when pediatrician refers your child to a specialist do you have to go?

[pinkmint]

So my 5 yo dd had her well child checkup and apparently she's slightly underweight. She's in the 3rd percentile and they want kids in at least the 5th percentile he says.

 

Do I really need to drag her to the nutritionist?

 

She is soft and fleshy and doesn't look unhealthy at all. She's just thin and small! Aside from being a chunky breast fed baby she's always been like this. She's not a big eater but is relatively heathy and normal.

 

The nutritionist referral seems unnecessary but I dont want to neglect it if it really matters.

Edited June 3, 2016 by pinkmint

[TravelingChris]

In your circumstances, I would go.  Not because you would necessarily get great information.  The nutritionist will tell you things like don't give orange juice, give grapefruit juice.  Use whole milk.  Add cream to cereal.  THings like that.  But since from your other posts I know you are having hard times, your refusal to go could cause the doctor to refer you to CPS.  You don't need that.

[TranquilMind]

So my 5 yo dd had her well child checkup and apparently she's slightly underweight. She's in the 3rd percentile and they want kids in at least the 5th percentile he says.

 

Do I really need to drag her to the nutritionist?

 

She is soft and fleshy and doesn't look unhealthy at all. She's just thin and small! Aside from being a chunky breast fed baby she's always been like this. She's not a big eater but is relatively heathy and normal.

 

The nutritionist referral seems unnecessary but I dont want to neglect it if it really matters.

 

Oh for goodness sakes, 2 percent?  NO, I wouldn't.  Take that girl out for a milkshake or two!   If she isn't showing any signs of illness, I would disregard that. 

 

Mine were always super thin, especially one.  You could count all the ribs and that one ate like a horse.   But since I had a family doctor who knew three generations of my family instead of a pediatrician, he knew we were all fine and that this was normal for this kid.

 

This kid is still slender as a young adult but quite healthy. 

ETA:  I did not know of any backstory.  If there is some reason you should definitely have the visit on the record - and sometimes that is wise - then I would go. 

Edited June 3, 2016 by TranquilMind

[pinkmint]

I wish I didn't have to worry about CPS but it seems like the combination of being low income, homeschooling and dd being underweight is enough to get me on their radar.

[lauraw4321]

I think I would do it just as a CYA thing. Are you on the low end of the weight spectrum? I have a friend whose daughter fits your description, but she is also very petite, so I think the doc is less concerned.

[TravelingChris]

I wish I didn't have to worry about CPS but it seems like the combination of being low income, homeschooling and dd being underweight is enough to get me on their radar.

  Yes, that was what I was thinking.  You have enough stress in your life without that being a threat.

[kiana]

Yes, I would go, just so that you have ammunition if someone decides to report you for your kid being underweight. I hate to say it, but I would do so just as a CYA. And I would also take notes and nod. If you disagree with the advice (like someone I know was told to give her kid more soda to bring her weight up), I'd just quietly not implement it.

[hornblower]

I'd go not only to CYA but also because maybe she's NOT well.

You can't just go by appearances of whether a child looks healthy or not. Of course we all hope not but this is sometimes the first symptom of some underlying illness. Get it checked, stay on top of it & follow up again in 6 months. 

[pinkmint]

Yeah they already told me to give her Pediasure Grow and Gain which is expensive and full of sugar but I bought some anyway.

[happypamama]

I wish I didn't have to worry about CPS but it seems like the combination of being low income, homeschooling and dd being underweight is enough to get me on their radar.

For that reason, I would take her.  

[Arcadia]

I'll bring her just to check that box. My hubby and I are underweight most of our lives and it is in our kids medical info. My DS10 had bloodwork when he fell off his percentile curve, like 15th percentile to 5th percentile. It is normal for this kid but it was standard procedure to check for such a drop. Insurance did cover everything. Otherwise we were never questioned about DS10 being underweight.

[pinkmint]

I'd go not only to CYA but also because maybe she's NOT well.

 

You can't just go by appearances of whether a child looks healthy or not. Of course we all hope not but this is sometimes the first symptom of some underlying illness. Get it checked, stay on top of it & follow up again in 6 months. 

 

Is being thin a symptom? So many people defend being overweight but thin/ "underweight" people can be healthy too. And how would the nutritionist know if she has a health concern? 

 

I will take her. I'm just thinking. 

