Failure to Thrive - Pead referral at 13 months

Hi all

A bit of history - DD is 13 months old and weighs 8.4kg. She eats well, is on cows milk twice a day and meeting all developmental milestones. She got a cold in February that hasn't shifted and I've been taking her to the GP monthly to check it hasn't gone to her chest. Her chest is always clear. We were given a script for dimetapp and told that due to her going to daycare a few days a week, it wasn't the same cold, just that she kept catching a different one over and over. She got an ear infection that led to a perforated ear drum a couple of weeks ago and was put on antibiotics. We had to go back today to check her eardrum had healed - which it had however there was still a bit of puss behind her ear so she needs another course of antibiotics. The Gp wanted to weigh her to check the doseage to prescribe and then basically freaked out about her weight. He went from her birth weight 3.7kg and said based on that she should weigh at least 10kg now. I don't actually believe in those scales that much however when he showed me that she was now very very low and had dropped 4 bands, I was a bit concerned. I know she doesn't weigh much but she looks solid and is doing everything she should. She eats super well, everyone comments on how much she eats so I guess it is strange that she isn't putting on weight.

I am gluten intolerant so I am wondering whether she may also be. I waited until about 10 months to introduce gluten and she seems fine with it. Or maybe she is just not putting on weight because she's had this cold for so long? The gp seemed to think her being sick was a result of her low weight and not the other way around.

My question is - has anyone else been in this situation? Should I be keeping a food diary or anything in preparation for the appointment? I guess I just assume the Pead will think she doesn't eat well which is really seriously not the case. The ladies at daycare said she eats the best out of all 8 children and the most and they don't know where she puts it. They are astonished. We did Baby Led Solids so I think that may have helped.......not that it is helping her weight.

Any advice/thoughts/suggestions are welcomed.

i would think she is spending alot of energy fighting off the infections and so doesn't have a lot spare. Not sure if you weighed her regularly, but has her weight gains been consistent since birth, or is there a point where the weight slowed?

FWIW, my DD was born 3.7kg and at 15 months is 9.2kg. She has gone from 75th percentile to 10th for weight. I am trying to give her little quiches and higher fat foods, but i also recognise that she is just so active and has always been a slow weight gainer. I have read the food you pack for your little one for care, and i don't know how much more you could add, the food is gourmet!

Thanks Hoti, I really appreciate your thoughts and kind words. I have to admit, I'm a bit teary over the whole thing. Not sure whether its preg hormones or just feeling of guilt that I'm not doing something that I should be. I got given a chart and these are the figures:

Birth 3.7kg
7 weeks 5kg
4 months 6kg
6 months 6.5kg
8 months 7.5kg
12 months 8.2kg
13 months 8.4kg

I have made an appointment with the mothers and babies clinic at the hospital who have mw/lc's etc to chat to about things as the pead appointment isn't until October. But apparently as she has dropped more than 4 bands on the scale, we are classified as urgent and on the waiting list. I think seeing the MW at the clinic will help me feel better but right now, I just feel really sick about it. I tried to tell the gp I thought she wasn't putting on weight because she was sick but he said he thinks she is sick because she has low weight. Go figure.

So sorry Star, what a shock for you. Your idea of a food diary is a good one though, so you can say to pead this is exactly what she eats every day. Doctors like that kind of thing because then they have a rough idea of the calories she is taking in daily. It is something they can strike off the list straight away iykwim? Has your GP ever taken any blood tests to see what her immune function is like?

At birth DS was 4.02kgs. At 12 months he was 8.4kgs. Not once was anything ever mentioned about his weight requiring further investigation.
He is 4 next week and he'd be lucky to be 16kgs. He's tall, skinny, full of energy and very intelligent.

Honestly these kids are all so different.

I think if a child is happy, healthy eating and drinking well, hitting milestones within the appropriate age 'limits' (although again, each child is different) then there really shouldn't be too much cause for concern.
If you are worried, you could maybe keep a food diary if you feel it might help?

