Health knowledge made personal
Join this community!
› Share page:
Search posts:

The Underweight Child

Posted Sep 07 2008 8:40pm
Dear Dr. Cason,

My underweight 2 1/2 year old (negative in the weight charts) was breastfeed until 22 months of age. She always refused a bottle. When I started to introduce milk to her at 12 months she wouldn't have anything to do with it.

I didn't really worry about it until after I stopped breastfeeding her. After trying all forms of milk (various formulas, even chocolate and strawberry milk) it turns out the only thing she would drink is Pediasure vanilla milk. That was fine but it started to get really expensive (I'd limit her to a bottle a day, but they cost more than $1 a bottle -- and that adds up). I found out that she loves "cafe con leche" -- milk with a tiny bit of decaf instant coffee, a little sugar, and a capful of vanilla extract. She looooooves it. It is cheap, healthy (I think), and tasty.

My husband is concerned that the coffee, since it is a diuretic, could dehydrate her (she does have a constipation problem which is relatively under control with Benefiber, Miralax, water, prunes, persimmons, whole wheat bread, etc.). I serve her about 2 cups of milk with a scant teaspoon of decaf coffee -- she drinks only one of these a day. I'd really appreciate it if you could tell me if this is healthy or dangerous? - J.

Dear J-

I feel for you. In a country that has excessive rates of childhood obesity, it can be disconcerting when the problem is actually the opposite- your child is underweight. The first thing you need to do with your underweight child is go to your pediatrician. There is a difference between a child who is just thin for their age and actually “failing to thrive”. Some people will think that every child that is less than the 5% in the growth charts is “failing to thrive” but this isn’t so. There can be healthy children that are just small and that is normal for them. A physician evaluates a child’s weight not based on just one point in time but rather over multiple points in time. At their well-child checks, we analyze their growth by looking at how their growth is plotted against the growth chart. It may be normal for a child to be at the bottom of the growth chart as long as they are still moving along at an acceptable rate. But there are some children who plateau and then drop, failing to even keep up with the expected growth patterns. These children are truly “failing to thrive”.

Making the diagnosis of “failing to thrive” vs. “small for size” is important. In a thin child who is still growing and doing well, you would just offer them nutritious foods and continue to monitor them. It’s important to avoid micromanaging a child and their meals. Over controlling a child can lead to control issues and food “strikes”. If, however, your child is actually dropping off the growth curve or failing to grow at the expected rate, then a diagnostic workup is indicated. Your pediatrician can look into whether there is a chronic medical condition that is contributing to their declining growth. If they are found to be otherwise healthy, then they may recommend keeping a food diary and meeting with a nutritionist to help boost their caloric intake.

In regards to your question about Pediasure and Milk here is the breakdown: Pediasure (8 oz) has 237 calories, 7 grams of protein 9 grams of fat and 31 grams of Carbohydrate. Whole Milk (8oz) has 146 calories, 7.8 grams of protein, 7.9 grams of fat and 11 grams of carbohydrate.When you compare the two, you are actually probably doing okay in terms of calories by giving her 2 glasses of her café con leche but she is definitely missing out on some iron.

Excessive dairy intake (greater than 24 ounces in one day) can lead to iron deficiency. Kids will fill up on the calorie rich but iron deficient milk products and avoid any other “real" food. Pediasure can get expensive but some insurance companies will pay for it if it is part of the medical treatment for the child. The diuretic action of coffee is due to the caffeine. So a scant amount of decaf coffee, while not exactly nutritious, probably isn’t all that bad as well. You may want to try blending different things in with the milk such as a banana. My sister did this with great success for her kids!

To help the- otherwise healthy but underweight- child, try to look at why your child isn’t gaining much weight. Here are some common reasons:

1. Too much juice: Excessive juice can start to replace other food groups when children are too full to eat real food.

2. Low fat diets: Children under two years of age need high fat diets for growth and brain development.

3. Skipping breakfast: It’s just as important that children get calories and nutrients in the morning as well as at other mealtimes.

4. Restricted diets: Kids who are served vegan diets need to have their meals planned carefully to make sure that they are getting the nutrients that they need.

I hope this helps! My next post will offer tips on mealtime and your underweight child.

Sheila Cason MD

Post a comment
Write a comment:

Related Searches