Two Days, By The Numbers
The End of the Hairz

Skinny Ike

Ike had his six-year routine physical yesterday, and in Classic Ike style, it ended up not being as routine as I was expecting. 

He's on track height-wise, shooting up over three inches this past year. Weight-wise...not so much.

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He's always been a skinny thing, but consistently 25th-percentile-or-so skinny. He gained just a tad over a pound this year, which knocks him all the way down to the 12th. And while growth charts are certainly prone to some year-to-year weirdness, our doctor was very much Not Happy and Rather Concerned with Ike's weight. At barely 39 pounds, he's underweight for both his age and height, and it's just super inconsistent with his growth so far.

Now, we dealt with our fair share of Dinnertime Pickiness Drama Shenanigans this year, but I really thought 1) he's been doing much, much better for several months now, and 2) we were more than making up the calories of a smaller dinner elsewhere throughout the day. Good breakfasts, a generous lunch, lots of healthy snacks. He drinks whole milk and loves cheese and yogurt and granola bars and fruit and chicken and steak and fruit/vegetable smoothies. He doesn't drink soda or get regular candy and his go-to treat is whole milk ice cream or a shake. At restaurants he'll certainly jump at the pizza and fries, but as I described his typical day-to-day diet and calorie intake I didn't sense I was putting the doctor's mind at ease. If anything, it was having the opposite effect, as her questions then moved to our family's history of a myriad of chronic diseases that could possibly be the culprit. 

Wat. 

Now, it's possible that his height growth-spurt came first, and he just needs to...round himself back out a little before the next one. (I could always tell my babies were about to jump to the next clothing size when they at their chubbiest. Then they'd lean out for a few weeks before fattening back up.) And he's a pretty active kid in a family of skinny beanpoles. Nevertheless, the doctor has given us six weeks to get him to gain some weight the old fashioned way, with a high calorie and high (heart-healthy) fat diet. Lots of extra oils and calorie-rich foods and daily nutritional shakes and just...packing in as much food as we can get him to accept. If, after six weeks, she's not happy with his progress, we move on to bloodwork and further testing to make sure there isn't something else going on. 

This morning I made him eggs with extra butter, some high-calorie granola, yogurt, and poured him a big cup of milk. Ezra (ever the helper, who now has Ike's diet on his list of things he cares about) peeled a banana and sliced up some pears with cinnamon. Ike first said he didn't want bacon, then cried because I made him eggs instead of bacon, then cried because I made turkey bacon and he didn't want that kind of bacon, also he didn't like the granola for reasonreasonwhine, then Poppy jumped up and knocked his plate and cup all over the floor and got herself a very nice breakfast of everything I'd just finished making. 

I think Ike ended up actually eating the banana and like half a yogurt. Then he said he was full and his tummy hurt, probably because he sensed how much I actually cared, and thus: PARENTAL WEAKNESS THAT MUST BE EXPLOITED. Meanwhile, I had to shoo Ezra and Noah away from the breakfast table around 11 a.m. Against my better judgement, I tasted the rejected granola and it is fucking delicious and approximately 3,000 calories a bite, so that's great to have around the house for me. 

It's going to be a fun six weeks! 

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(Here he is eating a s'more. Have s'more, child! Please. I'm begging you.)

Comments

Shannon

My daughter just had a 4 year checkup and clocked in at 42" and 37#, 15.1BMI. Neither are concerning to her doctor (although I'm sure the worrying for Ike has more to do with his tracking than the actual numbers). I just wanted to say that I think it's weird that the numbers for boys and girls are so very different. Here's hoping that the calorie heavy foods work for Ike!

Cheryl S.

Like your kids, my daughter gets a belly for a while, grows a few inches and leans back out. She's 12. It's always been that way.

As for some odd metabolic SOMETHING, I'd be getting a second opinion if they wanted to do any more than a bit of bloodwork.

jodi

Oh, this was always, always, always Michael. At every pediatrician appointment. It got so bad I told our doctor that until he falls off the weight charts I wasn't talking about his weight anymore. (He's tall and super skinny like his dad and swims 360 days a year).

Anyway, my suggestions are milkshakes and a lot of them, and starbucks frappucinos, creme based of course. Ice creme, custard, and Michael loves meat, but we don't eat a lot of it in our house because I'm a vegetarian. And at some point you have to stop caring because they will totally use that you care so much.

