Dieting Mom, Underweight Kid

Cross-posted.

I had to take Sammy to the doctor last night for what turned out to be
nothing. Anyway, while there we weighed him. He came in at 32.25
pounds at 60 months old. Sammy continues to be very underweight.

Sammy is getting taller and is rarely ill.

Children in our family tend to be slender. My daughter at 13 is
slender-normal, my son at 11 is chunky-normal (but was very slender at
the age of 5) and several cousins of my children have been hassled
medically for being underweight. My MIL even relates her mother being
hassled for the kids being so thin!

Here's my problem: we don't eat high-calorie-dense foods here much. I
try to put peanut-butter on everything's of Sam's, but he'll end up
eating half a plain banana or some yogurt or a few stalks of asparagus
and call that a meal. He resists being over-fed, complains that his
stomach hurts if I give him too much food. (It doesn't really, that's
his signal for us to back off and let him go play.)

In the past two years I've transformed myself - losing over 65 pounds.
I've got the whole family on a healthy way of eating - very little
sugar-dense crappy foods. The children have a snack cupboard they have
free access to, but besides pudding cups it tends to have whole grain
crackers or fruit cups or applesauce cups or stuff like that. They have
cheese shapes, cottage cheese and yogurt in the fridge for them,
too. Sammy gets to eat when-ever he wants.

Anyway, the doctor was astonished by my weight loss yesterday.

They suspect I'm starving my son.

What would you do? There are three problems he

1. How to defend my kid against unwarranted medical intervention? I'm
generally pleased with the pediatric practice we've got. They've been
thoughtful and responsive to me in the past. Advocating for the child
is exactly what I *want* them to do.

2. How to get my kid to eat without giving him food problems? We tend
to take the shortcut of putting sugar on his stuff - strawberry milk,
for example, or sweatened cereals. I don't really want him growing up
thinking that everything has to be sweet, though. OTOH, he just won't
eat unless it's palatable.

3. How to be sure there really isn't anything wrong? If I truly WERE
starving him I wouldn't be able to see it. I offer him food in variety
and plenty many times a day. Am I missing some parenting trick by not
giving him soda, poptarts and potato chips?

Dally

Hark! I heard Ignoramus2546 say:

I told you a long time ago, time to change a doctor and not deal with
suspicions. You do not want the doc to contact DCFS/CPS or whatever
you have in your state. Go to a new specialist with your son, do not
mention your weight loss, and have your son checked for health.

I have no insights into your son't health issues, but yes, 30 lbs at
60 months sounds very thin. Mine is 36 months and 31 lbs. So, it is
worth having a specialist look at it, without the accusations and
suspicions.

snip

I'm with Ig on this, especially since you say you keep plenty of
good foods around for your kids and let them eat at will. By assuming
that *you* are the problem, this doctor may be overlooking something
important, or perhaps he's just be a skinny kid! I'd get a second
opinion...


--
J.J. in WA (Change COLD to HOT for e-mail)
~ mom, vid gamer, novice cook ~
...fish heads, fish heads, eat them up, yum!

Hi -

I'd recommend that for a week or so, you keep a comprehensive food diary
of both what you offer your son (including measurements of amounts) and
what he actually eats. Include whatever steps you take to try to
increase his intake, and whatever steps HE takes to get you to stop.

Then, the next time you see your ped., show it to him and ask what he
thinks. Ask if what you're offering is appropriate, and what steps, if
any, he thinks you should take.

The purpose of doing this is to both alleviate your doctor's suspicions,
but also to see if there are any patterns that suggest an actual medical
problem (as opposed to a genetic tendency to slenderness).

My two cents,
--Beth Kevles

http://web.mit.edu/kevles/www/nomilk.html -- a page for the milk-allergic
Disclaimer: Nothing in this message should be construed as medical
advice. Please consult with your own medical practicioner.

NOTE: No email is read at my MIT address. Use the AOL one if you would
like me to reply.

