Why would a child who appears to eat well not gain weight?

[AimeeM]

Nico was born with a lung defect and some vascular issues. This was corrected (for now) with a surgery at 18 months old (we didn't discover the issues, unfortunately, until they were presenting as symptoms and he was well over a year old). He had struggles for the first 2.5 years that were (we are told) directly related - he didn't walk until 2 years old, is incredibly small (size of an average 18 month old, even now at 3.5 years old), no appetite for a long time...

Up until recently I've attributed his small stature to being "picky"... but the last few days I've been looking closer at his intake and comparing it to what other moms (at co-op and local friends) say their similar aged children eat and, really, nothing seems amiss there. Frankly, after looking more closely, he really isn't any more picky than it appears many preschoolers are.

He snacks several times throughout the day on cheerios, plain toasted waffles, graham crackers, nutella, peanut butter, etc.

He generally has an egg and toast in the morning, chicken for lunch, and a meat product/starch/vegetable for dinner (chicken, pork, or steak for the meat, peas are his usual pick for vegetable - or any veggie we can slid onto something resembling pizza, lol - pasta, rice, or potatoes). The only thing I see lacking in his diet is fruit (he hates it for some reason).

We have an open kitchen policy in general. We aren't fans of limiting intake and we encourage (with the pediatrician's blessing) grazing. There is always fresh fruit available, fresh vegetables, and crackers/cheerios/other snacks available and within sight/reach for everyone.

 

He's only gained about a pound in the last year. He is a whopping 26 lbs. We *know* that his previous weight issues were related to his medical condition, but he is almost 2 years post-op now. Why isn't he gaining weight?

I'm tempted to ask for a more thorough blood work up with his pediatrician. My other concern is his unquenchable thirst - all the time. He wakes up in the middle of the night, several times, begging for drink and he drinks throughout the day, always needing a drink available. I am pretty sure he had a CBC done a few months ago at my request, but I'm not sure that he's had anything more thorough than that since his last post op with his pulm/cardio-vascular team at the hospital (now he only sees a regular pediatrician but for his once a year check up with his Pulm team and radiology).

 

Cognitively he is fine - great even; physically he lags in some areas (but I tend to chalk that up to size).

 

Am I freaking out about nothing? I tend to that with him :tongue_smilie:. I'll admit that I towards helicopter-mom with him. Everything seemed to happen so suddenly, with such intensity, and with such seeming urgency that it still makes my head spin.

 

Feel free to just skim and not answer. I'm kind of thinking out loud right now. Lol.

Edited October 13, 2012 by AimeeM

[besroma]

I don't have any answers for you, but I would be concerned also, especially with the excessive thirst.

 

I wonder if he is absorbing the nutrients from the food.

 

I would look into seeing a specialist (possibly someone in internal medicine) to get a second opinion.

 

:grouphug:

[Whereneverever]

Has he been checked for diabetes?

 

Some kids are little, but the thirst worries me.

[Annie Laurie]

Has he been checked for diabetes?

 

Some kids are little, but the thirst worries me.

 

:iagree: That's what caught my eye, too.

[GWOB]

You know, I was sympothizing with you, up until the unquenchable thirst comment. My oldest dd has always been small. She is 12 and weighs a whopping 76lbs. That kid eats more than I do! She's stick-thin, always has been and probably always will be.

 

The thirst comment sent up a HUGE red flag with me. My fil was recently diagnosed with Diabetes, along with his cirrhosis and heart issues. His first symptom was unquenchable thirst. Same with my mom. My thin kid doesn't have that symptom. Please get your kid's blood sugar tested. Type 1 Diabetes is scary, and a colossal pain in the rear to deal with, but you just need to either know or rule it out.

[AimeeM]

Has he been checked for diabetes?

 

Some kids are little, but the thirst worries me.

It worries me too. I keep "starting" to potty train, but I will not deny him drink in the middle of the night with the sense of urgency he seems to relay regarding "something to drink". Definitely puts a damper in any sort of potty training.

[AimeeM]

You know, I was sympothizing with you, up until the unquenchable thirst comment. My oldest dd has always been small. She is 12 and weighs a whopping 76lbs. That kid eats more than I do! She's stick-thin, always has been and probably always will be.

 

The thirst comment sent up a HUGE red flag with me. My fil was recently diagnosed with Diabetes, along with his cirrhosis and heart issues. His first symptom was unquenchable thirst. Same with my mom. My thin kid doesn't have that symptom. Please get your kid's blood sugar tested. Type 1 Diabetes is scary, and a colossal pain in the rear to deal with, but you just need to either know or rule it out.

Can diabetes just pop up though? I know he had complete work ups before and immediately after his surgery.

