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

[TranquilMind]

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. 

 

Right.  It is more a matter of whether this is an aberration for this particular child or not.  Any significant change warrants investigation. 

[wintermom]

I don't consider this a referral to a specialist. A specialist, in my mind, is a doctor who specializes in particular area. I've had really great results going to see specialists. If your GP has any specific medical concerns (e.g., metabolism, blood sugar, bone development, muscle mass), then a referral to a specialist in a specific area could be really useful. I would ask the GP exactly what his concerns are, and to refer a specialist to address these specific areas. Just increasing weight through sugary drinks seems like a really artificial method to address overall health.

 

 

Edited June 3, 2016 by wintermom

[wapiti]

I would be annoyed at the expense.  I have experience with various types of nutritionists and mostly I didn't find them terribly helpful.  If you have access to an "alternative" outside-the-box type of nutritionist, perhaps they'd be interested in some sort of vitamin angle, food allergies/intolerances that may make her wary of foods, or something a "regular" nutritionist wouldn't think of (such as the parasite example above).  Some nutritionists can order bloodwork for these things.

 

Speaking of which, if the child is off her growth curve, it's surprising the ped didn't order bloodwork (happened to one of my kids).

 

As for the Pediasure, Costco carries it.  One of my kids has never liked milk and has been drinking pediasure (dang spell check keeps changing that to pedicure) for many years.  I suspect he may have some sort of milk issue (we recently learned a sibling is lactose intolerant, another has food allergies, etc.).

 

But yeah, sadly, like the others, I might go just for CYA purposes.  Our ped because she disagrees with the direction I have taken on a controversial issue (seeing an immunologist she thinks is kooky rather than the psychiatrist she referred us to) and I've avoided going back there - the whole power/"big brother" feeling freaks me out.  I need to schedule some well checkups and I'm going to aim for getting the nurse practitioner instead, on a day of the week that ped isn't there.

Edited June 3, 2016 by wapiti

[MEmama]

Right.  It is more a matter of whether this is an aberration for this particular child or not.  Any significant change warrants investigation. 

 

I agree.

 

If your child has always been generally on the small size but maybe this was a bit lower than his norm, I would wait it out until the next visit at least. But, if he suddenly dropped from the 50th or 25th percentile, say, to the 3rd, something might be amiss. Although, that's hardly unheard of either as growth and weight fluctuate so much in the early years. So even then I would be cautious, unless you felt that something was off. I might reschedule a visit with the regular pediatrician in 3 months or so, and then look into it further if it hadn't normalized by then.

 

 

[foxbridgeacademy]

First, it's easy to tell from your posts that you are a caring and capable mom.  It sucks that just because of a few of life's circumstances you have to worry about CPS and such, BTDT.  We used to be very poor and I have a child who's weight/height was always under the 5%.  She actually got sick regularly, colds/flu/ear infections, so we were at the doctor often. When you walk in with this tiny little thing running a fever and you "pay" with medicaid people look at you differently. No one ever called on us and now looking back I think I was overly sensitive to their censure, DH was laid off we were on all kinds of Gov. assistance..... It was a rough time. 

 

Anyway, DD was a picky little bird eater too. She would eat chicken, pasta, and french fries.  She loved ranch dressing and alfredo sauce, cheese of any kind.  So I begged and bribed her to eat "salad", which consisted of Spinach and little bits of broccoli covered in ranch dressing (homemade with hidden valley packets only) and bacon bits. I mixed ground up broccoli into our pasta sauce.  When we had veggies she had to eat how ever many bites as her age.  This led to many fights, some I won, some she won.  I always made her try a bite of something new or something that she hadn't tried in awhile, after all taste buds change.

 

She is now a vegetarian who loves broccoli, spinach, tomatoes, cucumbers, sweet peppers..... the list goes on.  As a child I was just like her, I only ate white things.  Now as an adult I think my favorite food group is vegetables (real close tie with beef). My advice, go to the specialist and nod your head, say  a lot of "huh, I never thought of that" then go home and keep doing what you've been doing. 

[Guest]

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.

I know it's so unfortunate we have to consider these things, but I'd recommend going as well just to check the box.

[Junie]

When dd5 was a baby, the pediatrician referred us to a nutritionist (or dietician?  I can't remember).  I remember thinking, "Really?  This is my sixth child and you think I don't know how to feed her?"  But I went and I was so glad that I did.  I made the recommended changes and dd5 looked like a different, healthier child in less than a week.  It was really amazing to me.  I didn't realize how sickly she looked until I saw her with full, rosy cheeks.

