Thanks.

And I would go away from the "first opinion", if possible.

This is serious and can cost you a lot of time, aggravation and
money. The worst case can be even worse than that, like some nutbag
CPS worker taking the kid away from you to some freak foster parents,
etc, weirder things than that have happened.

Obviously Dally's son's health deserves a serious look, but, without
undue suspicions.

*IF* the doctor is already insisting on a followup visits, raised the
issue of neglect etc, remember that he is a mandatory reporter and
MUST report any suspicious activity that MIGHT be an indication of
"child abuse".

If that is the case, it is high time to gather all kinds of
documentation, photos of your cupboards, his and his siblings medical
history, etc etc etc, so that it is available on a short notice if a
need arises.

i

Hi -

I'd recommend that for a week or so, you keep a comprehensive food diary
of both what you offer your son (including measurements of amounts) and
what he actually eats.  Include whatever steps you take to try to
increase his intake, and whatever steps HE takes to get you to stop.

Then, the next time you see your ped., show it to him and ask what he
thinks.  Ask if what you're offering is appropriate, and what steps, if
any, he thinks you should take.

The purpose of doing this is to both alleviate your doctor's suspicions,
but also to see if there are any patterns that suggest an actual medical
problem (as opposed to a genetic tendency to slenderness).

My two cents,
--Beth Kevles
 bethkevles@aol.com
 http://web.mit.edu/kevles/www/nomilk.html -- a page for the milk-allergic
 Disclaimer:  Nothing in this message should be construed as medical
 advice.  Please consult with your own medical practicioner.

NOTE:  No email is read at my MIT address.  Use the AOL one if you would
like me to reply.

Dally, I don't have children of my own but I do understand that this is
a bad situation.  I mean, you are trying to provide your kids with a
healthy diet/lifestyle and there is all this pressure to just dump
calories in.  I have been trying to come up with some calorie dense food
that he might go for.  You already have peanut butter.  How do you feel
about dried fruits?  Fruit and nut trail mix?  I'm sorry, I wish that I
could offer more suggestions.  It does sound like he's just slender and
that the doctor is likely overreacting.  Have you followed the recent
stories about parent's not recognizing that their children are
overweight?  Maybe your son's doctor has seen so many overweight
children that he is overreacting to a slender child who is healthy.

Well, with a new doc, at least, you could avoid mentioning any of your
recent dieting experiences, and relay this story as simply a concerned
mother.

I would say that there are two priorities, in no particular order:

1. To avoid state involvement
2. To ensure that your child is in good health

(duh)

If you can go to a new doctor whom you could present with a good case
of your home environment (take other kids with you, maybe except
DD13, show pictures etc), not mention your diet -- maybe you'd do less
of defending.

At this point, having proof of your good parenting is a necessary
precaution.

Internally, that's something that always needs to be done, yes.

Is there something that you can do, that is sane from a dieting
perspective, that you know you could do to make him grow faster?

If there is something of that nature and you do not do it, then,
there is a grain of truth to the doctor's suspicious. Obviously, you
come across here as a concerned mother, so it is unlikely, but it is
always worth thinking about.

Absent concerns about CPS involvement, as a parent, I would search
quite a bit for possible tangible reasons why my child was as small.

Understandable. Mine was tested for allergy (2 vials), and also was
screaming bloody murder. The good news, the allergist was effective in
making suggestions for not giving him nuts and for body lotions to
alleviate his ecsema like condition.

Do you have a choice about him not going to any doctor? I am not sure.

I am not a doctor, but, can you try to look at this issue from a
decision making perspective?

Do you have a choice about him not being seen by doctors?

If not, can you choose a more palatable doctor?

As for his health:

Is your child getting sick too often?

Is his mental development proceeding normally?

Does he look pink and not too pale?

Is he an active child like all other children of his age?

Does he look like a happy child?

Is his hair thick?

Are his nails good looking?

Is he hungry at some times and not getting nutritious food right then
(full of carbs and fat and protein and nutrients)? For example bread
with PB or franks.

I am sure that you can think of more questions like that. If he
appears to be healthy based on these answers, then maybe you could
really say that it is all his genes, and try not go to a doctor if you
can, there is risk to further doctor visits that is of non-medical
nature.

I would not be in a hurry to decide on this unless you examined his
health thoroughly.

Well, you know that can be changed easily. He is 5 years old, can you
give him access to other food? make little sandwiches for him that he
could grab from a lower shelf of the fridge? Let's say you would cook
5 tiny franks in the morning, and make a few cookies with PB on top,
and put it in the fridge someplace?

Sounds like a good idea, that's how we feed fruit to our kid.

At the age of 5???

He cannot get his own food???

I thought that there was someone home all day at your place, can that
person take some initiative?

I can relate, although we do not do it except with farmers cheese
where we add sweet yogurt.

My opinion only, I would make him completely exempt from your meal
schedule and rituals and whatnot. Have some alarm clock that would
ring often and offer him pieces of food then.

As for going to a doc or not, I am not sure if you have a choice of
not going.

Try analyzing the situation thoroughly...

Is it a must for Sammy to be seen by a doctor?
  IF YES

     - Find a better doctor

  IF NO
     - try to evaluate his health based on objective criteria. Is it
good?
       IF YES
          Avoid going to doctors
       IF NOT
          Find a better doctor

Can his feeding be improved to suit HIS needs? If yes, feed him
differently and forget the need to have everyone at dinner, etc.

i

I think sugar is not very helpful.   He needs nutrient dense
foods and energy dense foods.

A food is nutrient dense if the vitamin and mineral
content is more than its energy or calorie content such
as lean meats, beans, oranges, carrots, broccoli,
whole-wheat bread, and whole-grain breakfast
cereals.  

Energy dense foods contribute more calories than they
do nutrients such as chips, sodas, cookies and ice cream.  
Remember to balance healthy nutrient dense foods with
energy dense foods.  

http://www.keepkidshealthy.com/welcome/conditions/failure_to_thrive.html

Here are some examples of weight gain strategies:

Provide small frequent meals with nutrient dense foods
and energy dense foods and drinks.

Add fat to foods such as margarine on mashed potatoes
and toast, mayonnaise and cheese on sandwiches.

Offer whole (not reduced) fat products such as whole
milk, cottage cheese, cheese, creamed soups, pudding
and yogurt.

Add calories to foods such as canned fruit in heavy
syrup and vegetables with cheese sauce.

Children who skip breakfast eat less calories and
nutrients than those children who eat breakfast.  If there
is little time for preparing breakfast, choose foods that
are easily prepared or are ready-to-eat such as yogurt,
fruit bars, milk and leftovers.

Too much juice in the diet often replaces milk and
other important food groups because the child has
become too full. Juices often contain more sugar
and less vitamins than fresh, canned, or frozen fruits.

One thing that you may be able to do if he drinks milk
is to add powdered milk and/or heavy cream to the
milk or to make smoothies that are energy dense.

Children may also have failure to thrive from having
an increased requirement for calories, such as from
having a chronic infection, hyperthyroidism, congenital
heart disease or chronic lung problems.

Another possibility is physical abnormalities that
cause difficulty swallowing (dysphagia), such as
neurological disorders including cerebral palsy,
trauma to the mouth, congenital abnormalities, or
disorders with motility or movement of the uppger
gastrointestinal tract (such as achalasia).

Some advise from pediatricians include:

To make mealtimes easier and maximize the chances
that your child will eat, you can:

* avoid trying to force or bribe your child to eat.
Turning meals into a power struggle usually doesn't
help and may make your child more resistant to eating.
* Have a schedule for meals and snacks, which should
include 3 meals and 2-3 snacks each day of high
calorie foods with lots of nutrients (see below).
* Allow your child to feed himself, especially finger
foods, as much as possible.
* Only offer liquids, especially juice, after the meal.
* Avoid large amounts of juices, sodas, or water. Offer
milk or formula, which have more calories and protein,
instead.

A Pediatric nutritionist can also suggest ways that you
can provide your child with more calories by offering
high calorie foods that are high in protein with lots of
nutrients, especially since he will need additional
calories to help him catch-up with his growth, including
(disclaimer: only use these suggestions for increasing
the calories that you are giving your child under the
guidance of your Pediatrician or a Pediatric nutritionist):

* avoid junk foods, such as candy, which may have
calories, but are usually low in protein.
* for younger children, under the direction of your
Pediatrician or a nutritionist, your infant's formula can
be concentrated to provide more than the regular 20
calories/ounce.
* for older children, over 12 months of age, instead of
milk, you can offer Pediasure, which has 30 calories/
ounce (vs 20 calories/ounce for whole milk) 2-3 times
a day.
* or mix whole milk with a packet of instant breakfast
powder (adds 130 calories) or dry milk powder (adds
33 calories per tablespoon) to increase calories.
* when baking and cooking, substitute whole milk,
half and half, evaporated milk or condensed milk
mixed with dry milk powder for water or milk.
* for high calorie snacks, offer milk shakes made with
a cup of whole milk, a packet of instant breakfast powder
and a cup of ice cream blended together (can provide
over 400 calories).
* pudding can also provide a lot of calories if you add
1/2 cup of dry milk powder to the milk and instant
pudding mix.
* add cheese as a topping for sandwiches, vegetables,
etc.
* use peanut butter (about 100 calories/tablespoon) as a
snack and as a topping for vegetables, crackers, and
fruits or blended with milk, ice cream or yogurt
* make a high calorie fruit snack using fruits canned in
heavy syrup, add sugar or yogurt to fresh fruit or add
a packet of instant breakfast powder to strained fruits.
* make high calorie jello by substituting fruit juice for
water in its preparation
* serve meats and breads with added butter, margarine,
gravy or sauces
* serve fried foods, such as fish and chicken and add
breading or flour before cooking

--
Dorothy

There is no sound, no cry in all the world
that can be heard unless someone listens ..

The Outer Limits

<SNIP>

I would, personally, allow him to graze. Little ones have little bellies. If
you could have canned fruit along with fresh available, he can have a little
bit without you having to spend the whole day peeling and dicing and
whatnot.

Good advice.

This is a mistake in the long run IMO. It sets up a couple of things, one
the feeling that there is something wrong with the food you gave him in the
first place. And also the sense that there is something wrong with HIM or
something wrong about the act of eating that requires a dancing routine to
get him to eat.

Which is a cycle that will take some time to break. Does he have some drop
dead favorite foods which are less "jink?" I would do, and even can say have
done is this.

- New rule, even if you cannot tell your son, you know your new rule. No
meal fuss, no nagging to eat, no bribery.
- Offer stuff he likes exclusively at first and follow your rule. Add
grazing into the mix if you can. Add a flinstone's.
- Lessen intake of filling in between fluids if that is an issue for you.
- Continue to offer stuff he likes for  awhile. On my son's list would be
mac and cheese, crilled cheese sandwiches, pizza. Not bad food, but not the
best either.
- Slowly start bringing out other stuff. No bribery, no nagging. Place it in
front of him and allow him to control.

Just my opinion.

    I rather expect this is a very large part of the
equation.  I don't know if there's anything you can do
about this (some kids really just don't sleep, but in
other cases there are things that can be done to encourage
them to sleep more), but I would probably try working
the sleep side if possible.  Kids do virtually all their
growing while asleep.

Best wishes,
Ericka

Ya know what - DH and I were talking about this thread last night.
And something I recalled.

When I was 5 yrs old, I only weighed 24lbs.    My mom always talks
about her "little peanut" as I was so small that I was wearing 2T
clothes, size 1 shoes and only weighed 24lbs.

Little kids happen.   And if that is part of your family heridity,
they so be it.   It happens.   You certainly dont' starve your kids,
you give them heathy options to food.  You shouldn't have to force
feed your child and sneak in sugar and other calorie dense foods just
to get him to gain weight.

Understood. I pack DD fruit, raisins, "moo-tubes"
(tube yogurt), fruit, jello, or pudding cups,
peanutbutter- or cheese-filled crackers--foods that are
portion controlled, manageable by little hands and
tummies, and provide some nutritional value. If she
eats, that's great, if not, I assume she wasn't hungry.

Don't beat yourself up, though. As long as there are no
medical issues, then let the boy do as likes. Children
do not (normally) starve themselves, and they're
probably better at knowing when they're ready to eat
than we are.

Good luck!

Amy