Thanks LC, I will do the food diary I think. I just don't want to seem like a psycho parent. Before I saw this GP today, no one has ever said anything about her weight, let alone BT's etc etc. The Gp today mentioned BT but said that the pead would do that if he thought it was neccessary. I said "some kids are just small right? I was a very small child" and he said "yes, but we want to rule everything else out too."

I was refered to the pead for FTT at 9 months (well DD2 was) And now at 19 months she has just hit 8.6kg. We got a diagnosis of Cystic Fibrosis in April but that was after alot of testing. She was tested for coeliacs and many other things. It is possible that your LO has the gluten intolerance and she is small because of that

I think you can look at a few positives...she is gaining (it may be slowly but she is gaining), she is happy and healthy, she is developing well and she is eating so getting nutrients.
DS4 is/was FTT, he is currently 7.3kg at 18mths (he has not been on the charts for a long time). We have had every test under the sun to see if there is a problem...tested for CF, metobolic disorders etc.
We are under a dietitian at the hospital and have been for some time.
They got really concerned when he started losing weight...but at the moment our pead is reasonable happy because he is happy, healthy and doing well developmentally...just tiny
He seems to have a fat intolerance and that may have something to do with it.

I really understand your concern and but she may just be a little girl with a really good metabolism.

My DS basically didn't really gain any weight between 12-18 months, staying at around 10kg. It was at this time he also had sickness after sickness (it was during winter). However, after 18 months he started gaining again, and now at 2.5 years is 13kg.

I think a food diary including how much (and what) she drinks will give the paed a good head start anyway. If you or your DP are slight or were as kids then perhaps that is also worth noting also, if your parents have any info too that could help.
AB's can make your tummy pretty upset too so maybe that has not helped. Certainly if she seems to be eating lots and is happy and alert - minus the ear infections then surely that should make them happier??
One thing that may be relevant is not using low fat dairy etc - kind of the opposite to what most people do.
xx

ETA I have a friend whose 5yo has just hit 16kg and another whos 3yo twins were only 10kg at ~ 20months also so I think it is not unusual but worth following up ITMS

i would hazard that she is fine (bar all the lurgies poor poppet). fwiw, DD1 copped it a fair bit too as she is a wee thing. at almost 4 years old she has only *just* cracked the 14kg mark. i wouldnt think that her low weight is an issue in itself; it needs to be assessed in relation to all other factors (namely, mood eating, sleeping etc).

hopefully the paed will be able to giver the tick of good health :hug:

It's good that your GP is being pro active in refereing you to a pead as so many don't.

It is good that baby is still gaining but the amounts need to be more, slow weight gain is 1 thing as long as they are following curve on the growth chart BUT to drop 4 centiles on chart is a concern, it might be the fact she is using energy to fight infection etc or it might be some under lying issue, you have allready mentioned your intolerance to gluten, may be that may be coeliacs or something else.

No harm in keeping a food diary and its a very good idea to chat with your health nurse

Good luck xoxo

The extended illness could easily account for slow weight gain :hug: But what a worry for you.
It sounds to me like she is doing very well. I would certainly be looking to get a second opinino - your GP sounds like he has made a bit of a snap judgment, but it is good to be sure of thibgs,
My DS was 4.29 at birth and barely passed 9kg at 12 months, so he dropped a lot on those scales too.

I went and got DD2 book from over 20 years ago and at 12 months she was only 9.450kg and at 2 11.8kg. She was a very active child. Nothing was ever said about her weight as she ate well and was growing.

Remember every child grows differently so it's not fair to lump them all in the same basket.

I don't like the correlation between birthweight and weight as they grow. Some women grow beautiful babies in the womb, but once they are out, they grow as they are meant to grow. If it were me, I'd be looking at her immune system as the cause of the problem - being sick time after time seems to me like her immune system is really low - otherwise she'd not get sick all the time. By all means go to the paed to rule out an actual medical cause (because it could be an intollerance?), but in the meantime, I'd be looking at ways to support her immune system because the gut is the key to so many health problems. Perhaps start with a probiotic made for children and see if it helps at all.