Dally wrote:
I had to take Sammy to the doctor last night for what turned out to
be nothing. Anyway, while there we weighed him. He came in at
32.25 pounds at 60 months old. Sammy continues to be very
underweight.

What's his BMI? I ask because, depending on his height, he may not be *as*
underweight as you'd think by poundage alone.

I have a 15yo nephew who is very slender and people regularly think he must
not be getting enough to eat. That could not be further from the truth. The
good thing is that, despite the fact that his BMI is in the "underweight"
category, he is very well-muscled, strong, and *looks* healthy. (My father
was also a very slender guy, so my nephew comes by it honestly.)

All in all, I'd prefer to deal with underweight and healthy than overweight
and healthy. Both of my sons are above the top of the charts for weight,
height, *and* BMI. They are very healthy and active, however, and eat a good
diet. Nonetheless, I predict I will be pressured to put them on diets in an
attempt to reduce their BMIs, even though my personal suspicion is that they
are just *built* big all over and are not really overweight for *them*. Add
to that that my husband and I have *never* had problems maintaining our
weights and do not know what the word "diet" actually means in practice and
you see my dilemma!

As others have said, it may be a good idea to cover your bases to be certain
there are no underlying health problems and to ensure you're not accused of
starving the poor child. But it sounds to me like extreme slenderness runs
in your family and your son has inherited that predisposition.
--
Be well, Barbara
Mom to Sin (Vernon, 2), Misery (Aurora, 4), and the Rising Son (Julian, 6)

Aurora (in the bathroom with her dad)--"It looks like an elephant, Daddy."
Me (later)--"You should feel flattered."

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

Beth Kevles wrote:
Hi -

I'd recommend that for a week or so, you keep a comprehensive food diary
of both what you offer your son (including measurements of amounts) and
what he actually eats. Include whatever steps you take to try to
increase his intake, and whatever steps HE takes to get you to stop.

Then, the next time you see your ped., show it to him and ask what he
thinks. Ask if what you're offering is appropriate, and what steps, if
any, he thinks you should take.

The purpose of doing this is to both alleviate your doctor's suspicions,
but also to see if there are any patterns that suggest an actual medical
problem (as opposed to a genetic tendency to slenderness).

My two cents,
--Beth Kevles

I like this idea, Beth, thanks. I've never considered charting what the
kids ate. It seems so intrusive. I know people react differently when
they are being measured and I've never had any particular need to
measure the kid's food. They eat or they don't - I know they get enough
healthy foods because that's all we have!

But as someone who has tackled portion control as part of losing weight,
I really have the ability to track calories and macronutrient ratios
with him. I think I'll do this as soon as he's done in pre-school (as
I'm never really sure how much he ate of what I sent, despite discussing
this with them several times.)

My only concern is that the doctor will consider my data-taking as part
of my pathology, as if I ALWAYS scrutinize their every morsal. It's
easily dispelled - since I don't - but it's is a bad path to start down
if I'm trying to show that I'm not pathological about their eating!

Dally

Ignoramus2546 wrote:

I told you a long time ago, time to change a doctor and not deal with
suspicions. You do not want the doc to contact DCFS/CPS or whatever
you have in your state. Go to a new specialist with your son, do not
mention your weight loss, and have your son checked for health.

Igor, the doctor would be remiss to not consider the home environment
when evaluating a child's problems. It's not the problem that they
suspect me as being wrong, the problem is how to deal with it. Do I
waste time and effort bothering to defend myself? Do I disprove their
theory? Do I evaluate it for possibility of truth? Do I search until I
can find some tangible reason for him to be small instead of bad parenting?

I have no insights into your son's health issues, but yes, 30 lbs at
60 months sounds very thin. Mine is 36 months and 31 lbs. So, it is
worth having a specialist look at it, without the accusations and
suspicions.

I've been really slow to subject my son to testing to evaluate why he's
small. I've seen too many of the other kids in the family go through
this, including a particularly brutal scene where my niece had 8 vials
of blood drawn from her 24 pound three year old body while she screamed
bloody murder. (After a year of diagnostics the answer came back:
"she's small.")

