, toast, and crackers. He still has barely gained, but it's enough to satisfy the pedi. We also give him the spinach apple sauce pouches. That could be an option for the iron intake.

[Monica Geller]

My 3yo nephew has dealt with weight gain issues. This summer His pedi "prescribed" a bowl of ice cream every night since he otherwise eats healthy. They've seen improvement! Just an idea.

[missyny]

I agree with all others' great advice! And, I know this is hard. My youngest has/had sensory issues with textures and evendors some swallowing problems. Our state and county offered OT to help with it. (When she was 2)
Not sure what's available through your state, but OT is not just for acedemic fine motor skills. I hope you can get help for her if she would benefit. And, sneak those avocados into all her shakes!!

[bc1206]

Ugh, I know how you feel. It's so frustrating as a parent. FTT is such a hard thing to hear. My DD will be 6 in December and she weighs 33lbs. We've been dealing with this since he was a baby. DD won't drink Pediasure so we tried breakfast shakes using protein powder. She really took to them. Plus we can sneak in veggies and other stuff we can't get her to eat regularly.

Her pedi suggested soups, butter, healthy fats. We haven't been referred to a nutritionist yet, but I fear we will need to if she doesn't gain much by her next appointment. She keeps growing in height though, so I think that is why we haven't been referred there yet.

Hang in there!

[Deleted]

We also make extra smoothie and freeze it into Popsicles. We do let her have a regular popsicle but it's like one a day. "Smoothie-cicles" she can have as many as she wants.

I've found mine will eat more fruit when it's frozen (she's always liked really cold things"

And is she involved with cooking? Mine eats so many samples while "helping" that I'm sure some days it's a full meal some days.

[cleo29]

How much do you put on her plate? Do you watch her while she eats? My nephew used to not eat a lot and part of it I think was portions would overwhelm him and people hovering while he ate. So, you might be doing this already, but I would start plate with crazy small portions and just leave her be to eat. Let her come to you for more. And since she might not eat much anyway, I would make sure her foods have a good amount of protein and fats.

I imagine this is tough, but it sounds like you are getting some great advice here!

[sonrisa]

I don't know the details or stats, but I do know that as a kid I grew in fits and spurts. At her age, I was tiny. Noticeably so and didn't eat or grow much. I stayed pretty small until around 3rd grade. In contrast, I grew 6 inches in 6th grade, putting me at 5'7" by the end of the year.

[fivechickens]

One of my girls was about that weight at the same age (she actually got a 'failure to thrive' mark in her records by a nutritionist a few years ago which made my Dr roll her eyes). Now at 5 1/2 she isn't much bigger weight wise (MAYBE 35lbs). The Dr was pleased that she is gaining so the only thing she recommended was vitamins with iron.

V's biggest problem is that she would rather be doing anything else but eat so we have to really remove distractions or sit with her and make sure she is eating. She is getting better though and adding more to her palate.

Also, could genetics play a roll? my husband was lanky as a kid and our girls seem to be taking after him in that respect. I am a but surprised that your Dr is concerned, IME, Drs seemed to be happy that kids are growing.

[dowagercountess]

My kid was this way, and she's just small. She's still small. She's also incredibly strong. She is consistently tenth for height and anywhere between off the charts low and four percent for weight. Her Dr says it's just who she is.

[Deleted]

Sept 9, 2016 9:56:54 GMT -5 TR said:

Sneak healthy fats into things she'll eat? Like oils, butter, etc.

I second this.  Butter is wonderful and fat is very good for the brain, as well as the body. 

Focus on what she likes.

Also, don't worry too much.  I've had lower weight children.  As long as she's consuming a fair amount and is not food avoidant, then I wouldn't be too anxious about it. 

[coribelle26]

My coworker is at a feeding clinic right now because her daughter has delayed gastric emptying - basically she never feels hungry. It's super unlikely but worth at least looking into - she said it was a really hard road to the diagnosis and tons of doctors told her that her daughter's issues around food were purely behavioral (even when she was a tiny baby).

This isn't especially helpful with your current question but since she had never heard of it before getting the diagnosis I figured it would be worth mentioning.

[InBetweenDays]

Can I ask why they think she's FTT? Sounds like she's staying on her curve if she's consistently between 5-10%ile (and now 16%ile)? DD (10) hovers around the 3% for weight and 25% for height. But she's been stayed on that curve since she was 9 months old so our doctor isn't concerned (so I try not to be).

She's strong, healthy, and active. Just small.

ETA: I hope this doesn't sound like I'm dismissing your concerns. Because I totally understand the worry when your child is small. But for us it came down to not wanting to create a battle around food when her size is most likely just her genetics. As my BIL says - someone has to be at the 3rd (or 16th) percentile. 

[textbookcase]

Sept 9, 2016 12:15:34 GMT -5 InBetweenDays said:

Can I ask why they think she's FTT? Sounds like she's staying on her curve if she's consistently between 5-10%ile (and now 16%ile)? DD (10) hovers around the 3% for weight and 25% for height. But she's been stayed on that curve since she was 9 months old so our doctor isn't concerned (so I try not to be).

She's strong, healthy, and active. Just small.

Yeah that was my question as well, she has always been tiny, it's not a new thing. She has stayed on the curve, just on the low end of it. She did shoot up in height this year but her weight has stayed low. I'm not really overly concerned about the weight, I'll definitely keep my eye on it and sneak in as much healthy fat as I can. I am concerned about her becoming anemic, I have problems with that myself so I'm for sure going to try to push more iron.