 

I made her well-child appointment to see if she seems to be doing ok and the Dr gave her a good look over, tested her iron and blood at my request and she's quite healthy unless there is something insidious going on in her body which I have no reason to believe. She's been at the way low end of normal for most of her life. 

 

I am at the high end of normal. DD more takes after her dad's body type and eating pattern (I eat more than him almost always). 

Edited June 3, 2016 by pinkmint

[gardenmom5]

Oh for goodness sakes, 2 percent?  NO, I wouldn't.  Take that girl out for a milkshake or two!   If she isn't showing any signs of illness, I would disregard that. 

 

Mine were always super thin, especially one.  You could count all the ribs and that one ate like a horse.   But since I had a family doctor who knew three generations of my family instead of a pediatrician, he knew we were all fine and that this was normal for this kid.

 

This kid is still slender as a young adult but quite healthy. 

ETA:  I did not know of any backstory.  If there is some reason you should definitely have the visit on the record - and sometimes that is wise - then I would go. 

 

same here.  I could watch the muscles in her back ripple, count her ribs and vertebra.  she has quite a sweet tooth - and she's still extra scrawny as an adult.  she's very outdoorsy.  she eats more than her dh, and is skinnier.

 

I'd go not only to CYA but also because maybe she's NOT well.

 

You can't just go by appearances of whether a child looks healthy or not. Of course we all hope not but this is sometimes the first symptom of some underlying illness. Get it checked, stay on top of it & follow up again in 6 months. 

 

a nutritionist isn't going to be able to determine if she's well or not.  they'll just talk about what she eats and what she should eat.  I had to take dudeling to one as part of his work-up.  it was one more thing I was required to do to get a diagnosis that was a waste of time and money.

 

as a CYA, I would take her.

Edited June 3, 2016 by gardenmom5

[Arcadia]

Yeah they already told me to give her Pediasure Grow and Gain which is expensive and full of sugar but I bought some anyway.

If you are under WIC, check what they would cover. Pediasure is covered with a doctor's note for 5 and under here.

[Farrar]

I don't think it's always compulsory, but I'd go in your situation. And I'd hope it was a good nutritionist. And just keep in mind that kids' needs are so different. They need fatty foods and many things that would be unhealthy for adults. It's such a different mindset.

[pinkmint]

I give her all full fat dairy products (we all eat them) and try to give calorie and nutrition dense foods. I put butter in her oatmeal and bribe her to eat bacon. 

 

She's just a little bird eater. She does love sugar and I try to use that strategically but I know letting her fill up on empty sugar calories cannot possibly be good. 

[hornblower]

 

 

a nutritionist isn't going to be able to determine if she's well or not.  

 

no, but a nutritionist can recommend interventions which can improve rate of growth.

 

And then if the interventions don't work, then a physician may decide to ramp up investigations and run other tests. 

 

So it's a step in determining whether this is her normal or not. 

 

Of course the way percentiles work, someone HAS to be in the 2 percentile. But if a child's rate of growth suddenly veers off their trajectory, that can be a sign of illness. 

[SparklyUnicorn]

No you don't.  Will it cost a lot to go?  If not, then just go and get it over with.

 

A compromise might be to try to work on it yourself and give it to the next check up to seek the intervention.

 

What is her height percentile btw?

 

 

[pinkmint]

And for the record we are well stocked in food. It's a big priority for me. Growing up with an irresponsible caregiver who didn't bother buying groceries is part of that but also I never want my kids to feel that they can't eat as much as they need to because we don't have a lot of money. DDs biggest struggle seems to be trying to get out of eating the chicken and broccoli dinners we offer her.

[SparklyUnicorn]

And for the record we are well stocked in food. It's a big priority for me. Growing up with an irresponsible caregiver who didn't bother buying groceries is part of that but also I never want my kids to feel that they can't eat as much as they need to because we don't have a lot of money. DDs biggest struggle seems to be trying to get out of eating the chicken and broccoli dinners we offer her.

 

Have her eat more carbs.  Pasta, rice, etc.  I mean if you are looking to increase weight.  That is the stuff that tends to do that.

 

Growing up I was off the charts for height and weight.  I'm just small...always have been.  But there are others in my family who also are.  How about your family?  Do have any tiny people? 

 

[pinkmint]

She does like carbs and I don't hold them back from her. I do try to get some fats and protein in her though which is harder. Should I let her eat all carbs? I don't know.