[ILiveInFlipFlops]

I agree with the others about the thirst issue, but the growth issue could be celiac. Inability to absorb the nutrients from food because the intestinal villi are destroyed is a common early sign, IIRC.

 

I did a little searching on celiac disease and excessive thirst, and while some sites say the thirst could be related to celiac disease, here's an interesting site that links type 1 diabetes and celiac:

 

What are the celiac implications of diabetes?

There seems to be a link between type 1 diabetes and celiac disease. Some studies suggest that children with type 1 diabetes are more likely to have a subsequent diagnosis of celiac disease. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 3-8 % of people with type 1 diabetes will have biopsy-confirmed celiac disease, thus individuals with type 1 diabetes would benefit from routine celiac disease screening.

 

Normally type 1 diabetes is diagnosed first because this type of diabetes tends to strike early in life and its diagnosis is certain. Also, celiac disease associated with diabetes is usually silent, showing no symptoms, and may only be found upon screening. Signs and symptoms, such as abdominal pain, gas, bloating, malabsorption, weight loss, and abnormal liver function tests may also be seen and easily confused with poor glucose control of type 1 diabetes or gastroparesis - when the muscles in the wall of the stomach do not function normally. Untreated celiac disease may also contribute to irregular blood glucose swings. Unexplained hypoglycemia, or low blood sugar, can be a sign of malabsorption related to celiac disease and should be investigated, particularly in small children. Both celiac disease and diabetes require dietary modifications for proper management, so the control or elimination of certain foods will keep the individual with either disease healthy.

 

ETA: The more I read now, though, the more people I'm seeing talking about excessive thirst as one of their early symptoms of gluten-intolerance/celiac. Maybe try cutting gluten out for awhile and see if he improves at all? I even saw a few people mention extreme thirst with some of the other highly problematic foods (dairy, corn).

 

I hope you can figure out what's going on :grouphug: 26 pounds at 3 years old is pretty teeny. What does his ped have to say about it?

Edited October 13, 2012 by Sweet Morning Air

[GWOB]

Can diabetes just pop up though? I know he had complete work ups before and immediately after his surgery.

 

I really don't know. From my anecdotal experience with other parents, it does sometimes seem to just "pop up", mostly because you're not looking for it. It never hurts to get blood sugar checked out, if only to rule out diabetes.

[Jpoy85]

If it was just a weight issue you could give him Pediasure, but it has TONS of sugar in it so until you know about the diabetes, i wouldnt give it.

[Embassy]

I'd probably ask your pediatrician - especially about the excessive thirst.

 

You said his height is the size of an 18 month old so 26 lbs seems to fit with that. My 4.5 year old is 31.5 lbs and average height so it doesn't seem to small to me. I did have to go check a height weight chart and it seems my daughter is at a lower percentile.

 

I did have a child who was very small. He also had medical issues with a couple surgeries. I was concerned about his small size and always encouraged him to eat well and fed him foods that would help him gain. He did start growing and several years later he had gone from below the 5th percentile to above the 95th% percentile in weight.

 

We ended up changing our habits to help him grow into his weight. After a couple years he did. I wish I hadn't been so concerned about his weight when he was little. Lesson learned here. I'm not concerned about my daughter one bit.

 

ETA: I looked at my daughter's height and weight at age 3.5. She has only gained about 1.5 lbs and 3 inches in the past year.

Edited October 13, 2012 by Wehomeschool

[klmama]

The thirst issue sounds like a call to the doctor is in order, and possibly a visit. You don't want to mess with diabetes.

 

The growth issue could be celiac, as others have said, or it could be a growth hormone issue. Friends' dc just stopped growing at about the size your dc is. They give hormone shots.

[speedmom4]

My boys are both very small. My oldest has cerebral palsy and his growth for a time was limited because of his chewing and swallowing issues. We worked with a nutritionist and it was a tremendous help. We learned how to add calories to everything. We added a dash of whipping cream to milk, put butter on any vegetables or bread. Just getting the extra calories in without increasing the volume of food helped. We also have him Pediasure even though it's not ideal. I also bought Scandishake to help with weight gain. Our doctors have always said that if he weight to height ratio is good than the actual weight doesn't matter. It's concerning when a child in the 50th percentile for height is in the 3rd percentile for weight or not on the chart.

 

HTH,

Elise in NC

[Parrothead]

I agree with the others. Call for an appointment and have another complete check up just to rule out diabetes. If it wasn't for the thirst thing, I'd just say high metabolism would cause the rest.

[allymom]

My first thought was a gluten intolerance/celiac allergy. That could account for the smallness. Does he have any intestinal issues? Gas/pain, diarrhea. And does he have allergy eyes, dark circles under his eyes? Those would also be signs.

 

And of course, he should probably be rechecked for diabetes. My children have never been much more than that size around 3 years old, so he could just be a small child.

