# Trying to fatten up 18 month old with failure to thrive



## Debrah Cohen (Dec 7, 2006)

I'm looking for help with:
1. How to fatten up my daughter.

2. What specialists she should see other than a GI for unexplained "failure to thrive"?

My daughter is 18 months and is below the 3rd percentile. She was coasting along at the 6th percentile until 9 months and then started to drop off when she started solids. From 12-15 months she didn't gain anything which was probably due to trouble starting solids. In the last 3 months she's gained about 11 oz a month, but has not gotten up into the 3rd percentile.

She just had an endoscopy and biopsy and is negative for ee, celiac, cystic fibrosis (had a sweat test). The only thing they found was a little esophagitis. She has silent reflux - meaning no throwing up.

The GI said that unless her weight increases she'll have to go on a feeding tube. I think that the problem is that she doesn't get enough fat in her diet. She is allergic to milk, gets diarrhea from all beans and lentils, and is kind of picky. I've tried giving her avocadoes, and almond butter, she ate them for a week and now refuses one bite. I tried putting coconut oil into a smoothy, but it tasted weird and she wouldn't drink it.

I'm feeling very desperate. She does have a pretty good appetite and eats fish, chicken, bagels, fruit, veggie burgers, and tofu with relish.

We're seeing an accupuncturist today, the pediatrician tomorrow, and have gone to a homeopath last week.

Any suggestions would be welcome. Also, please tell me if there's a better board than this one.


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## lily7 (Aug 24, 2006)

You may also try a chiropractor.
Have you tried digestive enzymes? Probiotics?
Is she OK with eggs? The thing with eggs is if they are overdone they are really hard to digest and use a lot of energy, easy scrambled eggs are very goog - if you are afraid of salmonella- wash eggs and then place them in hot water for I believe 60 sec.
Also have you tried regular butter? For some people allergic to milk butter is OK. You could butter up bread or bagels put some honey on it.


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## rugbymom (Mar 21, 2007)

The people in Special Needs might give you some insightful answers.

My son got the FTT at about a year. All his tests were neg, but taking out milk & soy helped him a lot.

Have you talked to a nutritionist? Tips that ours gave us that have worked for us are:
1. Add oil to everything. For example, my son loves scrambled eggs, so I actually add oil to the eggs and in the pan. You can also add lots of oil to oatmeal.
2. Try to up the calories in everything you make, so if you make pancakes, add extra eggs and oil.
3. Coconut milk smoothies. (They are waay yummier than ones with added oil) You can also make yummy pancakes with coconut milk. It's high fat/calorie.
4. Focus on veggies more than fruit and add oil to the veggies
5. You can also try switching around how she eats. For my son, he eats more if he is constantly snacking. But, some kids eat more if you have them wait for a meal.

Good luck.


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## kdtmom2be (Aug 26, 2006)

Another mom with a kid with a milk allergy here. She is also 18 months. BUT, she can eat butter, yogurt and cheese without issue... have you tried processed or cooked milk products?

*I* had FTT as a toddler... 18months to 3 years I gained a total of 3 lbs. _(dropping from 15th percentile at 18months to less than 3rd percentile at 3 yrs according to the WHO charts)_ There is/was nothing wrong with me. It does happen sometimes. Do YOU feel that there is a problem aside from the reflux? What is your gut feeling on it? Sometimes the doctors are so set on those weight charts that they don't take individual kids into account.

My DD is following the same path as me... she's in the 25-30th percentile but 6 months ago she was in the 50th or better. She's gaining weight, just not very fast. She's active, bright, happy and healthy and learning things at a VERY rapid rate!







: I'm a little afraid of taking her into the doctor because I don't want to have to fight the FTT fight. (Also, her older brother is 70lbs and 4'10" tall at age 9, so genetics is a huge factor in our family, she's getting it from both sides.)

That said, if your gut feeling is that something is not right, keep looking until you get an answer. Ask to be referred to a pediatric GI at your nearest major center or University Hospital. If they tell you no, find a new doctor. Good luck.