Anne

My son just had his five year well visit two days ago with similar results. Height dead average, keeps on growing. Weight gain low, dropped from 25th to about 10th. Child, eat. Food is wonderful!

Amy

Yeah, those charts that those doctors rely on are SO accurate, nevermind the fact that we have a nationwide childhood obesity epidemic.

When my son was born at 38 weeks he weighed 7 pounds 9 oz. "We have to check his blood sugar," the nurses said, "because he's too big for his gestational age."

"He is 7 pounds 9 ounces, that is hardly the Hulk. What the hell??" I said, as I tried to pass the placenta (not kidding).

"But the chart...." they said.

"Does he have any symptoms of anything being wrong?"

"No," they said.

"What happens if you stick him and you don't like the answer?"

"If it's low we'll just give him a little formula."

"Nope nope nopity nope nope nope. I have successfully breastfed both of my daughters, and I do NOT consent to formula, so there's no point in sticking him."

"But....."

"Nope."

"But...."

"If you are concerned, call his doctor and have him come here at 3 am and assess him for symptoms of low blood sugar, but I am NOT going to let you stick him and then pressure me to give him formula because of a piece of paper. He weighs 6 ounces more than my daughter who was 39 weeks and 6 ounces more than my other daughter who was 36 weeks, and a half a pound of growth a week is normal at term, and none of this was done to them, and they're both fine, and he will be fine too."

"But....."

"You are not going to screw up my breastfeeding of this child before I even get his placenta out!"

"But....."

"I do not consent."

He's 6-1/2 now and he's perfectly fine.

In the absence of any other symptoms of distress or discomfort, I would either ignore it or get a second opinion. Kids eat when they're hungry. You know this.

Jean

Custard is great...and kids love it. Pudding from scratch and use heavy cream as an extra kick in milk shakes. Get some regular bacon too :). Also I know this is weird but I loved butter as a kid. Maybe he would eat a few pats of some yummy kerrygold?

Sun

Talk to a nutritionist ASAP. Ike looks healthy! When our 15mo. fell off the height/weight charts, our pediatrician wasn't super worried as my daughter looked & acted healthy, but she wanted to rule out any physiological reasons for the drop (i.e., thyroid, intestinal blockages, Turner's etc.). All the specialists pronounced nothing wrong. But the pediatric gastroenterologist was concerned about her lack of weight gain compared to the growth charts and proscribe adding heavy whipping cream to her whole milk, butter & oils to all other foods, etc. My daughter stopped eating. The whole milk with cream was delicious and had all the calories she needed, plus I was too invested. I think you've read Ellyn Satter's books? She was totally right. My daughter knew how many calories she needed, and ate/drank only that much.
When we finally got in to see the nutritionist, she said to back off. Stop adding cream to the milk, butter to everything, etc. my daughter was healthy and reaching all her other cognitive & physical milestones. She said that she has been seeing many pediatric patients with HEART DISEASE (as young as 10) because of recommendations like from our GE. She said that the main concern of many doctors is to hit the weight #, but not necessarily in a healthy way.
Anyways, once we stopped adding the cream to the milk, her solid food intake increased, especially after I stopped showing how much I cared about how much she ate. Later, when I thought she wasn't eating enough, we switched to 2% milk and it led to her eating more real food. We're now at 1% milk and my kids eat plenty of real food.
Please re-read Ellyn Slatter's books and see a nutritionist as soon as possible before you change Ike's diet. (But try switching to 2% milk if you want his food intake to increase.) If Ike does need to increase weight, the nutritionist can tell you how to do it in a healthy way.

Lauren

I second the previous commenter--switch to 2% milk. My little guy was a super picky eater from ages 2 to 4 so I kept giving him whole milk to keep his fat/calorie intake up and he LOVES milk so he was consuming a lot of it. When I mentioned that to the ped, she said to get him off the whole milk because it fills them up too much! Sure enough, as soon as we switched to 2% he ate a lot more actual food!

Jess

We're dealing with this rodeo with my 5 month old son (who only recently stopped needing a decimal point to describe his BMI). I cringe to see a lot of comments here saying to ignore the doctor and that he looks fine... my son "looked fine" in pictures with clothes on, but was most definitely not fine. Yes, 99% of kids eat when they're hungry.... but there's always that last 1% to reckon with. My kid is that 1% (well, was - he finally turned a corner this week). Probably/hopefully yours isn't and has just masterminded his way into all the ice cream he can eat, but you never know... which is why I haaaaaate hate hate choruses of don't-listen-to-your-doctor-everything-is-ok. I've had enough medical weirdness in my family to never want to be placated into a false sense of security when a quick blood test could give me much more solid peace of mind.