[Bluegoat]

No, you don't have to.  I would be hesitant - from the way you put it, it sounds like they are misusing the whole percentile chart idea.  I've come to the conclusion they are seriously flawed even if they are being used correctly, but even if they were perfectly valid, it makes no sense to say everyone has to be over some particular percentile.  If everyone was over it, it wouldn't be that percentile.

 

Over the years, fully half of the people I know with kids have had doctors send them to a pediatrician or nutritionist because of the percentile chart, and in each case the only response was essentially to tell them to fatten the kids up.  In the end, not many were successful at this (none actually had more than a marginal effect.)  The few kids I've known with more serious weight issues had serious problems where there were other symptoms and adding fattening foods would not have helped anyway - things like metabolic or heart problems.

[Guest]

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?

 

Do you mind sharing what you used for parasite regimen?

Black walnut and wormwood tinctures (its wicked gross!) Followed by a full cup of water and coconut oil gummies i made with gelatin to keep everything going in the proper direction.

[bolt.]

I'd go. There's probably no harm in it, and you will probably leave more self-assured than you went in.

 

But, your doctor, on the other hand -- is an idiot when it comes to math. Percentiles, dear doctor, refer to the number of individuals out of a population of 100, arranged from smallest to largest.

 

The ones he has are statistically generated, but what they mean is that if you grabbed 100 perfectly healthy female children your DD's age, and arranged them from lightest to heaviest (if the world were mathematically perfect) the lightest one would be on the 1st percentile, the next one the 2nd percentile, the third one your DD, the fourth one the fourth percentile, and the next one (child #5) would be the first child he thought was a health weight. He believes that 4% of all humans are unhealthy just because they are members of a normal population distribution -- because that's what "we want to see everyone above the 5th percentile" means. And it means he's an idiot.

 

If he had said, "3% of all girls your DD's age are her weight or lighter, and that's perfectly normal, but it is also possible for a child to be on the light side of things for an unusual reason. It's wise to check up on all lightweights to assure ourselves that it's a good worthy for them, not a warning sign of anything bad. A nutritionist will know the details of that, so let's get you in touch with one." -- that would be the same action for a non-idiotic reason.

 

The idea that he *wants* a whole population to be above a certian percentile that is within the scope of that population is absurd. It defies logic. I'd be at least thinking about a new doctor, if such things are possible for you.

[pinkmint]

Thanks, everyone. 

 

The pickins are slim as far as doctors with dd's medicaid. I probably take her to the best option anywhere near us. In fact her doctor's picture was on a poster about being chosen for some recognition. I don't know what the deal is with doctors though. Do they have to cover their own butts? If another care provider in the system saw that dd was "underweight" and hadn't been referred to someone because of it, would he be in trouble? Is he really truly just trying to be caring and what he perceives as helpful? Her doctor is young. Probably early to mid 30's and he doesn't have kids that I know of. So maybe that's part of it. 

 

And Foxbridge... yes, thank you. I bring in my thin, pale dd with an ear infection or whatever and pull out my medicaid card and just feel all kinds of shame and self consciousness rising up in me. Like I don't have any rights or credibility as a parent, when reality is that I make huge decisions based on how important they are to me. 

[Bluegoat]

Except - if there is an underlying issue, a nutritionist won't solve it.  Does he actually have some reason to think she is not being fed properly?  It is pretty unusual for healthy kids not to eat enough to meet their needs, and many many kids are very light eaters.

 

 

 

[Bluegoat]

Thanks, everyone. 

 

The pickins are slim as far as doctors with dd's medicaid. I probably take her to the best option anywhere near us. In fact her doctor's picture was on a poster about being chosen for some recognition. I don't know what the deal is with doctors though. Do they have to cover their own butts? If another care provider in the system saw that dd was "underweight" and hadn't been referred to someone because of it, would he be in trouble? Is he really truly just trying to be caring and what he perceives as helpful? Her doctor is young. Probably early to mid 30's and he doesn't have kids that I know of. So maybe that's part of it. 

 

And Foxbridge... yes, thank you. I bring in my thin, pale dd with an ear infection or whatever and pull out my medicaid card and just feel all kinds of shame and self consciousness rising up in me. Like I don't have any rights or credibility as a parent, when reality is that I make huge decisions based on how important they are to me. 

 

It seems really common for doctors to respond this way, to kids who are smaller, and say - well, she's in the 10th percentile, that's low so we want to get her up.