At the age of 60 months my other children were 34 and 35 pounds to
Sammy's 32. My daughter reached menarche at the age of 12 (at 89
pounds), i.e., she's not starved.

I do not believe that feeding your son junk food is the answer, based
on common sense and not on any specialized knowledge. You seem to be a
sensible parent most of the time.

Um, thanks.

I think part of it is the difficulty in having a grazer when we live in
a heavily scheduled world. We tend to give him a bowl of macaroni and
cheese or raviolis and some fruit and expect him to eat it because it's
meal time and this is when we can fit in time to feed him and to wait
for him to eat.

My MIL spoke to me in April about offering Sammy small portions of lots
of things. She gives him a SPOONFUL of something and then replenishes it
when that's gone. He seems less intimidated by it that way.

He prefers to graze all day long, but that's a bit hard on scheduling
just because he's so little and needs to have food provided for him.
(His older siblings can pop up a bag of popcorn or get some cheese
sticks from the fridge, but he rarely takes the initiative to feed himself.)

When we're trying to get him to consume his entire meal in one sitting
we usually end up bribing him with sugar on it, just for expediency. I
don't like this dynamic but the alternative is letting him go away from
the table until he's hungry enough to come back. That's what I'd do
with the older two, but with him I've got so much pressure to get
calories in him that I find myself giving him junk. (And he still
doesn't gain weight.) Sigh.

Dally

Ignoramus2546 wrote:

A quote from

http://www.hardtruth.net/abuse/index...Rhode%20Island

You're such a troll sometimes.

But just to feed you a little, my mother had my youngest brother taken
away for a little while in 1969 when he was about five months old
because she insisted on breastfeeding him and he wasn't gaining weight
fast enough and the physicians insisted on putting him on a karo syrup
formula. (I think he was hospitalized, not put in foster care.)

It was incredibly traumatic for my family (which ended up divorcing soon
after) but I had somehow forgotten about it. (I've blanked out most of
that year.) My mother mentioned it to me when I told her I was
concerned about Sam being so small.

The point was, the child was a slow gainer. He's fine - extremely fit
and active in fact. And karo syrup is NOT superior to mother's milk. I
just can't believe that our pediatric practice would be that stupid 25
years later.

Slender, slow-gaining kids are on both sides of the family. I just
can't make myself subject my well child to testing about it. Must I?

Dally

On 6/10/2004 2:34 PM, Dally wrote:

When we're trying to get him to consume his entire meal in one sitting
we usually end up bribing him with sugar on it, just for expediency. I
don't like this dynamic but the alternative is letting him go away from
the table until he's hungry enough to come back. That's what I'd do
with the older two, but with him I've got so much pressure to get
calories in him that I find myself giving him junk. (And he still
doesn't gain weight.) Sigh.

Dally, I don't have children of my own but I do understand that this is
a bad situation. I mean, you are trying to provide your kids with a
healthy diet/lifestyle and there is all this pressure to just dump
calories in. I have been trying to come up with some calorie dense food
that he might go for. You already have peanut butter. How do you feel
about dried fruits? Fruit and nut trail mix? I'm sorry, I wish that I
could offer more suggestions. It does sound like he's just slender and
that the doctor is likely overreacting. Have you followed the recent
stories about parent's not recognizing that their children are
overweight? Maybe your son's doctor has seen so many overweight
children that he is overreacting to a slender child who is healthy.

--
jmk in NC

Dally wrote:

2. How to get my kid to eat without giving him food problems? We tend
to take the shortcut of putting sugar on his stuff - strawberry milk,
for example, or sweatened cereals. I don't really want him growing up
thinking that everything has to be sweet, though. OTOH, he just won't
eat unless it's palatable.