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## SweetPotato (Apr 29, 2006)

This might go without saying, but if she's still nursing, then I would definitely try to have her nurse frequently and before offering solids.


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## Blucactus (Nov 20, 2006)

I fattened up my little guy noticably in about a month's time. He's not FTT, but he is little and thin. I put fat in EVERYTHING he ate. (He is meat/dairy/egg/soy/nut/wheat free so it's not that easy!) Olive oil, coconut milk, avacado, tahini, sesame seeds, sunflower seed butter depeding on what he was eating and what it went with. Hummus you can get both olive oil and tahini into. Sunflower seed butter on a spoon. Nutritional yeast & olive oil over steamed potatoes. Chickpeas cooked with tahini and garlic. Veggies cooked in tons of oil. Dried fruit is calorie-dense, my guy likes dates. It took a lot of thought about what calories I was going to cram into his each meal, but he chunked up noticably...(he is still nursing round the clock every couple of hours at least)..then he got a cold and was teething and only wanted to nurse, not eat, and he's looking pretty thin again...







Good luck, it is HARD to worry about getting enough calories into someone so small and helpless.

ETA: A pp mentioned oatmeal...you can add coconut milk, tahini/sunbutter AND sesame seeds to oatmeal, and it's still delish.


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## PiePie (Oct 2, 2006)

avocado
banana
yogurt (assuming it's a straight up milk allergy rather than to all dairy)
grilled cheese using french toast
add oil to everything


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## bright_eyes (Dec 7, 2007)

I've been making delicious smoothies with coconut oil in them for a few weeks now. My 2 year old loves them. Here's what I mix together:
-frozen mixed berry blend (rasberries, blue berries, black berries)
-1/2 banana
-almond milk
- tbsp or so of ground flax seed (I don't measure, I just dump some in)
- and a heaping spoonful of organic cold pressed coconut oil

And that's it! And it is soooo yummy! If the coconut flavor is too strong, I just add more banana or more berry mix. Usually, I can only mildly taste it.

Also, you should read the book My Child Won't Eat. It is published by La Leche League and has some excellent advice dealing with kids who are just small or not huge eaters.
http://www.amazon.com/My-Child-Wont-.../dp/0912500999


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## eepster (Sep 20, 2006)

Quote:


Originally Posted by *Debrah Cohen* 
The GI said that unless her weight increases she'll have to go on a feeding tube.

Wow that seems like a huge over reaction on his part. Is she showing any signs of malnurishment? Lethargy, not meeting mile stones, thinning hair? If she isn't showing any symptoms of malnutrition, then why does he care that she is light weight.

3% on the growth charts means that 3% of *healthy* children weigh less than she does or the same amount. 3% doesn't mean she isn't healthy, if she were an adult everyone would be delighted. Also it's not like she started up in the 99% then suddenly dropped to the 3%, she only was ever in the 6%. If she had started at 50% and dropped to 47% would you worry?

DS is in the 0%. He had breifly made it all the way up to the 30% when he was about 4 mo, but when he started solids he steadily dropped back down to 0% (he was born in the 0%.) He is health energetic, and meeting mile stones well ahead of schedual.

His Dr had been concerned and sent us to specialist, but I eventually just started saying "no." I just don't believe anything is wrong with child and did not want to get him addicted to pediasure or expose him to barium and radiation, so I just said "no".

I'm not concerned about his weight. My family and DH's has a lot of very healthy, but very light weight people in it.

I also highly reccommend the book My Child Won't Eat! Your local LLL may have a copy you can read.


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## Curlyfry7 (Jun 20, 2007)

I also feel like 3% does not warrent a feeding tube unless there are other signs of problems.

but I mainly wanted to say that Whole foods carries a yogurt made out of coconut milk that is actually very good- my DS has dairy sensitivities and loves his "coconut yogurt"!


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## henny penny (Mar 26, 2008)

Will she eat fatty meats like sausage or hamburger? Egg yolks scrambled in butter or olive oil do some chunking up at our house.