[SparklyUnicorn]

She does like carbs and I don't hold them back from her. I do try to get some fats and protein in her though which is harder. Should I let her eat all carbs? I don't know.

 

Not ALL carbs, but more carbs.  I bet that is what the nutritionist would say to do.

[StephanieZ]

Nah, you don't have to, but I can see your concern. I'd probably go this once (for the CYA reason), and then find a new pediatrician. :)

 

(My youngest was always TINY, like off the charts slim, but also super, duper healthy and strong and developing well . . . so no DR ever DX'ed a problem or referred me anywhere . . . But I was always nervous at well child visits, so I get your concern!) And, FWIW, my youngest is now 13 and finally fleshed out just a bit, so at least she's on the charts, and she seems to be having normal pubertal development, so I'm not sweating it . . . But I did always keep my eye on her weight and push fattening foods her way . . . Honestly, I think she's my healthiest kid!

[SKL]

Normally it is just a recommendation.  The exception would be if the child was a foster kid, had a "case" open with child safety authorities, etc.  However, if the doctor thinks you aren't feeding your kid, he could eventually report you.  Hopefully he is just making a routine recommendation that all parents of slim kids get.

 

My kid was also a very low %ile as a baby.  A couple years later she had an above-average BMI due to being so muscular.  As long as your child eats and grows and develops mentally, I wouldn't worry about it.

[SKL]

With my skinny kid, I pretty much let her eat whatever (real food) she will eat.  Often it's chicken in large quantities.  She's getting better about branching out to a variety of foods.

[Ravin]

If she's height/weight proportionate and her head size is good, the doc needs a lesson in what the percentiles mean. For every 100 kids that age, 98 will weigh more. It doesn't automatically mean she's unhealthy. The nutritionist sounds like a waste of time.

 

But if it will cost nothing to you, I would go as a CYA.

[Guest]

1. No, you do not have to take your child to a nutritionist.
2. But it can't hurt.
3. Also, you don't have to do whatever the nutritionist recommends. YMMV (obviously) but I wouldn't be giving SUGAR of all things. As of right now, she's healthy. Sugar addiction is a real quick way to change that.
4. One time I did a parasite regimen just to make sure we didn't have any. Oooops, they all did. You may want to look into that. Kids play in the dirt, which is very good for them but you can (and do) pick up alllll kinds of unpleasantness.
5. No, you should not give up on veggies, fat and protein and let her eat all carbs.

 

Sounds like you're doing great already, OP. I agree with the PPs who've said you might want to go just to put your own mind at ease re: authority figures. It can't hurt.

[SparklyUnicorn]

Although it's kind of crazy with some of this stuff.  My mother was given flack about my size.  There isn't much anyone can do and I was eating anything I wanted in any quantity.  Certainly it was not a food issue.  And then now, I need to lose weight.  What the hell?  Where is the fairness there?!  LOL

 

My MIL was so thin as a child they sent her to a special weight gaining camp.  Now as an adult she's overweight.  Again...what the hell?!

 

 

[Guest]

Just to illustrate why you have to be determined to lay your own common sense on whatever the nutritionist says....

 

One time a nutritionist told me to eat more KETCHUP, to "get in my vegetables every day."

 

She was completely serious.

 

OH! Which reminds me, if you're going to go to the nutritionist, go ahead and start keeping a food log of everything your dd eats and drinks now, just to have it in hand.

Edited June 3, 2016 by OKBud

[Valley Girl]

Just to illustrate why you have to be determined to lay your own common sense on whatever the nutritionist says....

 

One time a nutritionist told me to eat more KETCHUP, to "get in my vegetables every day."

 

She was completely serious.

 

OH! Which reminds me, if you're going to go to the nutritionist, go ahead and start keeping a food log of everything your dd eats and drinks now, just to have it in hand.

 

Ketchup? Soda (somebody else mentioned)? How on earth do these people get their jobs?

[SparklyUnicorn]

Just to illustrate why you have to be determined to lay your own common sense on whatever the nutritionist says....

 

One time a nutritionist told me to eat more KETCHUP, to "get in my vegetables every day."

 

She was completely serious.

 

OH! Which reminds me, if you're going to go to the nutritionist, go ahead and start keeping a food log of everything your dd eats and drinks now, just to have it in hand.

 

Unfortunately, this is exactly my experiences with traditional nutritionists.