(that being said I bet he's a-okay, I wish you luck with the stuff-the-turkey campaign, and godspeed on fighting the good fight against the granola)

Meredith Brim

Make scrambled eggs/ omelets with cheese and heavy cream? That's the way they used to make them at a deli I worked at and people loved them. I, personally, have almost always had weight issues and love skim milk-- full fat milk tastes bad to me, so I don't have much to offer there. Hopefully, he'll plump up like a proper little turkey and you won't have anything more to worry about.

Pamela

I hear you. My son is 6 weeks younger than Ike, and pretty much the same height and weight.

Nicole

He's sooo precious!! Good luck w the weight gain/ eating thing. You got this.

Annie

I would also cry if I asked for bacon and someone made me turkey bacon instead of real bacon. ;-p I was a super skinny, picky kid too...thank goodness for peanut butter because I lived on it. My mom says I never would have survived going to school today because so many schools have gone nut free! I literally ate a peanut butter sandwich every single day all the way through elementary school.

Katie W

Meh. I'd be hard pressed to get my skinny guys to gain any weight in 6 weeks. My older son was maybe only a pound or two ahead of Ike at the same age. I'd be more interested in waiting six months, especially since his height seems fine. It's not like he's terribly unlike his big brothers. Hugs. I hope this doesn't make you tear your hair out.

Melissa

I'm with Jodi. I've had this conversation many times, including at my 15 year olds last appointment. Ice cream is probably your best bet, because they'll eat it. Make it with fruit and then it's almost healthy! I think some kids are just naturally that skinny and all of your boys seem to be very lean.

Amy

I haven't time to read all the comments at the moment, but please please PLEASE do not just take the ped's recs at face value. Unless they specialize in nutrition med students get all of like five minutes in nutritional training. As long as he's happy, eating, and shows no other signs of illness, the very *most* you should do is schedule a visit with a pediatric nutritionist. (And even that is probably way high on the "precautionary" side of the spectrum.)

Also, they rarely take genetics into account, and that definitely plays a factor. I put my oldest (now 10.5) through nearly a year of testing as a baby because of a "failure to thrive" diagnosis, and it all turned out that hey, dad's a beanpole, grandpa's a beanpole, uncles: all beanpoles. Maybe he will be too, and I dunno why it took 8 months of testing and four specialists to figure that out.

Abesha1

My second son has been "low" on the curve, too. Make sure you're looking at the World Health Organization charts and not the CDC charts. Also , sometimes you can't see a pediatric nutritionist unless there's a gastrointestinal concern, and I don't think you want to go down that road. It's very hard for children to move up the curve, so maintaining is a better goal. And genetics, for sure! My husband and I were both painfully thin-looking as children.
Protein, healthy fats... and what does 6 weeks have to do with anything, anyway? I'd start weighing every 4 weeks and chart it myself. And then, stop worrying about it.

Janice Barnett

My two year old Granddaughter is having a similar problem but their doctor is saying "Don't worry." I know that one of the things they talked about was her activity level. She is only quiet when she is sleeping otherwise it is constant movement. We honestly believe that she is just going to be small. She only weighs 23 pounds and only gained a pound and a half the last 6 months.
I hope that Ike gains some weight in the next 6 weeks and you can try and relax again.

Jennifer

I love you but turkey bacon is a crime

Laura

I feel like in this case, statistics should be calming, Amy. 6th percentile means there will be a non-zero number (6 out of every 100!) of boys who are completely healthy who are even skinnier/beanpolier than Ike. I am sorry that you are so concerned, and I'm sorry that Ike is sad about turkey bacon (sad, but cute), but I think if this were the Advice Smackdown you'd tell the OP not to worry and to trust her happy, healthy, eating what he wants and being offered food all the time, kid.

Could I be wrong and he secretly has a tapeworm? Sure. But until he is NO LONGER ON THE CHART, I do not think I would change a thing.