I don't really understand why you would try to increase
his intake of sugar. Most people I know who are trying to
increase their kids' weight are trying to increase protein
and healthy fat intake, not sugar intake. I'm not saying
you need to be ruthless with his sugar. If a little makes
certain things more palatable to him, it's probably not the
end of the earth, and I doubt it would ruin his eating
habits for life. I wouldn't really be looking to get him
extra calories by increasing sugar intake, though. If he'll
drink milk, giving him strawberry milk instead of regular
milk won't boost his calorie intake much at all. Give
him strawberry milk if he'll drink strawberry milk and
not regular milk because the milk has protein and calcium.
You can also give him whole milk, which will boost the
calorie intake because it has more fat. Really, gram for
gram, carbs and proteins have the same amount of calories.
It's only when you move to fats that you get something
more calorie dense, which may be helpful if he's sensitive
to the volume of food he's eating.

Best wishes,
Ericka

jmk wrote:

Dally, I don't have children of my own but I do understand that this is
a bad situation. I mean, you are trying to provide your kids with a
healthy diet/lifestyle and there is all this pressure to just dump
calories in. I have been trying to come up with some calorie dense food
that he might go for. You already have peanut butter. How do you feel
about dried fruits? Fruit and nut trail mix? I'm sorry, I wish that I
could offer more suggestions.

I'm listening. In advance, apparently! For lunch I gave him (in a
series) a tub of cottage cheese duets (jelly you mix in with cottage
cheese - he likes to mix in the jelly.) He ate approximately half of
it, 75 calories. Then I gave him a half of a banana with one side
unpeeled and a wedge of banana removed and peanut butter inserted (then
I put the peel back on so he can finish unpeeling it himself.) He ate
NONE of this. (I'll offer it again in a little while.) He had about 6
ounces of apple juice, about 2 ounces of chocolate milk, and an unknown
amount of trail mix (he's got his own tub and he sorts the ingredients
into piles and eats some and it's godawful difficult to figure out how
much he ate, but it appears some raisins, almonds and sunflower seeds
are gone.) He also swiped two chunks of grilled pork loin off of my
salad. (He declined my offer of salad fixings of his own.)

As you can see, my busy little boy likes to process his food. It's an
activity thing for him. The fork-to-mouth action or tasting food in his
mouth action is not the primary motivator, unlike me. He needs to sort,
peel, pile, stir, or hunt down his food.

Another big hit with him is a myoplex shake. I put it in a shaker
container with a few ice cubes and he gets to shake it up before
drinking it and periodically in the middle.

It does sound like he's just slender and
that the doctor is likely overreacting.

Well, the doctor isn't really reacting - yet - just eyeing me
speculatively and asking some pointed questions. But it mostly sounds
that way because I wrote it that way. I guess I'm realizing I have to
make an appointment and really talk to the doctor about this. I like
Beth Kelves' idea of bringing a food diary in with me.

Have you followed the recent
stories about parent's not recognizing that their children are
overweight? Maybe your son's doctor has seen so many overweight
children that he is overreacting to a slender child who is healthy.

That's my thought. This doctor really thought a nine year old
developing a roll of fat on his belly was okay. (That new emergence of
abdominal fat on my middle son is partly what made me realize that me
being fat was going to doom my children to being fat, too. I'm not
longer worried about that son: his tummy is still a bit rolly-polly, but
it's receding and he's developed much better habits. My plan is just to
continue on the course we're on - not dieting, just eating healthy and
getting lots of exercise.)

I know at least Igor thinks the answer is to change doctors. The thing
is, this is a small town and I've got three kids and the doctors all
share on-call... IOW, I've met nearly every doctor. In some cases I'm
personal friends with them. I changed practices about 6 years ago and
interviewed several doctors at that time. I liked this practice partly
because I liked nearly every physician in the practice. A pediatric
practice ends up being an ensemble cast really, and just liking one
doctor isn't good enough, IMO.

If I absolutely can't persuade them that I'm not abusing the kid, yes,
I'll change doctors because my lines of communication are fouled. But
I'm not going to change doctors because the one I've got is watching out
for my kid's best interest.

Dally