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15 Month Old Twins-one Underweight and Won't Eat, the Other Will Eat Everything

We took the boys to their 15 month checkup two weeks ago. The dr said one is very underweight, and he was concerned. He had a bunch of bloodwork done, and had me see a nutiritionist to find out how to fatten him up. She said that he is missing about 300 calories, to add more snacks and to add fats/oils when cooking. The problem is, he doesn't eat very much at all. Sometimes just a couple bites. He is a picky eater, he spits food out, hits your hand away and covers is mouth. He is always on the go, so I think the calories he getting he's just burning off. I asked the dr if his weight could be caused from being premature (1 month early), and he said at this age that is not a factor. I will not force feed him, but I don't know how to get him to eat enough. We have a follow up appointment on Friday 8/17 and I know he hasn't gained weight. According to my scale, he hasn't gained weight. I'm VERY concerned and at a loss of what to do. How can I get him to eat? All of the bloodwork came back okay. So it's a calorie/eating issue.

What can I do next?

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Hi H.,

I have twins as well. One of them is small and underweight and eats a good variety, but the quantity is small. They are 34 months old and this has been the case from day 1. As far as I'm concerned, if your son is not falling on the growth charts, he's ok "for HIM". Where does he fall on the growth charts? My daughter has always been in the 5th-15th percentile since about 6 months old. (she was only 4#11oz when born, so it took awhile to get onto the chart!)

My twins were full term, but one of them was just small, the other was big, even for a singleton, and remains in the 75-90th percentiles. So what I'm getting at, is what is your son's normal range. Has he lost ground on the growth chart? Or is he staying stable? (is he on the growth chart at all?)

Also, I thought preemies, like yours, were always "playing catch up" until 2 or 3 years old??? That's what I've heard. So your son's "adjusted age" is 14 months. How does his weight look on that growth chart? Better?

Kids weight gain typically slows down dramatically after 12 months old and they will "eat when they're hungry". As long as a health issue is ruled out, I think you should shelve the push for extra bites if it becomes a struggle. It will only stress you and baby out. Offer food and hope he takes it.

I would go the more traditional route of healthy foods, just increase quantitiy to add weight. Another option (I've struggled with poor weight gain all my life, for health reasons) I really like Scandishakes. If your son drinks milk or milk shakes, try Scandishakes for extra calories. 8oz of whole milk, plus one packet of shake mix is 600 calories and 32 grams of fat. Good stuff! And tastes good too. There's also Scandical. It's a powder that has no taste or odor. Add it to your son's favorite meals and it boosts the meal by 35 calories for every tablespoon you sprinkle on. He won't even know it's there! The company that makes all these is Axcan Scandipharm.

Good luck.

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Is food really an issue or is it a control issue about protecting his airway or protecting his mouth? It sounds, from what you describe like one of your twins has some general oral aversion. This _is_ realated to being premature- but more to what gets done to preemies in the NICU than a biological need. I see oral aversion in kids who have difficulty breathing/chewing/swallowing as well as those who have had invasive oral procedures. Consider going to see the nutritionist, good nutriton is always a plus. I would also consider getting an appointment with a occupational therapist (OT), or in some areas, the speech therapist (PT) covers oral aversion.

Warmly,

C. BSN, RN

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Oh I really empathize with this. I think the focus should be on nutrition though and not just eating more food. I give my son a particular protein shake as it has pharmeceutical grade protein, amino acids, pro-biotics for a healthy digestive tract, live enzymes, minerals, essential fatty acids and basically all the nutrients the body requires. He is naturally thin and very very active. He does not like proteins except for beans (and rice). I started giving them to him when he was 2 and now he is just turned 4. He loves them. I give him 1/2 of the regular adult serving and add fruit and ice and some apple juice which I know adds sugar but he really loves the shake and I feel like as long as he has one a day he will be okay. I also give him bars from the same company but I would wait on those until he is really chewing and swallowing foods. Maybe when he is 3. They are really quite good. I have a shake a day too. Call me at ###-###-####. I can give more info.