Amalah

Ok I will accept all the conflicting weitght info but MICROWAVED TRADER JOE'S TURKEY BACON IS HEAVEN AND EVEN IKE CAVED WILL FIGHT YOU

Heather

Eh.This is your child so I'm surprised this warrants a post? What is the doctor suggesting???
My 3rd child is small and doesn't hit the weight marker his older sibs do... but I'm not terribly concerned. The doctor noted that he wasn't on the charts but saw that he was energetic, talkative, and hit all the other "developmental milestones" so NBD.
Relax, Amy. Look at Ike and really think about if this merits all the concerns. You said that he eats healthy almost 3xday? Ok. Unless the pediatrician points to a real Issue (which you didn't mention) then don't freak out. He looks happy and healthy to me! Plus Chef Ezra is in da house!

Heather

*This is your 3rd child

MissingNoah

I'm surprised they are so worried. My big kid is about to have his 6yr checkup and is barely 35lbs.

Shaynee

I hope it all turns out to be a transient change and your mind will soon be at ease. The doctor is likely bothered less by Ike's absolute numbers and more by the change in his personal trajectory. My kids have always been on the low end of the curves, 3rd percentile for weight and 15th for height for one, reverse those numbers for the other. But they have consistently tracked along those curves so that's just them. They also are not morning eaters--Ike's breakfast of a banana and half yogurt is more than they can manage on most days.
A growth spurt is definitely a possible explanation here. Good luck in the upcoming weeks.

Anne

My mother-in-law who raised three boys and 4 grandchildren always said they have an out year then an up year i.e. they put some weight on then they grow taller. It seemed true for my two boys too.

Personally I hate the charts. In the UK they now weigh children at the end of primary school (age 10/11) then write to you if your child is 'too heavy' and you are supposed to do something about it. My oldest was positively fat at age 11 and I changed nothing about his diet or activity. Two years later he was 6 feet tall and skinny as a rake. I knew that would happen as I was exactly the same. I honestly think genetics is the key factor. I also think if there were a real problem you would have had an inkling yourself anyway. I would keep an eye on him but I wouldn't try and change his diet too much or it will become a 'thing'.

Kris

I feel ya. I have a picky eater/super skinny kid. Food is tiring. Oh, and then we added ADHD medicine and that really made food tiring. Good luck.

E

Um. I love you, but I think you need to chill. By definition, 50% of kids will fall on the bottom half of the growth chart. Some kids are thin. Some are 12%. Some are 5%. That doesn't mean there is a medical problem.

Liz

Okay - so I am going to be the naysayer here. My beautiful now 13 year old was always the tallest and skinniest girl. She kept growing height wise but never put on much weight. She always looked like she ate well but she was super picky and tended to complain about her stomach hurting. We met with several nutritionists over the years, and the new plans would work for awhile and then not so much. She had GERD as a baby but we thought she was past it.

Things came to a head when she was 10 and started complaining about stomach issues and throwing up in her sleep. Turns out she has celiac disease (and before anyone questions that, it was diagnosed definitively through an endoscopy). For the last three years, we have seen a transformation. She is still skinny - 5'5" and 98 lbs - but she feels good, her stomach never aches unless she is truly coming down with a bug, and her small intestine looks fabulous.

I guess I would say that you shouldn't be freaking out but I wouldn't be too dismissive of the pediatric concern. Ours was quick to bring in a GI as soon as the midnight puking began, and I suspect yours will move through some sort of nutritionist / blood work if his weight doesn't come up. Good luck.

Christine

I don't know what you're supposed to glean in 6 weeks. Did it rapidly seem like he thinned out? And is he acting tired, or have his energy levels changed dramatically? And/or does he have gastro complaints? Because if so, I wouldn't wait the six weeks and I'd try to get him in for a blood test and specialist.

But if he's eating relatively well, and he's acting normally, I'd probably just keep on keeping on. Just like I said when I told my doctor to never bring up my kids BMI in front of him - some kids are going to be big, and others small, and most in between.

But really my takeaway from this is that I want bacon.

Meri

I had a period of time where I had no appetite due to a combination of meds and stress and it was really hard to get back up to a healthy weight. My stomach hurt if I ate more than I was used to; I'm wondering if that's what's he's experiencing.

I ended up having to calorie-load my food and make sure I ate my protein first, then eat veggies or carbs because I couldn't manage all 3. I did eat a lot of ice cream and mac & cheese (extra awesome with a tablespoon or two of cream in the milk) and nuts. That's what worked for me; YMMV.