 

All it says to me is that there is a significant number of doctors that have not actually understood the point of the thing, and are not thinking - they are just going through the motions. 

[eternalsummer]

I'd go. There's probably no harm in it, and you will probably leave more self-assured than you went in.

 

But, your doctor, on the other hand -- is an idiot when it comes to math. Percentiles, dear doctor, refer to the number of individuals out of a population of 100, arranged from smallest to largest.

 

The ones he has are statistically generated, but what they mean is that if you grabbed 100 perfectly healthy female children your DD's age, and arranged them from lightest to heaviest (if the world were mathematically perfect) the lightest one would be on the 1st percentile, the next one the 2nd percentile, the third one your DD, the fourth one the fourth percentile, and the next one (child #5) would be the first child he thought was a health weight. He believes that 4% of all humans are unhealthy just because they are members of a normal population distribution -- because that's what "we want to see everyone above the 5th percentile" means. And it means he's an idiot.

 

If he had said, "3% of all girls your DD's age are her weight or lighter, and that's perfectly normal, but it is also possible for a child to be on the light side of things for an unusual reason. It's wise to check up on all lightweights to assure ourselves that it's a good worthy for them, not a warning sign of anything bad. A nutritionist will know the details of that, so let's get you in touch with one." -- that would be the same action for a non-idiotic reason.

 

The idea that he *wants* a whole population to be above a certian percentile that is within the scope of that population is absurd. It defies logic. I'd be at least thinking about a new doctor, if such things are possible for you.

 

 

I doubt this is the case at all.

 

Probably he just thinks (or his profession guidelines indicate) that the first 4 kids in line and the last 4 kids in line are at risk for having some sort of disorder that causes either failure to thrive or obesity, so he wants to make sure (as a first step) that the parents have basic nutritional info about how to feed a kid who tends toward either extreme.

 

eta: then, presumably, if the kid is still either skinny or fat (to be blunt) at the next well-child checkup, he could say, well, we tried these things and I am at least reasonably sure you've got good info about nutritional guidelines; should we test for a medical problem?

Edited June 3, 2016 by ananemone

[Junie]

Two of my children are at/near the 50th percentile.  They are healthy.

Two of my children are at/near the 25th percentile.  One is healthy, one is underweight for unspecified reasons.  (Testing yielded negative results.)

Two of my children are below the 5th percentile.  They both have a congenital birth defect.

 

According to the CDC, about 3 percent of all children have birth defects.  This may be where that 3rd percentile number is coming from.

[pinkmint]

Two of my children are at/near the 50th percentile.  They are healthy.

Two of my children are at/near the 25th percentile.  One is healthy, one is underweight for unspecified reasons.  (Testing yielded negative results.)

Two of my children are below the 5th percentile.  They both have a congenital birth defect.

 

According to the CDC, about 3 percent of all children have birth defects.  This may be where that 3rd percentile number is coming from.

 

Would there be symptoms? She's no stranger to the doctor's office. She gets all her checkups and goes as needed for assorted minor issues. Would they not have seen anything? She was born full term, normal birth weight, spontaneous vaginal birth, breastfed, no apparent issues. She's just been consistently on the bottom of the weight chart since about age 3.

 

It's ok. I'm used to going to the doctor a lot and it makes me glad my kids are homeschooled. My toddler has been hospitalized for really severe asthma episodes and my 7 yo has severe environmental allergies. They referred me to an ear nose throat specialist for him and when we went she said "I don't know why they referred you". 

 

I will go to the nutritionist with her. Better safe than sorry. 

Edited June 3, 2016 by pinkmint

[hornblower]

I doubt this is the case at all.

 

Probably he just thinks (or his profession guidelines indicate) that the first 4 kids in line and the last 4 kids in line are at risk for having some sort of disorder that causes either failure to thrive or obesity, so he wants to make sure (as a first step) that the parents have basic nutritional info about how to feed a kid who tends toward either extreme.

 

eta: then, presumably, if the kid is still either skinny or fat (to be blunt) at the next well-child checkup, he could say, well, we tried these things and I am at least reasonably sure you've got good info about nutritional guidelines; should we test for a medical problem?

 

 

Yes. This. 

 

there are a few (mercifully few) silent but serious diseases of childhood and the first signs can be loss of appetite or  weight loss,  or slowed/plateaued weight gain. 

 

Nobody wants to leap into testing for these but you do have to note it & consider the child's growth. 