 

When's the last time he was in for a check-up? Does your ped seem concerned with his size? I don't think it would hurt to ask for a pediatric gastro referral to check into the growth issues if it's really concerning you.

[AimeeM]

My first thought was a gluten intolerance/celiac allergy. That could account for the smallness. Does he have any intestinal issues? Gas/pain, diarrhea. And does he have allergy eyes, dark circles under his eyes? Those would also be signs.

 

And of course, he should probably be rechecked for diabetes. My children have never been much more than that size around 3 years old, so he could just be a small child.

 

When's the last time he was in for a check-up? Does your ped seem concerned with his size? I don't think it would hurt to ask for a pediatric gastro referral to check into the growth issues if it's really concerning you.

He was last in for a check when he turned 3 (a wellness check). He is due to see his lung team for a check up in a couple months.

The ped is concerned about his weight but just says he isn't eating enough? He DOES eat enough. I know these things - I'm with him 24/7, lol. The ped is more concerned about things I'm honestly NOT concerned about in the slightest (speech, physical milestones - these are concerns that were addressed by his surgery and specialist teams and he wasn't involved with since he wasn't our ped at the time).

 

ETA: your first question - no allergy eyes or circles; no gas pain or diarrhea. He is pretty chronically constipated.

[Chris in VA]

Cystic Fibrosis has been ruled out, right?:grouphug:

[AimeeM]

Cystic Fibrosis has been ruled out, right?:grouphug:

That was ruled out with a sweat test at the hospital pre-op. Although there was some *wonder* on our end as to whether or not a sweat test is very accurate, the doctor did say that in every case he's seen of CF there is a family history and we have no history of it on either side. It was definitely a concern initially.

[Laura Corin]

What is your family pattern? Are you big/small tall/short? Is there anyone else in the family who is small/thin?

 

Laura

[*********]

Has he been checked for diabetes?

 

Some kids are little, but the thirst worries me.

 

You know, I was sympothizing with you, up until the unquenchable thirst comment. My oldest dd has always been small. She is 12 and weighs a whopping 76lbs. That kid eats more than I do! She's stick-thin, always has been and probably always will be.

 

The thirst comment sent up a HUGE red flag with me. My fil was recently diagnosed with Diabetes, along with his cirrhosis and heart issues. His first symptom was unquenchable thirst. Same with my mom. My thin kid doesn't have that symptom. Please get your kid's blood sugar tested. Type 1 Diabetes is scary, and a colossal pain in the rear to deal with, but you just need to either know or rule it out.

 

Yep, this jumped out at me too. Get his blood sugar checked next time you have a dr. appt. It's easy, quick, and will either help you get answers or rule it out right away.

 

I agree with the others about the thirst issue, but the growth issue could be celiac. Inability to absorb the nutrients from food because the intestinal villi are destroyed is a common early sign, IIRC.

 

I did a little searching on celiac disease and excessive thirst, and while some sites say the thirst could be related to celiac disease, here's an interesting site that links type 1 diabetes and celiac:

 

 

 

ETA: The more I read now, though, the more people I'm seeing talking about excessive thirst as one of their early symptoms of gluten-intolerance/celiac. Maybe try cutting gluten out for awhile and see if he improves at all? I even saw a few people mention extreme thirst with some of the other highly problematic foods (dairy, corn).

 

I hope you can figure out what's going on :grouphug: 26 pounds at 3 years old is pretty teeny. What does his ped have to say about it?

 

THAT is interesting. I'd look into celiac too, OP.

 

I agree with the others. Call for an appointment and have another complete check up just to rule out diabetes. If it wasn't for the thirst thing, I'd just say high metabolism would cause the rest.

 

I'm with Chucki. If the blood test for diabetes comes back ok, then it may just be that your son has a high metabolism. I know adults like that; who can eat the same amount as me, but they'd lose weight while I'd gain weight. :glare: SO not fair. I've got a girlfriend who cooks all homemade, organic, lovely yummy food. Her husband has lost 15 pounds in the past year due to his metabolism (his family is like that). She, however, wants to lose 25 pounds and is struggling with it. SO not fair. :tongue_smilie:

[ondreeuh]

I would take him back to the doctor. I have a medically complicated kid and I can't tell you how many rabbit trails we've chased trying to pin down various symptoms. My son is primarily a cardiac kid but he has "unrelated" issues in neurology, ENT, and GI. Our pediatricians have been marginally helpful in referring us to specialists, but they themselves don't handle anything but vaccines and sinus infections.

 

How long ago was his last pulmonology appt? I would call that doctor, explain his symptoms, and ask which further tests should be done/specialists should be seen. I'd expect to start with endocrinology and GI. Obviously he should have his blood sugar tested again (a glucose tolerance test?) but I would also want a thyroid test. I'd ask about a stool sample (parasites, malabsorption issue). An upper GI scope may be appropriate to check for celiac. Is he digesting well?