 

Kinda like the ones they also hire at all the grocery stores to recommend "healthy" products.

[hornblower]

One last thing - do not confuse nutritionists with dietitians. They're not at all the same thing. 

I think much of the loopy or just plain quack advice I hear people have been told was told them by a nutritionist - which is in most of North America an unregulated profession. 

See a Registered Dietitian preferably one that is a child specialist. 

Edited June 3, 2016 by hornblower

[SparklyUnicorn]

Ketchup? Soda (somebody else mentioned)? How on earth do these people get their jobs?

 

Sometimes I think they assume someone won't take most of their advice and they try to figure out what is doable.  That's my theory anyway.

 

My sister is under the impression she can eat whatever she wants in moderation.  (She has diabetes.)  Well first off what is "moderate".  Second this is how she interprets that:  little bit of white rice, small container of sugary yogurt, small amount of pasta, one small slice of bread, handful of crackers...I can have all of this because look each portion is moderate.  Except she isn't eating a moderate amount of carbs is she?!

[SparklyUnicorn]

One last thing - do not confuse nutritionists with dietitians. They're not at all the same thing. 

 

I think much of the loopy or just plain advice I hear people have been told was told them by a nutritionist - which is in most of North America an unregulated profession. 

 

See a Registered Dietitian preferably one that is a child specialist. 

 

They can be as bad and in fact most of them are RDs (I mean the ones we are talking about here).

[rwilk]

One of my sisters was born severely premature---like at 23 weeks.  Once she got passed the initial year or so of being severely underweight, she still had problems gaining.  It's not just an issue of how much a child weighs, or how much fat there is.  At a certain point, you worry about things like bone development, muscle development, and the like.  My mom took her to a nutritionist that specialized in premie low weight kids, and got lots of great ideas.  She has grown into a healthy, well developed adult and she's now taller than I am.

 

I agree with PPs who say you should go.  Not just as a CYA (but I'm crazy paranoid too, and would go to CMA), but also to start the process of figuring out what is going on with her.  Maybe it's nothing.  Maybe it's a sign of tapeworm, or some hormonal imbalance.  

[sbgrace]

I didn't read the replies. But I would go. Some pediatricians would be ok with parental choices, but others definitely aren't. And if you get one of those, you can get real messes or even CPS referrals. It happens.

 

If this pediatrician is too conservative/easy to refer for your tastes, you might check around to see if there are other options. But I would follow through on doctor recommendations to protect yourself.

[JFSinIL]

I'd keep a log of everything she eats, and make the appointment if only to document that you DID follow the doctor's orders, just in case 1. something is amiss or 2. some nosey parker calls CPS on you.

[Spryte]

I'd go, because of the reasons already stated.

 

It's just one more thing for you to do, but for this - I'd definitely go.

[Lawana]

I assume the 3%ile is weight for age? Is she shorter than average? What %ile is she on a weight for stature chart such as http://www.cdc.gov/growthcharts/data/set1clinical/cj41c026.pdf

[pinkmint]

She's 22 percent for height. So kinda short but closer to average than her weight.

[Lawana]

She's 22 percent for height. So kinda short but closer to average than her weight.

That is short. I suspect when you plug the numbers in to the above chart, she will be about 25th percentile weight for stature.

 

ETA Looking again, it may be significantly lower than 25th percentile

Edited June 3, 2016 by Lawana

[TammyS]

I wouldn't go.  I would talk to the pediatrician about more closely monitoring her for a while by bringing her in to have a nurse weigh her.  Actually, I wouldn't.  I'd just weigh her myself and keep a closer eye on her nutrition, but I know you may not be comfortable with that.  So, I'd do the weighing her at the ped's office.

 

If the ped doesn't like that very reasonable plan, I'd find another ped.  Because someone has to be at the top and bottom of the curve.

[NotSoObvious]

It sounds like in your situation you should just cross your t's and go, but if it makes you feel any better, I wasn't even ON the charts. I was always super tiny. I didn't weigh 100 lbs until I was fully grown and I was always a head shorter than anyone in my grade. I'm so grateful my pediatrician didn't jump all over me every time I went in. Teachers were another story. I was accused of having an eating disorder my whole life and it was awful! I always felt bad about how skinny and short I was. It was just genetic. (Not that it always is!)

 

P.S. Ketchup counts as a vegetable for school lunches, too.