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How under weight is he? I'm with you about not force feeding. I would also think that he is possibly burning the calories he is getting from being so active. My son just turned 16 months (25.4lbs) and weighs less then he did at 12 months (27-28lbs) because he became very active he actually lost all the way down to 21lbs. I don't believe in adding junk food like Mc Donalds or cooking with fats and oils because this will probably be given to your other son who doesn't need it. I would probably wait for his follow to see how his blood work came back. As adults we are all different shapes and sizes and we all eat different amounts and have a different metabolizm.
As for getting him to eat, I would find something he really like and make it available to him so he can eat whenever he wants to eat. I keep cheerios out for my son to snack on because every time we sit him down for a meal he falls asleep and doesn't eat what is on his tray. Good luck, hope you find something that works.

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Dear H. D,
Have you tried pedisure shakes. My daughter still has a problem with eating and she's 8 years old. We switched to 6 smaller meals instead of 3 big meals and 3 snacks a day. With her being diabetic she has to eat to help prevent lows and for about 6 months we barely got her to eat anything. Anytime she ate more than a snack amount she would throw up. Causing acid reflex which she had to take maeds for. They give the nutrional supplement that he is lacking and it should help him gain weight. They all kinds of different flavors, Chocolate, Banana, Vanilla, Orange Cream, etc. We have since switched her to Glucerna Shakes to help better manage her diabetes.
Also give vitamins. We get 240 count at Costco for 9.00. With 2 kids it lasts us about 2 months to 2 1/2 months. 2 vitamins a day for my kids they are 8 years and 5 years. The force your child to eat new things. Introduce things slowly. Have you every tried making a chart of what he does like to eat. Get Velcro, poster board, Pictures of what he likes to eat. Make a board of pictures of what he will eat and let him choose what he wants. It's called picture communication. Let him help you make it or retrieve the food he wants. It will give him an insentive to want to eat. Any questions please e-mail me at ____@____.com... M. Petersen

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Carnation Instant Breakfast with whole milk will add about 340 calories to their diet. For my son I would use the chocolate and then some hersheys chocolate syrup to make it really chocolately. The kids also love the vanilla.

I would buy the nutritional drinks (Ensure or pedia sure) but the carnation is a lot cheaper and tastes better. The nutritional drinks for weight gain run $6.00 and up per 6 pack (for the store brand) and I buy the carnation at sams club for $6 for 22 packets.

I looked at the nutritional information and it is about the same on both, but you get more calories with the carnation.

If you could get your baby to drink one cup at each meal you will add an extra 300 calories per meal with the carnation alone.

I have a 9 y/o that was diagnosed as failure to thrive and he was able to put on about 5 pounds in a couple of months.

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I agree w/not force-feeding him....it will just cause a battle of the wills, frustration for both of you & also possibly some serious food issues. I understand if you want to fatten him that you'd give him the foods he likes but this could make him an even pickier eater so you should try to offer new foods along w/his favourites. We had a friend who's son was a very picker eater as a toddler so they only gave him what he liked & at 6.5 years old, they still struggle to get him to eat anything new. Like the other moms suggested, try giving him Pediasure shakes or similar drinks. But, really, all you can do is just give him the food & hope he eats more. Hopefully, the doctor will have some suggestions on your next appt. Good luck!

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Underweight is not always BAD so don't be to concerned yet! Wait to se what the Dr. says about the bloodwork and all that stuff firts! And your right about the force feeding thing too! He may just need to gain a few pounds and be just fine. For me.. rather that change the way I cook for the family (adding fats/oils etc. I just faound something to give to my son that was easy to stop giving when he didn't need it any more. Have you tried any of the drinks like pedasure(?) or anything like that? It comes in all different flavors and you can blend it with ice or freze it for a while to make it kinda icee. It has been a few years (like 10!!) but my oldest son had the same problem and we had to do that with him. Try giving him something like that as a "treat" "milkshake" whatever you need to call it to get it in him!! all it is is extra callories and vitamins and it seemed to work for my Alex. He is 13 now and plays football for one of the middle school teams here in town. He is still really small!! 13 years old 4'7" 80lbs but he can hang with the big kids ;) Good luck with your little man!! Tiff

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