I think what Trill says about growth rates is exactly right.
I don't suppose you have any other childcare options? FDC even (so exposed to fewer kids)?

DD was FTT from 2 months till 8 months (when she had consistent gains, rather than losses :( ) and we kept a food diary, and i took Domperidone to boost my supply and BF every 2 hours during the day.
Shes 14 months and 10kg, after weighing 4kg at birth, (dropped to 3.5kg at 1 week)
She was sick recently and lost 500g, but we've finally got the weight back on! The Paed has NEVER suggested that she was sick due to low weight, but he put ME on bedrest and back to exclusive BF until she could tolerate solids again.
Shes only the 3rd % for weight but the 97th% for height.
Im not sure if your LO was FF (or if formula is more calorie dense than cows milk?) but Id reintroduce a BF/FF each day, as well as adding avacado, fish and olive oils to her diet.

Thanks so much everyone for your comments.

Trishalishous - I BF DD until 6 months and then expressed until 10 months and she was on formula for 2 months and now cows milk. We give her 2 lots of 200mls of milk/day but sometimes if she has a super big meal she won't drink all of the milk. I will def start adding avocado and other oils to her diet - thanks for the tip.

MadB - DD really loves childcare and she's only there 2 days a week now so I don't really want to pull her out. I half suspect the MCHN might tell me not to worry at all about the weight gain and when my normal GP comes back from his holidays I'll make an appointment with him to get the 2nd opinion.

Trillian - I started her on probiotics a few weeks ago and I'll keep it up. Thanks for the tip because at least I know I'm on the right track, I was wondering whether I was just wasting my time with the probiotics.

Rivlas - I know! That's the thing, no one has ever said anything about her weight to me before. :(

Feeb - thanks for your comments, now that I have calmed down a little bit I feel a bit better and that it's probably better to be safe than sorry.

Cass - thanks hun. Xx

Mak - I was a really tiny kid so I think genetics might have something to do with it. Good point.

Sterla, RB, Alligator - thanks so much ladies. I really appreciate your thoughts and support. It's great to hear from people who have been in this position and to hear the outcomes and what happened.

If I have missed anyone, my apologies. I love belly belly for this reason. It is such a comfort.

:hug: Miss X has been sick for ages and she has started walking, and she has continually been putting on weight. "Try" not to stress about the appointment too much, I'm sure they just want to check her over and make sure everything is okay.
Like the MCHN and drs always told me with P, DH and I aren't big people or have big builds, so P isn't going to be either and as long as they are happy alert and meeting milestones, it doesn't matter if their weight gain is rapid. Is X in proportion with her height and weight?

Also, a friend was told to give her 15month old sustagen (sp?) to help with her weight gain

xx

I had a similar issue with my DD aside from the sickness.. She was perfectly healthy but weighed 8.9kg at 19 months.. She hadn't gained a thing since 6 months of age.. I wasn't concerned as she was active, ate well and was meeting all her milestones just fine

CHN wanted to get a blood test to find out what was wrong.. My GP agreed with me that she was fine but tiny.. We had to increase certain foods and was given a month to see some sort of weight gain.. One month later (after increasing yoghurt, cheese and milk which she didn't like as she was BF) she gained 200 grams :)

Long story but she is now a very exciting 15.1kg at 3 yrs and 8 months (that is what my boys all weighed before they turned 2)

Oh honey :hug: please don't stress. Darcie has only just cracked 9kg after hovering over 8.5kg for about the past 6 months. I thought it was odd at first as max weighed 12kg at 12 months..... Weight doesn't mean everything. As you said x does everything she should be, and apart from colds and dodgy ears she would be perfect, and she eats well.

You're obviously doing a fab job. A gorgeous little girl who loves to socialize and is a happy little soul (I've seen pics!!) so try not to let it upset you.