[TammyS]

  But since from your other posts I know you are having hard times, your refusal to go could cause the doctor to refer you to CPS.  You don't need that.

 

I don't disagree with you, but I can't stop myself from saying what a sad state of affairs we've gotten into with this stuff.  You shouldn't have to fear having your doctor report you to CPS because you disagree with a treatment.  And yes, I know some people may die because of the disagreement, but some people may also die because they don't seek treatment because they are afraid of this kind of thing.

[TammyS]

.  You could count all the ribs and that one ate like a horse.

 

Yeah, that's my son.  You can totally count his ribs.  He's 178lbs.  And eats like a horse.

[TammyS]

Just to illustrate why you have to be determined to lay your own common sense on whatever the nutritionist says....

 

One time a nutritionist told me to eat more KETCHUP, to "get in my vegetables every day."

 

She was completely serious.

 

OH! Which reminds me, if you're going to go to the nutritionist, go ahead and start keeping a food log of everything your dd eats and drinks now, just to have it in hand.

 

And this is the potential harm that the nutritionist can do.  While mom doesn't have to go along with what the nutritionist says, it will be very undermining for mom if the nutritionist tells her to do something stupid like above, kid hears it, wants to go along, but mom says no.  Now the kid has something to argue about, with an "authority" to back them up.  And possibly a food struggle that didn't exist at all before.  So mom wants the kid to eat avacados, the kid wants to ketchup, and the nutritionist said so!

[pinkmint]

DD is already happy about the Pediasure chocolate flavor. So now she can drink sugar and processed oils beverage and fill her stomach with that and continue to refuse things like delicious skin on chicken and buttered veg? It doesn't really make sense.

 

But yeah this is the world we live in.

 

I don't know if her peds office really cares if I go to the nutritionist or not. But I err on the side of being paranoid.

 

Best case scenario the nutritionist would back me up and help dd realize she should eat real food. DD would eat goldfish crackers and m&ms only if it were up to her.

[Arcadia]

Does she like food higher in salt content? Mine had salt cravings at times.

 

My DS10 didn't gain much weight until his tummy wasn't "over digesting" food regardless of what he ate. Once he wasn't pooping so frequently, he gain weight and height. However his diet was the same, so his digestive system took longer to mature than DS11 apparently.

[MEmama]

If you aren't concerned, why not just straight up ask your pediatrician, "Does my kid need to go to this specialist? If not, okay. If so, what can I expect? What EXACTLY are your concerns?" . I mean, doctors can't tell you how to parent, or even what's normal for your kid. I've known plenty of people whose kids are off the weight charts (low end) and only one was made to feel like she actually needed to take action (which was especially dumb as she and her DH are Japanese and the weight charts were for northern Europeans). Doctors shouldn't add unnecessary anxiety, especially when it's unwarranted. But I put very, very little into those charts, knowing how little they reflect any individual child. 

 

I'd be new-doctor shopping before I went to a nutritionist, assuming you are a normally intentional parent (and from your posts I know you are!).

[fraidycat]

I would go, just to CYA, even if I planned to disregard all of their "advice".

 

The "health professionals" (idiots) worried my poor SIL half to death over my niece's size. The SAme freaking doctor (GP) who induced niece 3 weeks early because they measured SIL wrong and thought niece was going to be too big (it was all amniotic fluid), she was small. The same doctor who sat in the same room as my just barely 5 ft. tall, 95 lbs. (soaking wet) SIL and my 5'10" skinny as a rail brother and told them that their DD was "too small". Too small for what exactly? Um, you do see the small parents who carried the kid in, right?

 

 

• No, you do not have to take your child to a nutritionist.
• But it can't hurt.
• Also, you don't have to do whatever the nutritionist recommends. YMMV (obviously) but I wouldn't be giving SUGAR of all things. As of right now, she's healthy. Sugar addiction is a real quick way to change that.
• One time I did a parasite regimen just to make sure we didn't have any. Oooops, they all did. You may want to look into that. Kids play in the dirt, which is very good for them but you can (and do) pick up alllll kinds of unpleasantness.
• No, you should not give up on veggies, fat and protein and let her eat all carbs.

Sounds like you're doing great already, OP. I agree with the PPs who've said you might want to go just to put your own mind at ease re: authority figures. It can't hurt.

Do you mind sharing what you used for parasite regimen? Edited June 3, 2016 by fraidycat