As an IBCLC I've had my share of teeth gnashing sessions at doctors who IMO are too fussy and worried about weight gain but honestly, I GET IT.  You're thinking "kid's fine, she's just small" The physician is thinking a whole bunch of possible things & they're not happy thoughts. 

 

 

 

 

[eternalsummer]

I would say that this is their first indication that something might be wrong (that she is low on the growth curve).  Something might not be wrong.  Probably they just run the numbers and say, of the kids who come in at the 2nd percentile, 1/3 of them are normal, 1/3 have some sort of medical issue, and 1/3 are just not being fed well for x reason.  So the easiest thing to do is send everyone to the nutritionist so they can start to account for that 1/3 (this won't hurt the others, so they figure it's a wash that way).  

 

I am making up the ratios, of course :)

 

What does she go to the doctor for besides checkups?  

[Junie]

Would there be symptoms? She's no stranger to the doctor's office. She gets all her checkups and goes as needed for assorted minor issues. Would they not have seen anything? She was born full term, normal birth weight, spontaneous vaginal birth, breastfed, no apparent issues. She's just been consistently on the bottom of the weight chart since about age 3.

 

It's ok. I'm used to going to the doctor a lot and it makes me glad my kids are homeschooled. My toddler has been hospitalized for really severe asthma episodes and my 7 yo has severe environmental allergies. They referred me to an ear nose throat specialist for him and when we went she said "I don't know why they referred you". 

 

I will go to the nutritionist with her. Better safe than sorry. 

 

I really don't know.

 

I went around and around with the pediatrician when she said she thought there was a problem with dd8's health.  I said that there was no problem and she was growing just like I did when I was a baby.  Slow growth/failure to thrive, but no major issues.

 

It turned out that I was right and wrong at the same time.  Dd8 did have a problem -- a birth defect that she inherited from me.  She was diagnosed at age 1.  I was diagnosed a moment later.  Dd5 was also born with the defect.

 

Thankfully, our symptoms are not major issues.  Mine were hidden for a very long time.

 

OP, your daughter is probably fine.  I hope that my post didn't scare you.  But I learned the hard way that doctors often make referrals for a reason.

[Artichoke]

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.

 

 

This is what I'd do.  It would be both a CYA and not a time/money waster at the nutritionist.  Although I have to say that I'm biased since we've been down this road. The nutritionist at the children's hospital didn't tell me anything I didn't already know.  For that information  we had a five week wait, travel time, and expenses plus the pre-requisite telephone calls and paperwork.  Now if you have none of that extra hassle, then go just to CYA. 

[pinkmint]

 

 

What does she go to the doctor for besides checkups?  

 

She's had a couple ear infections in her life, her eyelid was swollen and painful recently (solved by antibiotics) and things like stomach bug to make sure it's not something worse etc. 

[eternalsummer]

This is what I'd do.  It would be both a CYA and not a time/money waster at the nutritionist.  Although I have to say that I'm biased since we've been down this road. The nutritionist at the children's hospital didn't tell me anything I didn't already know.  For that information  we had a five week wait, travel time, and expenses plus the pre-requisite telephone calls and paperwork.  Now if you have none of that extra hassle, then go just to CYA. 

 

 

This is reasonable to me - but to the doctor, it might make sense to make the referral, because we are not the average parent.  It is possible that the average parent he sees with a kid who is significantly over or underweight actually does benefit from a referral to a nutritionist.

 

 

Like, I go to my prenatal appointments.  For the most part they are useless and a waste of time.  They weigh me, measure my stomach, take my blood pressure, and ask me if I'm feeling okay.  I can do all that myself at Walmart!   But to *them*, it makes sense to have me in every month or 2 weeks, because their average patient (or at least enough of their patients to justify the trouble) do need that level of monitoring.

[eternalsummer]

She's had a couple ear infections in her life, her eyelid was swollen and painful recently (solved by antibiotics) and things like stomach bug to make sure it's not something worse etc. 

 

Ah, that makes sense.  We don't go for any of that (except the eyelid thing) because we pay cash and I hate pediatrician offices :)

 

but it doesn't sound abnormal.  I was wondering if maybe there was something else you went in for that made the doc think she needed intervention or something.

 

probably he is just CHA himself :)

[MistyMountain]

I would go as a cover your ass but it would annoy me. I was a really skinny child who was just off the chart and I have two skinny children. One child is On the bottom of the charts. Thankfully my pediatrician sees me and listens to my history and he knows that just is her genetic build. Someone has to be on the bottom of the chart. Everyone gave me a hard time as a child and I was bullied in high school over my weight. I was healthy and ate plenty.

