My 21 month old weighs 18lbs 4oz.

[Angela77]

Hi,
My 21 month old daughter weighs 18lbs 4oz.  Her height is 23 inches and her head circumference is just below the 50th percentile.  In 3 months, she has gained one pound.  She eats very typically and her urine and BMs are normal  All other areas of development:  language, cognition, fine and gross motor skills, etc. are normal.  As an 18 month old, I was diagnosed with renal tubular acidosis.  At 15 my daughter's doctor did bloodwork and everything came back normal.  I am concerned that my dr. may be missing something given my daughter is so low on on the weight chart and not gaining as other children my daughter's age with a similar profile.  What other conditions could attribute to such a low weight.
Thanks,
Angela

[Deanna L Aftab Guy, MD]

Her height and weight are both below the curve, I would look at her growth curve with your pediatrician, if she has maintained a curve just below her whole life then monitor her, but if she has fallen, in particular with height I would indeed pursue things, check a blood count, electrolytes and urine(you have history of rta-easily treated, often missed), celiac antibodies, thyroid etc.
Then have her weighed and measured about every 3-4 months at the pediatrician.
Assess her diet, consider adding a ton of fat as you can, butter anything she eats, dips with whole yogurt or sour cream, butter pasta and in sauce.
If she is not milk intolerant these things will add weight, making for every bite 2 times the calories without forcing her to eat more volume.
Lastly a sweat chloride test is often needed to rule out cystic fibrosis-rare and unlikely but important in a child who is not gaining weight.
Work with your  pediatrician but be patient and monitor together closely.

[MommaSharon]

Are you and the child's father small in stature or thin?  Sometimes children's growth reflects the growth of their parents.  What does your dr. say?  Sometimes we over think what may be wrong with our children.

[Angela77]

I already do the carnation but will try the half and half.  My daugher loves ice cream and eats it often.   You made an interesting point about some kids needing more calories.  I feel like the chef Paula Dean adding butter, fat and cheese on everything but I know that is a way to get the extra calories in.  Thanks for your comments and advice.

[Rachelinpain]

I have a child who will be 3 in march an just passed the 20 pound mark.  She has had every test known to man including surgical procedures and there is no eplainathion for her small stature.  She is adopted so I do not know about the size of her parents but ever since birth she has been small.  She was born full term but only weighed 5 pounds so she had IUGR.  She has only been ON the growth curve once at about 12 months I think and then fell off, we have been seen by a specialist since who monitors her every few months.  Every time I see him he mentions putting in a feeding tube, but would really like to wait it out until she is 3 or 4 and see if she catches up.  As long as she continues in the upward direction, no matter how small, he has agreed to hold off on the tube.  She is a slow gainer, but every gram counts.  I would definately get a good specialist to follow her and make sure she has gotten worked up appropriately.  As long as she is not sick or does not loose weight I would not be too concerned.  Use your instinct.  If she is healthy then she is safe.  I have been working with a nutritionist as well for her.  Some kids just need more calories and eventhough she may seem like she is eating adequately, she may not be getting enough calories for her needs.  What has worked for us is using carnation instant breakfast to fortfy all of her milk.  She gets 3 glasses of milk a day (I use 3 oz half and half + 3 oz whole milk + 1 packet of carnation-for breakfast-at one point this was with breakfast and lunch).  Also making her smoothies using ice cream and fruit work well too.  Just make all of her calories count-peanut butter, cheese sauces on her vegetables, etc.  My nutritionist said if it has butter, fat or cheese and you can added it to what she eats then go for it.  Obviously you have to still incorporate her fruits and veggies but just stick with higher calorie choices like bananas and carrots, etc.  Hope that helps.  Hang in there.  I am sure she will do fine.  

[Angela77]

Thanks for the tip about the urine.  I was really at a loss as to how to get the sample.  I will talk to the dr. office about getting one of the bags you described.  I am a special ed. teacher (ABA) and my instinct is to look at the data.  I want to montior progress and see the trend line.  As long as she is growing, I am okay with that.  You gave me some useful information in terms of what to look for and questions to ask.  I am very appreciative of your input.

[Deanna L Aftab Guy, MD]

To collect urine in an infant there are sticky urine bags that they can put on her, with a corner sticking out of the diaper to see if she has urinated(a trick my nurse uses). You can go and get the bag at the doctor's and place it at home or have it placed at the office and bring a big sippy cup to guarantee a few drops of urine. I am very confident that she is following the same curve, she has lots of time to be followed and see how she does. I agree, keep monitoring. You are a good mommy.

[Angela77]

Thank you for your reply.  My daughter's blood was tested and everything was normal.  I am not sure how to get a urine sample from a child who is not potty trained.  The data on her growth charts are consistent and growing, just at a low percentile.  Its like she is making her own curve at the 0-1 percentile.   I am glad you gave me some guidance for some questions to ask.  I just took Sammy in for a weight/height/head circumference check the middle of Jan.  Her next appt is the 1st week of May for her second birthday.   I know I have to be patient.  I just hear from other mothers what a peanut she is and people compare her to other children who are so much bigger than her and younger.  It is difficult to hear.  I have to keep telling myself that she is exhibiting no other symptoms than a low weight.  I think it would be wise to keep monitoring.  Thanks again for your response.  Angela

[Angela77]

Yes, I am small in stature.  I am 5 foot tall.  I was always called petite.  I was on the smaller side in terms of weight until I had her.  Still trying to get those extra baby pounds off.  The dr. says, and I quote, "You have a normal baby who doesn't weigh a lot."  Her dr. is our dr. and has many babies and children in his practice but is not a peditrician.  We chose him because he has always been an observant and proactive dr. in terms of my and my husband's health.  Thanks for your comments.  I have never been on one of these types of sites but Sammy's weight has been a concern of mine.  I am just afraid we might be missing something that is interally going on that presents no other symptoms than being low weight.