Underweight/slow Weight Gain Toddler

Updated on March 14, 2013
R.S. asks from Chicago, IL
10 answers


I took my 19 month old for a wellbeing checkup today and, as I figured, the doctor said I need to increase his calories and even suggested putting him on formula 4 x a day, saying it was higher fat than cow's milk. I went through this with our daughter, who was petite and slow to gain weight. She is now 3.5 and is a perfect weight for her height. My husband and I are both petite so we're not going to create big babies...so part of me just wants to totally ignore the doctor's advice. My son is definitely petite but he's well-proportioned and does not look malnourished or scrawny whatsoever. He is just very slow to gain, like our daughter was. Right now, he's 20 lbs, 7 oz, and wears a solid size 12-18 month in clothing. I just stopped nursing him 3 weeks ago, he drinks milk and water, and eats many foods. He has yet to eat pasta or meat ---but what he does eat, he eats well and often in good sized portions. As he gets older, I'm sure his repoirtoire of foods will expand...and honestly, I cannot force him to eat things he doesn't want. I guess as a mom, nobody wants to hear that a child is underweight...oh, and to make it worse, I noticed he put the diagnostic code "failure to thrive"...I was so annoyed by that but the nurse said it's routine for any child who is under the chart.

So, anyone else have a petite little one? Am I right to just let it go...knowing he's perfectly healthy and knowing that genetics-wise, we have small kids, and that's normal for us and perfectly okay??? Or, would you go running to buy the high-calorie formula?

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answers from Chicago on

I understand how you feel, both my kids are slow weight gainers and weighed 20 lbs at 2 years. I was more concerned than my doctor. She said as long as they were still growing, there's no need to worry. My parents told me that my sister and I were the same way so I am more relaxed. Both kids are fine, still on the bottom of the charts, but happy, healthy, and very active.

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answers from Santa Fe on

I had a chunky little one who took after his dad. And now I have a petite little one who takes after me. I know she is perfectly healthy just like I was...she will just always be skinny. My mom was a skinny kid - it's just genetic. Her doctor was so worried that he prescribed she drink 3 chocolate malts a day. My grandma could not believe it but did it. Guess what? They did not help her gain any weight! My mom is now a very skinny 70 yr old. I'm a skinny 42 yr old and my daughter is a skinny 3 year old. Some people just are this way. I drink whole milk as an adult and I love butter. I ate high fat cooking growing up and I ate a LOT. I'm more healthy now but I still believe in eating fat. I think you could feed him a well balanced diet with plenty of fats but he probably will stay petite if he is just genetically that way. Do your best though...avocado, pudding, cheese, bacon. I found that cooking tiny cut up cauliflower in bacon grease and then putting in bits of bacon in it is delicious! My daughter loves brocolli with a sauce to dip it in that is half mayo and half mustard mixed together. She also loves dipping things in sour cream. Breads, baked goods, scones made with lots of butter! Lasagne, homemade chicken pot pie, mashed potatoes made with cream cheese and butter and milk. Refried beans, enchiladas, full fat yogurt. Roast a chicken and make a nice gravy with the drippings to serve on his rice. Yum! Make his carrots with some butter and brown sugar. Anyway...if he is like the people in my family are this will not help him to gain all that much weight.

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answers from Dallas on

I have a bit of experience with this. The same thing happened with my son. He was born the 95th percentile and fell off the chart by his 9 month check up. Since the fall was so fast, everyone was concerned. We started out with some testing. And after a bad experience at the hospital, I decided to stop testing until there was a reason to. Our son was tiny, but he was an early walker, not lethargic, never sick, etc. Except for that failure to thrive label, he was fine. The doctor reluctantly agreed. We did up his calories. Butter added to some veggies and fruit (we did this in unpredictaly so we didn't form bad habits). Offered extra snacks. Lots of meat, protein and avacados. Meat sticks and Vienna sausages were a staple. We dealt with it for months. In the end, milkshakes made with pediasure helped pack on the weight.

When our daughter came along, she did the same thing. Her weight dropped off at about 10 months. Again, it fell fast (possible related to walking???). This time the doctor said that we had a family history and that he wouldn't run any tests, beyond checking her blood sugar, until there was a indication tests were needed. We were still encouraged to add calories. Which we did. You can google it to see the problems that can arrive from underweight kids. But our pediatrician also said in our daughter's case, that we weren't necessarily going to worry about her percentage on the chart. He was going to worry about the curve on the chart. As long as it continued to go up, he wasn't concerned. It did and now at four, she is perfectly average.

I don't know that I would run out and buy high calorie formula, but I would still work to up the calories. There are lots of tricks that you may be a bit more comfortable with doing. I wouldn't be anxious, but I would be proactive.

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answers from Phoenix on

Since he's not eating a well rounded diet, I would swap milk for formula like the doctor suggested and focus on providing him with all types of food. Not sure if you only offer certain foods or if he just selectively eats what you give him. If you're limiting what you offer him, stop now and give him what the rest of the family eats. He needs well balanced meals loaded with protein, fat, fruits and veggies to grow.