Edited June 4, 2016 by MistyMountain

[Daria]

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. 

 

But a nutritionist isn't going to be able to diagnose anything. 

[Junie]

But a nutritionist isn't going to be able to diagnose anything. 

 

True.  I would be much more concerned by a referral to a cardiologist or a geneticist.  I would recommend that you never miss those.

[hornblower]

But a nutritionist isn't going to be able to diagnose anything. 

 

I and others have already explained why seeing a Registered Dietitian is a good first step in this kind of case. 

 

it's not to diagnose anything. It's to rule out simple interventions. 

 

It's to get a firm grip on whether this is a food / inadequate intake / inadequate nutrition issue. You start with the simple. If these interventions don't help & she starts sliding or plateauing further, then you go further up into testing. 

 

 

[Artichoke]

This is reasonable to me - but to the doctor, it might make sense to make the referral, because we are not the average parent.  It is possible that the average parent he sees with a kid who is significantly over or underweight actually does benefit from a referral to a nutritionist.

 

 

Like, I go to my prenatal appointments.  For the most part they are useless and a waste of time.  They weigh me, measure my stomach, take my blood pressure, and ask me if I'm feeling okay.  I can do all that myself at Walmart!   But to *them*, it makes sense to have me in every month or 2 weeks, because their average patient (or at least enough of their patients to justify the trouble) do need that level of monitoring.

 

I'd have to respectfully disagree.  Pediatricians go by the BMI charts, which are not always accurate.  Again, I'm biased.  The same dd who was underweight all through her childhood was suddenly overweight at fourteen. At the time of her "overweightness" she was running track and doing field competitions.  There wasn't a spare ounce on her body. Prenatal appointments seem to follow a more linear course of growth which is based on the size of the fundus and not height and weight. They also listen for the babies heartbeat and perform other tests occasionally,  

[Paige]

I would not go but I'm not you. I probably wouldn't have accepted the referral in the first place, however. Could you call the pediatrician and discuss it? I would probably say that I really think DD is ok, and would he be comfortable letting her come in 6mos for a growth check. That is pretty common.

 

I was a small kid and my mother does not have my body type at all. She had a very hard time with doctors and them telling her I was too small. I take after extended family members. I bet if my mother had been smaller, I would have had an easier time with doctors as a kid because my size would have had an obvious explanation. Since I'm small, my kids don't usually get too much concern for their size.

 

My youngest is especially small. I'm so glad we had a doctor when she was a baby who said that if she went by the charts, she would be concerned (below 1st percentile- always), but she looks at the child in front of her, and this child was healthy. She looks for a healthy skin tone and healthy muscles. She looks for normal mental and physical development, healthy eating habits, and she looks at the overall impression the child presents, and my child was healthy. On the other hand, my slightly larger girls did see a nutritionist because they were not eating and were unhappy. 

 

My youngest has a well check next week and I am a little nervous because it is with a new doctor who has never met us. I know DD is short, skinny, and below the 1st percentile for BMI. Hopefully the doctor will look at the overall picture and her history and not want to get all anxious about it. DD is like me- the numbers do not tell the whole story. She doesn't look skinny, she's growing, she's active, and she's eating well. Most doctors look at me and aren't concerned with how small my kids are but sometimes we have been asked to come back for weight checks. We always comply and have always passed.

[Plink]

Didn't read all the responses, so I apologize if this is a repetition

 

Yes, I would take her to the nutritionist.  My underweight child was sent to one, and I enjoyed it much more than I thought I would.  Not all of it directly applied to DD, but it was  interesting none the less.  

 

Also, I was advised by our doctor (not threatened, although it seems like a threat when I type it this way) that if DD didn't gain they maybe required to hospitalize her to "remove the mom factor."  Going to a few appointments was much easier than hospitalization and dealing with social workers.

 

Ask the doctor for a prescription for any supplements they recommend.  Many insurances cover them fully.

[zoobie]

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.

I would make healthy "milkshakes" in lieu of Pediasure. You can throw in an avocado and/or coconut oil. A frozen banana, peanut/almond butter, and cocoa powder make soft serve ice cream in a blender. You could easily throw in a quarter of an avocado with no taste change, and the cocoa powder hides the color. Freeze the avocados in quarters when they're ripe.