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## pghgranola (Jun 22, 2007)

OP...go with your gut feelings. if you think your little one is fine, let it be.

she probably doesn't want to eat the high-fat foods because she knows she doesn't *need* them. our little ones regulate their food better than most adults.

i second, or third, the suggestion to read "My Child Won't Eat!"

the same pediatricians who tell the parents that their toddlers are too thin, are the same pediatricians who complain that those children (as teens) are too big.

we've been down that weight-chart road. dd (who is actually bigger than hubby and i were at that age) is healthy, bright, and happy.

each visit to the ped, i would question myself.

but as soon as i walked out of the office, i knew we were doing everything right. dd nurses/eats healthy foods. i'm not about to fill her with fatty foods just to satisfy the insane need of my ped to see dd's weight on some point on an imaginary chart.


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## ShyDaisi (Jan 22, 2007)

Unless you feel it is necessary, I would not think that a child that has gained just over 2 lbs. in 3 months needs a feeding tube. 11 ounces in a month is A LOT of weight in a toddler! If you feel there is something wrong, then by all means, take any steps necessary, I just wanted to say that the recent weight gain would make me reevaluate the necessity of more invasive measures.


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## veganf (Dec 12, 2005)

She seems like she is gaining enough to me! 11oz is good!
Is she still breastfeeding? If not, maybe get some donor milk?
Add nut butters, avocado, coconut milk (not oil), protein powder to smoothies. Make hummus with lots of tahini & olive oil.
Coconut yogurt.
Pasta with butter/margarine.
Noodles with nut butter sauce.
Sunshine Burgers (made with sunflower seeds--very high in fat, protein, etc.)


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## sunnysideup (Jan 9, 2005)

First of all, it sounds like she's always been small, so maybe her weight is what it should be for her. Are mom and dad on the small side? How is her development? Is she reaching normal milestones?

It's not unusual for a toddler's weight gain to slow when he/she starts solids. Is she still nursing? if so, more breastmilk is the best way to get good calories in her.


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## hibana (Jun 9, 2006)

Quote:


Originally Posted by *pghgranola* 
OP...go with your gut feelings. if you think your little one is fine, let it be.

she probably doesn't want to eat the high-fat foods because she knows she doesn't *need* them. our little ones regulate their food better than most adults.

Yes, this. I don't think my dd gained more than a pound between 12 and 18 months. (at 18 mo she was about 21 lbs and very small- for this reason we did not do dr visits because I did not want to have to deal with ftt diagnosis, etc, when I knew my kiddo was fine and was convinced she would grow soon) Between 18 and 24 months she grew about 6" and put on a bunch of weight. She went up 3 sizes of clothes in less than a month.

So, some kiddos catch up on their own.


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## bri276 (Mar 24, 2005)

she eats, is meeting milestones...and they want to put her on a g-tube. typical. My mother is a pediatrician and we've had this convo many times, gastros can be very quick to put kids on the mic-key button (or whatever) when it is NOT the last resort. it's a CYA method. That is not to say there aren't kids who need them- believe me, my child has a chromosome disorder and in the groups I belong to, they're necessary more often than not.

but being small is not necessarily pathological, and it needs to be proven that it is before such a drastic and invasive step is taken.

healthy fats are wonderful and essential, but I think it's a bit of myth that they put on weight. what actually does that really well is carbs and sugars. of course, loading up on unhealthy carbs and sugars is a terrible idea nutritionally. but healthy grains and sugars from fruits could help. with allergies, I'm not sure what your DD can eat. I'm not sure what her height/weight ratio is, what size your family normally is, whether she could have a growth hormone deficiency, or anything else that simply can't be guessed over a message board. But I would say if she's growing well in height as well a developmentally, eating well, ... certainly, make sure every bite she takes is nutritious, but failture to thrive is not purely a weight issue and shouldn't be treated as such.