It was really hard to go through and I can't imagine dealing with this for your baby. A million hugs!

Jessica

The switch to a lower fat milk changed a lot for us. We had been given the same advice of 'high fat everything' and it just made him only eat smaller portions because he felt full. Now we're on 2% and he's actually eating and gaining weight. He's been either not on or at the 3rd percentile since he was 6 mo old and now we're at the 5th. So that's not a huge change but it's going in a direction we're happy with.
And also the fighting about food? Sorry Satter, I heart you but this has not been a good direction for us. If we let him eat until he wants to stop? That's 7 cheerios. Or if 'get down from the table means it's over and you can't eat until morning'...well, that's fine with him too, and he's eaten three pieces of pasta. I just have to put my priorities on food intake until that's sorted and we'll work on behaviour later, I guess. Sigh...
So usually he (he's 4, almost 5, and is just now growing out of 3T clothes) will eat about half his meal, have a 'break' and then will be coaxed into eating the rest. He was a 'happy barfer' when he was a baby (actually you can read about him in old Advice Smackdowns) and I do wonder if there is any correlation, but no Dr has ever said there was and they look at me like I'm crazy pants when I ask. So...I guess now?

Anywho, best of luck and don't let your Dr make you feel mental about it.

Onlooker

Wowie, a lotta people in here who know way, way more about Ike's health than his doctor and what to worry or not worry about better than his mother! Lucky you.

I have no clue how you do this mommyblogging gig. I would be giving murder eyes to everyone. Anyhow, as everyone has pointed out, you're a great mother with three kids, so probably you got this and are doing just fine. All the sympathy for your worries and I hope Ike gets back to his spot on the curve without needing blood work.

SarahB

No other issue has opened such floodgates of "advice" for us than our daughter's eating/weight issues. For years she's been on the low end of BMI. About 6 months ago she was at the 50th percentile for height and 1st percentile on BMI...almost shockingly skinny. Trying to get her to eat outside a small-ish selection of food was exhausting. We requested and got a consultation with a pediatric feeding specialist and saw some big improvements. One thing that was counterintuitive for me was his recommendation we reduce snacking. She was grazing nearly constantly (and I was thinking "she eats so much!") but was never really eating anything like a full meal. Once we reduced time windows for snacks and meals and followed some of his other suggestions, we saw big improvements (though she might only be at about 3rd-4th percentile BMI right now). Best wishes to you all, whichever way things go-- he's in outstanding hands!! You've got this!

Kate

I just now realized we never took our daughter in for her yearly physical so that's where I am with my current parenting skills.

Sarahd

Turkey bacon=better than regular bacon! Agreed!

ali

I'm not saying ignore the pediatrician because I certainly didn't go to med school, but I wouldn't be overly concerned. If his overall diet is healthy, he eats a decent amount, and isn't showing any signs of problems, my level of concern would be pretty much non existent. I really think different peds look at this very differently. My oldest is tiny, tiny, tiny for his age, but is a wonderful eater....will eat almost anything and eats as many calories as I do. He's just a naturally skinny kid (as his dad and I both were as kids). My youngest, on the other hand, eats very little and is extremely picky, but his weight/BMI falls closer to the 50th percentile. My general thought is our country is really good at encouraging unhealthy ways to gain weight, so I am not going to worry about kids that eat lots of healthy foods and aren't showing signs of illness.

CallMeJo

Our son is a stick. He comes by it rightly, neither of his dad or I are big people, but in the last few months I'm kinda freaking out. He usually eats TONS and now he's 4, and pickiness is infesting our meals, and he's a shadow of a stick and weighs nearly the same as his 1 year old sister :/
The doctor hasn't said anything, since he's been at the bottom of the weight chart since he was 9 months old, but I can see that it's coming.
Kids, they constantly throw you for a loop. I'll be waiting to hear about your follow up. Hoping it's just a regular old kids-be-worrying-their-parents thing and nothing serious.

Alice

Good luck!
I've got a skinny six year old myself but not a worried doctor so I try not to worry. Nobody in my family has ever been skinny but my husband looked exactly like our son until he reached puberty and whatever he ate started sticking. This worries me because I don't want to create unhealthy preferences now just because he burns everything he eats at the moment, when I know what kind of genes he'll be fighting later ;)

JenVegas

AVOCADO ON EVERYTHING!!

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