[Laurie4b]

It worries me too. I keep "starting" to potty train, but I will not deny him drink in the middle of the night with the sense of urgency he seems to relay regarding "something to drink". Definitely puts a damper in any sort of potty training.

 

Possible diabetes is an EMERGENCY. It's not something to worry about until your next appointment. Get him to the doctor TODAY, even though its Saturday, to get the blood sugar checked. Really, diabetes is LIFE THREATENING if it is present and not treated.

Edited October 13, 2012 by Laurie4b

[EKS]

Possible diabetes is an EMERGENCY. It's not something to worry about until your next appointment. Get him to the doctor TODAY, even though its Saturday, to get the blood sugar checked. Really, diabetes is LIFE THREATENING if it is present and not treated.

 

:iagree:

[Whereneverever]

Possible diabetes is an EMERGENCY. It's not something to worry about until your next appointment. Get him to the doctor TODAY, even though its Saturday, to get the blood sugar checked. Really, diabetes is LIFE THREATENING if it is present and not treated.

 

:iagree:

[Supertechmom]

Chronic constipation could be a sign of celiac. My oldest's constipation issues went away gluten free and my youngest's a thousand times a day diarrhea stopped. I would try that. It can also make them very picky eaters

[Laurie4b]

Can diabetes just pop up though? I know he had complete work ups before and immediately after his surgery.

 

Yes. Type 1 can just pop up. Type 2 there is creep up. Given that he is a child and small not obese, if it's diabetes, it is much more likely to be Type 1.

 

If I read your post correctly, the surgery was over a year ago, right? There hasn't been a subsequent one done within the last week or month or so, correct? Bloodwork done that long ago is no longer current.

 

Please take him to a doctor. All it will take is a simple glucose test. If it's not diabetes, all you've lost is your co-pay and part of your Saturday afternoon. If it is diabetes and has been going untreated, your child's internal organs are being assaulted every day that he has high blood sugar. Over a period of time, they become permanently damaged: nerves, kidneys, brain, cardiovascular system. Low blood sugar has its own risks. Diabetes is nothing to mess with. If it is diabetes, and you have no blood glucose monitor, you have no way of knowing how serious his condition is right now.

 

At least call your doctor today and report the excessive thirst and lack of weight gain and how long that has been going on. Maybe they will say you can wait until Monday, but they are not going to blow those two symptoms off.

Edited October 13, 2012 by Laurie4b

[mommy5]

I'm probably no help here but my almost 10 year old is 50 pounds ... he has all kinds of physical problems ... like not meeting his gross and fine motor goals on time ... delayed walking (and also cognitive) and excessive thirst. He has had several workups ... especially for malnutrition, celiac, diabetes, and thyroid ... all came back normal. His own growth curve has dropped dramatically (went suddenly from 90 to 30 then down to 10th). I can't help because we just keep feeding him as much as he wants ... making sure he gets a lot of fat & protein and calories ... I'm curious, though, what causes it, too. Have you seen an endocrinologist with your son?

Edited October 13, 2012 by mommy5

[Lily_Grace]

What does he drink most of the time?

[AimeeM]

The surgery was about 2 years ago. Well, the initial surgery. After the lobectomy (they removed most of one lung, an abnormal growth, and fixed some vascular issues), he had a subsequent collapse of his partial lung and had to be admitted for another procedure. All in all, he was *finished* about 1.5 years ago. I know that since then (as recent as his 3 year well check) he had a CBC done, but hasn't had a full work up since immediately post-op. His pulm and cardio/vasc team have done function tests and x-rays, but nothing more than that.

I will call today. His ped is less than helpful so I think I'll call his surgical team or his pulm team.

Yes. Type 1 can just pop up. Type 2 there is creep up. Given that he is a child and small not obese, if it's diabetes, it is much more likely to be Type 1.

 

If I read your post correctly, the surgery was over a year ago, right? There hasn't been a subsequent one done within the last week or month or so, correct? Bloodwork done that long ago is no longer current.

 

Please take him to a doctor. All it will take is a simple glucose test. If it's not diabetes, all you've lost is your co-pay and part of your Saturday afternoon. If it is diabetes and has been going untreated, your child's internal organs are being assaulted every day that he has high blood sugar. Over a period of time, they become permanently damaged: nerves, kidneys, brain, cardiovascular system. Low blood sugar has its own risks. Diabetes is nothing to mess with. If it is diabetes, and you have no blood glucose monitor, you have no way of knowing how serious his condition is right now.

 

At least call your doctor today and report the excessive thirst and lack of weight gain and how long that has been going on. Maybe they will say you can wait until Monday, but they are not going to blow those two symptoms off.