Don't forget a little thing called genetics plays a part in how our bodies are built and neither you, nor your dh are the size of a house from what I've seen!

Go easy on yourself and just enjoy your baby girl and I hope all the lurgey germs leave her soon! Xx


Sent from my iPhone using Tapatalk so sorry for mistakes!!

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Don't forget a little thing called genetics plays a part in how our bodies are built and neither you, nor your dh are the size of a house from what I've seen!

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I agree! they weren't too worried about our DD, as Im tall and I WAS skinny, as long as she had a gain at each weigh in. Shes always been active and alert, just is a skinny minney :)

Looking at DS - birth 3.75kg (75th centile), 12m 8.5kg, 14m 9kg (9th centile). Currently 14kg, has been since he was just over 3 (he's now 4.5yrs). The puts him on the 2nd centile: so still perfectly normal. There are children out there lighter than him still.

He eats like a horse and has the same metabolism as his parents had. What a shocker! If anyone were to refer him for failure to thrive at 13m I would laugh and point out he eats, he develops, he is as skinny as expected given genetics.

I just thought I'd comment on the tests that my DS is having as he hasn't been gaining on the normal curve. Our paediatrician is great, she is reassuring but at the same time very thorough in her approach.

We've had a stool sample to check for how he absorbs nutrients as I'm reporting quite a reasonable BM intake (I EE so I know how much he has).

I'm also coeliac and you can get a Buccal Swap taken (they run a brush inside their cheek at pathology) to see if they have the genetic mutation for coeliac disease. If it's positive it means they have the potential to develop coeliac disease in their lifetime. This test can be bulk billed!

If you LO has been having gluten for the last 6 weeks they can also take a blood test to check for coeliac antibodies.

The slowed weight gain for my DS just might be him finding his centile after birth (he was on the 75th for weight at birth) due to his genetic imprint for body size - my family is mostly on the thin side.

I think you need to consider that she hasn't lost weight - she has consistently gained, just not quickly. I think that says something. If she was FTT I would think that she wouldn't be gaining at all. You have said she is happy and healthy - not lethargic. Also I think a mum is the first person to get an idea that something is wrong, not a dr. You are with her all the time, if something wasn't right you would notice! And JFYI my youngest is constantly sick (ear infections every fn) so is on AB a lot and when they irritated her tummy she stopped eating, so if there was something wrong with her tummy I would think she wouldn't want to eat, which isn't the case!
I hope the MCHN helps to calm your fears though but I say if mummy instinct says she is fine she probably is!

I just wanted to post an update in here about what has happened since I started this thread. I decided to go and see the midwife at the hospital and get her opinion on everything including getting her to check my food diary which I'd kept for about a week. It's $30 but I really wanted another opinion and this is the same midwife that we saw until DD was 6 months old so I have complete faith in her and wanted her opinion. Anyway......she weighed X and she was 9.7kg!! That's 1.4kg more than the GP had weighed her at the week before. There is no freaking way DD could have put on that amount of weight in one week, the measurement must have been simply incorrect. GP weighed her by getting DH on the scales, then getting DH to hold DD and subtracting. The midwife was really annoyed as it turns out she is on the 25th percentile for weight and length and 50th for head. She said that is perfectly fine and looked at our food diary and said that was great for a toddler her age and the GP clearly doesn't understand about genetic disposition (I think that's the word) and him saying that due to her birth weight she should be 10kg was just wrong. So I left feeling SO MUCH BETTER. You guys had all already made me feel heaps more confident about the whole thing but now knowing that her weight is okay I feel so so relieved.

Thanks so much for all of your lovely comments.

Wow, that is a big difference in measurements! Glad you were able to see someone whose opinion you trusted, and her advice gave you confidence in what you are doing.

take care

Excellent!

That is great news, a second opinion is always a good thing.
You must be relieved and able to relax a bit more now.

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:dance:

love a second opinion...especially as this makes heaps more sense IYKWIM...:dance: