Last week I posted about a child put in foster care because the parents refused to follow medical advice to fatten him up with junk food. When experts also failed to increase his weight, the authorities admitted that the parents weren’t the problem and the family was reunited.
Over the years I’ve encountered many toddlers who did not eat or gain as much as they were supposed to. Before getting concerned, ask the following questions:
- Is the child really underweight? As Ingathered learned, older growth charts are based on bottle-fed babies. Breastfed babies are expected to gain 2.5 times their birth weight by a year, not triple like some charts indicate. Children at the 5th percentile are generally not underweight, just small compared to all healthy children their age.
- How much is the toddler really eating? Toddlers have small stomachs. Breastmilk and formula are high in calories and may not leave room for much more. Growth slows down in the second year so a toddler may eat less than a younger baby. And parents who record what a child consumes throughout the day are often surprised by how much is eaten. Toddlers are known for having irregular appetites.
- What do the parents look like? Babies follow two distinct growth patterns. For the first six months or so, they follow the growth curve of their birth weight. So babies born large continue to measure at a high percentile. Between 6 and 12 months, babies switch to a curve closer to that of their parents. Sometimes a drastic drop in percentile can be a normal leveling-out to match a genetic growth pattern. I learned this when my daughter dropped from the 90th percentile for height to below the lowest line on the chart, holding that position for many years. I remember being very short as a child as well.
- Is the baby happy, healthy and developing normally? Look at the whole picture, not just numbers. An active and good-natured baby is a strong indicator for overall health.
- Is the child gaining slowly, or is he failing to thrive (FTT)? It’s important to know the difference. Slow gainers stay on a curve, while FTT babies gain erratically or lose. Slow gainers have good skin and muscle tone, are active and alert, and meet developmental milestones. A good doctor can tell the difference.
- Are scales accurate? Always use the same scale from one weighing to the next, as differences can be significant.
A word about breastfeeding toddlers: I don’t believe in delaying solids much past six months, but a small number of breastfeeding babies are not interested and do well on breastmilk alone for a year or more. If the child is happy, healthy, and gaining weight, there is no reason for concern. In fact, starting solids too early can lead to poor weight gain.
Dr. Jack Newman tells of a child who ate only jello and breastmilk. The mother was told to wean so the child would eat more solids. After weaning the child refused everything but jello. Breastmilk is high in calories and has antibodies to fight illness. Weaning will not help a toddler gain weight.
I believe we have to trust our children, and our instincts. A healthy child will eat as much as he or she needs. A child who doesn’t is sending some kind of message. I have known many children who did not eat as much as their parents or health providers thought they should. They outgrew it.
Sometimes, even after the issues above are resolved, there is still concern. Reasons for poor appetite, rejection of solids and low weight gain include allergies, reflux, celiac, abuse, sensory issues, anemia, and illnesses such as cancer or cystic fibrosis.
An excellent and humorous resource is Dr. Carlos Gonzalez’ book, My Child Won’t Eat.
If you enjoyed this post you might also like:
Four-Part Series on Feeding Babies Frugally (at CookingManager.Com)