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answers from Albany on

More Dr's need to base their concerns on the child's development and types of food they eat rather than size. I too have 3 petite children! My 7 year old daughter was born at 7 lbs 3 oz, but slowly fell off the charts and didn't fall back onto the charts until she was 4 years old! She always ate well, slept through the night at 2 mos. even though she was nursing, hit all of her developmental milestones early and was thriving... just tiny. She was 18 lbs at 18 mos and 20 lbs at 2 years. Our pediatrician was very honest and down to earth. She said that there was no reason to be concerned as long as she ate a variety of foods and was developing normally and seemed happy and well ajusted. She said if we were concerned we could add healthy fats such as olive oil and peanut butter to her foods. But,I am petite, so she always just said, "it's genetics and somebody has to be in the 1st percentile!". I knew someone who went to the same pediatrician whose baby was the same age and size who the Dr. was concerned about, but there were other reasons (she wasn't hitting milestones and barely ate a thing)- it was more than just being little.
My daughter is 7 now and weighs barely 42 lbs., but she is healthy and active. My 21 month old weighed 20lbs and her 18month apt. and she seems big to me! Ha! Sounds like your child is just fine. And, one bonus we had with my daughter is she didn't outgrow clothes so fast!



answers from Houston on

Sounds just like us. Both parents small. He was a small baby (6-3 at birth)My mother's brothers are over 50 and still have the highest metabolism that I could even imagine. (Seriously, it's crazy how they have NO inches to pinch, just skin over lean muscle over bone.) When the substitute doctor used that "failure to thrive" label, I had a fit! I told them that he IS thriving...happy and energetic and eats good foods!! They wanted me to have him tested with a GI. I called to find out what that entailed and said no, thanks. I wasn't putting him through that when he showed no signs of beign deficient. He nurses (26mo) and takes his vitamins. I take vitamins. He drinks soy milk and soy formula. He eats the hell out of hamburger pizza, sweet potatoes, flour tortillas, chicken, spinach. He just started liking oatmeal a couple of months ago, so that's a good filler. And he will not sit down!

Dairy is bad in his body. He does not eat sweets, because I don't think that it's necessary. (He can eat oatmeal cookies when he and my mother make them, to taste the fruits of his labor, but just for the hell of it? Nope.

We did sit with a nutritionist, just to get some tools for making sure that his diet is balanced and he is getting everything he needs. I decided to offer him something just about every hour. I think that he weighs about 21 pounds, and his mind is sharp, sharp. Last night he was making my husband and me chase him around the sofa, and when we stopped, he kept going.

I can't tell you to "let it go" because I'm not there, but I get it. How I handle it is a choice that I make every day.



answers from New York on

Since he is not even on the chart, I would be concerned. When making food, add extra butter, coconut oil, or olive oil. You can also give him light cream to drink if he will drink it and well as bread and pasta. He can also eat pudding that you can make at home with cream. Sorry, but you need to fatten him up. If he gets sick, he could lose a lot of weight and become very ill.



answers from Washington DC on

Is he on his curve? I'm not sure why he's suggesting formula vs milk. There are many ways to add calories with good food. If you are no longer nursing but he's not eating well, I would try to give him superfoods - foods that will give him the nutrients he needs in small amounts. If he won't eat meat, will he eat beans? Can you add butter to his food? Etc. I wouldn't get the formula til you've tried other things. Especially with the genetics in the family.



answers from Chicago on

Years ago, my older son, who throughout his childhood was "small for his age" was, at times, off the bottom of the charts. But like yours, he was healthy, and the doctor confirmed his height and weight were in sync with each other. I think the biggest concern is when a child weighs significantly more or less than he/she should for his/her height. Then medical causes need to be considered, diagnosed (or ruled out) and treated. For my son, since there were no medical issues, we did nothing. It sounds to me like you're doing everything right here; don't turn food into an issue with your child or you could have long term problems. If it ain't broke, don't fix it.



answers from Chicago on

my daughters are now 10 and almost 14. We are so happy to say that the 13 3/4 yr old is ALMOST touching the bottom line of the growth curve for her age! She is almost 75 lbs, which is the average weight of a 10 yr old. The younger one is a bit heftier at the 25th percentile for her age, weighing in at 64 lbs. She's bulked up this past year.

both of them were diagnosed failure to thrive, but the new term is failure to gain weight since they ARE thriving (happy, able to play, good skin tone, etc.)

At this age your son should be eating all four food groups, and meat is a good bulk-er, but nuts or hummus would work for that too.

With our first we freaked out. Now granted at 18 months the endocronologist (sp?) didn't tell us how valid our freak out was til we went back 4 weeks later and he told us that she had been in the latter stages of starvation. Apparently she no longer had fat pads on her toes or fingers at that point. Her hair also had gotten brittle. I'm still angry that he didn't admit her since she literally could have just died on us!

She was tested for celiac disease, CF and many other things. The celiac was inconclusive so we had a biopsy done. It was clear but at 10 we repeated the blood test since when it was done as a toddler she had not eaten grains (on her own choice) very often. She did the barium swallow and so many blood tests. Some came back ok, others not, but then the next test would be that thing ok and a different thing wrong. I hope that you have had those tests done because sometimes it IS due to a real issue. Finally the diagnosis was a super high metabolism, and we had her eating the fattest foods and drinking a "weight gain cocktail" which is 1 cup milk, 1 cup heavy cream and 1 packet Carnation Instant Breakfast.

I must say though that I think she was not born with a hunger mechanism. She didn't ASK for food till she was a few days shy of 4 years old. The thing that changed it for her was taking milk out of her diet. This also made her finally sleep through the night.

When our second daughter came around we weren't as freaked out. Even though she was almost oz for oz what the older one had been at each age she was MUCH shorter so she looked just fine, or at least not as bad. The docs thought we were crazy when we said she was so chunky, lol. She has always been around the 10 to 25th percentile but her height was not the 75th that her big sister was but more like the 50th.

My older daughter is having issues now that she is almost 14 and so skinny. Finding cool clothes that fit is hard. When she went to 6th grade and still was in size 13 kids shoes it was really hard for her to get non kiddy shoes. But overall it has not been a major problem.

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