My 2 1/2 yr old daughter is underweight

My wife and have reached a point where we are now very concerned about our daughter's (Laura) weight. This is a snapshot of her growth from birth to now:

Born 8lbs 5oz, 18.5"  
At 2 months she was 75% weight & height (11lbs 8oz, 23")
At 1 yr she was 50% both weight & height (20 lbs 8oz, 29")
At 2yr she was 22lbs 33.5"
Now, at 2.5yrs she is 45% height, <5% weight (23 lbs 35.5")

So, she seems is gaining weight, but not a rate to keep up with the growth charts.  If it wasn't for the growth charts, I don't think we would have any concerns.  She is developing perfectly well mentally and socially.  She does not look unhealthy, and is not often sick.  

She never eats a lot, but always eats some at every meal, and will eat a little of anything you give her.

Our pediatrician says he is concerned, and recommends that we "feed her more", including pedialite, ice cream, etc...  This sounds easy, but when she is done eating, she just doesn't eat more.  I don't want to make every meal a stressful battle of forcing her to eat.  Our doctor has not ordered any tests.

Three questions:
1)  What type of problems could the low weight cause?  
2)  Should we be concerned that maybe there is a medical problem causing the low weight?
3)  If it is just low calorie intake and high metabolism, how hard do we try to pessure her to eat more?

Thanks in advance,
Stephen & Liz

[Kevin Kennedy, Ph.D.]

Dear Stephen and Liz,

I won't address your first two questions, because our focus is on child behavior and it wouldn't be a responsible thing for me to speculate about possible underlying medical conditions.

If your daughter receives a clean bill of health, and you are faced with the task of increasing her food consumption in order to build her weight, I'd strongly suggest not engaging in battles or struggles about this. Let Mother Nature, for the most part, take care of it. You can increase her caloric consumption by focusing on what she eats when she is hungry, rather than trying to focus on her taking in additional food, particularly when she is not hungry.

If the pediatrician is concerned, but is taking no action around diagnosis of any possible underlying problem, it would be reasonable to pursue this a bit, even to the point of seeking a second opinion. When the doctor says he is worried, have you asked what he is worried about? What is he speculating might be the problem, if there is one? Sounds like you need to get back to him about this, if for no other reason than your own satisfaction that you're doing everything that is reasonable under the circumstances. Dr. KDK

[TSM]

If your child seems normal in all others areas, I would not worry too much. My 2.5 yr old son is only about 22lbs. All my kids have been skinny and tall. My husband and I were very thin when we were kids (painfully so in my case) so the doc says its probably inherited. If he's eating and gaining wt. however slow- I would not woory too much.

[Diane]

My son was born at 5.9lbs in the 10th percentile,  and I was always concerned about his weight...he did creep up to the 40/50th percentile by age five, but all through his toddler years, eating was a huge issue. You could count his ribs.  I feel like I made it worse by trying to force the issue, monitoring food intake, and in general, letting him see how it upset me when he didn't eat.  When my second son was born he went on a hunger strike for about four days, and I was in tears over it. He learned to use it against me.   I was finally given the advice not to go crazy cooking him two or three dinners in the hopes that he would eat something, but just let him eat when he wanted, but always provide calorie rich healthy food.  I held off switching him off of whole milk as well.   Since I've relaxed about it, and I've accepted the fact that he is just a lean child,  we've moved into a pretty acceptable situation.  He eats a lot of small meals.  Not all kids and babies are chubby, and certainly not all have baby fat to spare.

[Cathy]

I am from the UK and presume the Centile charts work the same way.

My first born weighed in at 6.5 lbs and though as a toddler had a very limited diet (his choice!) he gained weight well.  He moved between 9th and 75th centile and at 5 yrs old settled on the 50th.

My second born was 9lb born (both myself and my partner were 6lb babies and are average height & weight now).  My daughter will eat ANYTHING but in tiny tiny portions.  As a baby she fell 5 percentiles from the age of 11 weeks and seven months from the 90th to the 9th.

We tried everything with her.  Accelerating her diet (though we didn`t wean before 15 weeks) she ate little and often and high carb foods such as bread, avocado weetabix etc.

She started crawling at 5 months which didn`t help as she had activity levels of a 9 month old with the diet of a 5 month old.

It got to the point that the professionals were going to recommend tests for malabsorption and milk intolerance but all of a sudden at 8 mnths she began to gain weight.

Now at almost three uears old she is 33lbs.  Our GPs guess was influx (as she was a very sicky baby) combined with early physical activity.

My point here is that we sought advice as we were concerned about her lack of weight gain but in the end she sorted herself out.  To be honest, if it weren`t for the centile charts we would not have been concerned as otherwise she was very active, alert and in a lot of ways ahead of my son in development.  I am not saying disregard the centile charts, I am saying do not be blinded by them and look at the whole picture.

I hope this helps...

[Jane]

I would make sure your child is able to eat a variety of foods. Also is your child able to eat it without chlking.  Does it take a long time to "chew" food, etc? Some cyildren may not gain weight due to a feeding disorder.   In that case an evaluation by a speech-language pathologist would be a good idea.

[loveable_scarlet]

A related discussion, vomit when upset. was started.

[kirkirilouda]

A related discussion, Severely Underweight was started.