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## bscal (Feb 13, 2006)

I've had conversations with 2 different peds over the years about my 3 kids. My oldest didn't gain any weight between 15 mos and 18 mos... she started walking right at 15 mos. My middle child didn't gain any weight between 12 mos and 18 mos... she started walking at 13 1/2 mos. My youngest child didn't gain weight between 12 mos and 15 mos (well, he didn't walk until 16 mos but he crawled a LOT and very quickly to keep up with his big sisters!). At my oldest DD's 5 yr checkup last year she was at 75% on weight and 95% on height. At my middle child's 3 yr checkup in September she was at 50% for both and at my youngest child's 18 mos checkup (also in Sept) he was at 50% for both.

As I told the ped at my son's 15 mos checkup, kids develop at their own pace. I know from experience that when a child starts crawling more and then walking they are burning a ton of calories. So each of mine has had appointments when they didn't gain any weight. I just keep feeding them healthy meals and snacks and don't worry about it as long as they are happy and hitting other milestones when they should.

The "best" advice is when the one ped told me to feed my middle child more McDonald's fries and chicken nuggets to fatten her up. Are you kidding me? Granted, I was pregnant with my youngest at the time... so we were already hitting the golden arches once a week for my french fry fix.

I did start feeding each of them a slice of buttered toast each morning... DS actually loves toast and will eat 3 slices. If your LO can't eat butter perhaps one of the other alternatives pp mentioned. But really, I think it's a big step (and a scary thought!) to jump right to a feeding tube. That seems a bit drastic. My understanding of FTT (from a convo I had with our ped when my middle child wasn't gaining anything) is that it is a concern when a child keeps dropping lower and lower on the chart. She said if a child drops 10% (or more) each visit for 3 visits then it's a concern... or if they suddenly go from 50% to 5% between visits.

GL,
Beth


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## Vancouver Mommy (Aug 15, 2007)

You don't mention why the ped thought it was failure to thrive. Other than the small size, that is. My ds went from 50th percentile to below the third in about 4-6 months. He has stayed at just below 3rd for the past year. I took him in once to the ped for a check and some bloodwork, but once the doc started talking about FTT I left and never went back. My son is healthy, strong, happy, ridiculously smart and gorgeous. He's just small. Like his Dad and uncles and cousins.


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## milkybean (Mar 19, 2008)

Why do they focus just on sheer poundage?

Is she growing taller? Have you changed her clothing size at all to reflect height changes? Is she moving, talking at a good level for her age? Changing, growing in other ways?

Why is it always about weight????


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## snuffles (Apr 11, 2002)

Quote:


Originally Posted by *sunnysideup* 
First of all, it sounds like she's always been small, so maybe her weight is what it should be for her. Are mom and dad on the small side? How is her development? Is she reaching normal milestones?

It's not unusual for a toddler's weight gain to slow when he/she starts solids. Is she still nursing? if so, more breastmilk is the best way to get good calories in her.

I agree with this. Going from 6% to 3% is not a huge jump, especially when they're talking about feeding tubes! That's a huge deal!

A couple of my kids have always been in the lower percentiles.. it's genetic. Are you or your husband small? Also, after the first year they don't grow nearly as fast. In fact, it's absolutely normal to not grow at all at certain points. Trust me, I'm a mother of five and it happened with all of mine.


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## Vancouver Mommy (Aug 15, 2007)

I wanted to add, if you didn't already know, that there is a tribe for parents of small or skinny babies? http://www.mothering.com/discussions...ad.php?t=92716

I think you will find that there are lots and lots of babies off or at the low end of the chart that are perfectly healthy and happy.

I thought about your original post all night last night and really feel that your GI was intentionally trying to scare you. Unless there are some other health or developmental issues that you didn't mention.

Please keep us posted on your upcoming appts with the ped and so on.


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## mtn.mama (Apr 1, 2007)

It sounds to me like your child has multiple allergies/intolerances... not just milk. I recommend seeing a pediatric allergist who does atopy patch testing, and going to www.kidswithfoodallergies.org. Good luck! (And go hang out in the allergy forum at MDC...)
Lisa


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## crazyrunningmama (Dec 16, 2006)

I just wanted to add, that if you _do_ decide to include more healthy oils, that you might want to try a few different ones for taste. For example, pumpkin seed oil, sesame oil, etc to see what your child likes/will tolerate in different foods. Good luck!!!


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