 

If the ped asks whether you're giving Pediasure, you can say she prefers avocado smoothies. Don't say "no"; answer with an intelligent, informed "other" if that makes sense. :)

 

I agree re: keeping a log.

 

ETA: the benefit of a Pediasure is that it's quantifiable fat and calories. If you calculate your versions to be equal or superior, you're doing great. Myfitnesspal is a free app that will do that calculation for you.

Edited June 4, 2016 by zoobie

[FaithManor]

I have a boy that is very thin. Very, very thin. It is a metabolic disorder that my cousin has as well so it is very hard for sufferers to gain weight, and it does cause health problems. We've never had any good advice from nutritionists, but we did find a pediatric endo that was wonderful and a big help. It was also nice to have a specialist tell us that we didn't need to worry as much as the pediatrician was worrying us.

 

I have to recommend CYA due to the fact that a neighbor once decided that ds was "too thin", figuring I was starving him or something, and turned us over to CPS. It was resolved with a few phone calls, but nonetheless scary and I was glad to have a paper trail with the doctor that said we were proactive and following sound medical advice. Then we had a substitute ped whom we'd never seen before who did not bother to read ds's chart. I took him in for a tetanus booster because I knew he was close and he'd stepped on a nail and it penetrated 1/4" into the bottom of his foot. Better safe than sorry, right? Boy, nope. Wrong. Should have gone to the health department or something. The guy took one look at ds, yelled at me that I was an abuser and when we left the office called the police. That didn't fair so well for him because I reported him to the state medical board, and he got some uncomfortable heat from them. Well, and the investigating social worker who told me she yelled him a good one because it was such a waste of the system's time when he had the file right there in front of him that said he had a health issue, and we were good parents. Good grief! I asked him point blank, "Do you walk into a room and call CPS for every pediatric chemo patient that comes through because you've got some pretty skinny ones with mask out there too???" I was so dang angry. He never filled in for the regular ped ever again. But, I ended up having the endo give me a letter to keep with us at all times so if we were turned in again and someone came to the door, I had something to hand to them to look at ASAP and especially  because I was worried about weekends when the ped's office would be closed.

 

You may not get any help. However, at this point you may simply want to do a CYA to avoid trouble in the future.

 

Mrs. Mungo, who is no longer on the boards, used to worry about this type of thing. All of her kids are thin by nature, but the youngest had a medical condition that made it difficult for him to absorb nutrition and growth was an issue. She was always worried any time they had to see new medical professionals. Thankfully for her little man, a new doc put him on the right kind of additional supplement plan and he grew a bunch, gained a few pounds, and looks really healthy now.

[hornblower]

I miss Mrs Mungo.

 

 

Sent from my iPad using Tapatalk

[TX Native]

Has your daughter always been that low on the weight percentile curve or is she slowly dropping on the curve with each visit? My low weight child that stays around the same percentage each time doesn't concern the doctor at all. My low weight child that loses weight instead of gains weight ever so often has gotten frequent follow up for weight checks, numerous amounts of lab work and medical tests, iron supplements, and is asked to drink Carnation instant breakfast. I give homemade whole foods shakes like zoobie mentioned instead of the instant breakfast stuff. This child has asthma as well and I think the weight loss coincides with times my son has to take a preventative steroid inhaler to keep asthma controlled, but not sure I can convince the doctor of that. The doctor has not referred me to a nutritionist. He does specifically tell me to be sure my son is getting 3 full meals, snacks, meats and/or beans, fruits, and veggies everyday. I keep telling him my son eats a lot of all those things including the whole foods smoothies with healthy fats (ETA: and a double decker cheeseburger from 5 Guys or 2-3 slices of PaPa John's pizza once in awhile), but I guess the MD keeps repeating it so he can mark on the chart that he is advising on nutrition.

 

If your daughter is staying steady with some weight gain over time, but just has always been low on the curve, I wouldn't worry about nutrition or medical issue being the reason. I would take her to the referral, if it isn't too expensive for you, just so the doctor can be satisfied nutrition was addressed. Or I would instead ask for a weight check follow up in about 3 months, do some whole foods shakes, increase the healthy fat foods, increase calories, and say you will do the referral if she hasn't gained any weight in that 3 months. If she was previously higher on the weight percentile curve and has gone down to below 5% over time, I would take her to the referral now over concern that something needs to be addressed. If she doesn't gain after seeing the nutritionist and increasing calories and fats with healthy foods, I would take her back to the doctor to rule out a medical cause.

Edited June 4, 2016 by TX native