The texture issues is interesting, I might have to look into that. She is so weird with her pickiness, sometimes she will eat certain foods with no problem and other times they make her vomit, literally. Smell seems to be an issue with her, she won't eat things with strong smells (like cumin), or she throws up.

[adhdfashion]

I have recently had some luck with getting Natalie to try Nutella. She loves it. It's chock full of nut fats and calories. She is actually starting to gain weight.
She only gained two pounds last year and is off the chart tall. Our goal is to break out the of 20th for weight. :/
I haven't had any luck with shakes or smoothies. But I keep trying.

[kellykapowski]

DD1 is very petite and her doctor said as long as she's growing consistently on her own curve, there's not a concern. She's been between 5th - 20th percentile for weight her whole life. Last well check she was in the 13th. She eats like a bird and if she eats too much, she will throw up. Though it's not brought on by panic. Just an overly full stomach. I was very much like her growing up, petite, ate barely anything. People would tease me for being skinny (thanks loving hispanic family!) I have no issues with my weight now. In fact, I could stand to lose a few pounds to get me back into the "health weight" range.

Anyway, I have definitely tried to sneak extra calories in for years. Olive oil is my go-to. I put it on everything it tastes good with. When I make eggs, I use a good splash of it, I drizzle on avocados, I drizzle on sweet potatoes, I put it on corn, in pasta, on a slice of toast. She loves it. I got a lot of that, too, growing up. I sneak it into everything if I feel she needs a boost in calories and fat.

If she eats a decent dinner, I'll give her ice cream for dessert. I still give her whole milk with every meal. Almond butter, peanut butter, cheeses, full fat yogurts. I don't ever bring fat free or low fat anything into the house if I can help it.

I never force her to finish her plate if she says she's full. I've learned that she's honest about it and if I force it she ends up getting sick. So if she says she's full and hasn't finished what I served, that's fine, just no dessert. I will offer fruit later on if I feel she needs a little something else.

However, I will say this, the older she gets, the better she has become with eating. She's finishing her meals consistently, I'd say for about the last year. She's about to turn 7. It was a struggle before, but she's getting better. I hope the same happens for your little girl.

[Gato]

My DDs are also small and DD1 was very picky (we found out some of that had to do with swollen tonsils, so you might have that double-checked just in case).

She was more like 2-3 y.o., but when DD1 dropped down to 1% for weight, her pedi recommended cooking in olive oil, lard, or bacon fat - anything fatty. Also she loved to eat cheese and whole fat yogurt, so we loaded her up on that. The one caveat is too much dairy can cause constipation. She did gain, though.

[lolo]

If you are making smoothies, you could throw in some pumpkin seeds for iron.

Sweet potatoes, lentils, and lots of spices also have a good amount of iron. I make a lentil soup with turmeric etc for example.

Also note that iron needs vitamin c to be absorbed so you might think about adding some of that too.

[truckentruck]

I haven't read all the replies, but if she's on the small side, borderline anemic, and having some issues with eating, it might be worth requesting the comprehensive celiac panel to see if celiac could possibly be causing the issues. Those are common symptoms.

[textbookcase]

Sept 10, 2016 7:21:50 GMT -5 truckentruck said:

I haven't read all the replies, but if she's on the small side, borderline anemic, and having some issues with eating, it might be worth requesting the comprehensive celiac panel to see if celiac could possibly be causing the issues. Those are common symptoms.

Oh, thanks! That's interesting. I'll talk to her dr about that possibility. She doesn't have any stomach issues, no pain or diarrhea. I'll definitely look into it.

[adhdfashion]

Sept 9, 2016 14:57:55 GMT -5 kellykapowski said:

DD1 is very petite and her doctor said as long as she's growing consistently on her own curve, there's not a concern. She's been between 5th - 20th percentile for weight her whole life. Last well check she was in the 13th. She eats like a bird and if she eats too much, she will throw up. Though it's not brought on by panic. Just an overly full stomach. I was very much like her growing up, petite, ate barely anything. People would tease me for being skinny (thanks loving hispanic family!) I have no issues with my weight now. In fact, I could stand to lose a few pounds to get me back into the "health weight" range.

Anyway, I have definitely tried to sneak extra calories in for years. Olive oil is my go-to. I put it on everything it tastes good with. When I make eggs, I use a good splash of it, I drizzle on avocados, I drizzle on sweet potatoes, I put it on corn, in pasta, on a slice of toast. She loves it. I got a lot of that, too, growing up. I sneak it into everything if I feel she needs a boost in calories and fat.

If she eats a decent dinner, I'll give her ice cream for dessert. I still give her whole milk with every meal. Almond butter, peanut butter, cheeses, full fat yogurts. I don't ever bring fat free or low fat anything into the house if I can help it.

I never force her to finish her plate if she says she's full. I've learned that she's honest about it and if I force it she ends up getting sick. So if she says she's full and hasn't finished what I served, that's fine, just no dessert. I will offer fruit later on if I feel she needs a little something else.

However, I will say this, the older she gets, the better she has become with eating. She's finishing her meals consistently, I'd say for about the last year. She's about to turn 7. It was a struggle before, but she's getting better. I hope the same happens for your little girl.