Question from Richa:
I have 2 boys – 6 and 1.5 yrs old. My older one weighed 6.5 lbs and has always been below 5th percentile. He actually hit 5th percentile this year. It was a struggle to feed him bottle when he was a baby and then solids when he grew up. He always prefers fruits over any other food although now we make sure he eats all his meals which includes milk, egg, rice, vegs, lentil etc. But he does not gain weight easily. Due to his low weight I feel he does not do good in sports although academically he is very good. He does not get sick too often, just like any other kid. His pediatrician once diagnosed him with low Vitamin D and low bone density. We gave him Vitamin D for almost 2 years. His eating has improved in last few years but he is still in 5th percentile and very thin.
My 2nd boy was born at 7 lbs but once we started him on bottle his weight is on downward trend too. It used to take me an hour to feed him one bottle of milk which other kids finish in 10 mins. He eats better than his brother but still falling below the chart. He weighs 20.5 lbs at 19 months.
I want to understand is there anything I am doing wrong in feeding them or are they genetically like that. Me and my husband both were very thin as kids and not anymore.
Answer from: Keith-Thomas Ayoob, EdD, RD, FAND, our contributing Nutritionist. If you want to learn more, please follow Keith’s twitter @KeithAyoob
First of all, it’s great that your older son is now at the 5th percentile because that’s showing signs of improvement. Nice job! I’m concerned that he had a low vitamin D level and 2 years is a long time to restore vitamin D levels to normal levels, so stay on top of this and have him checked regularly. Meanwhile, definitely make sure that he has at least two glasses of milk daily, and make them whole milk. That is contrary to usual recommendations for skim and 1% milk but the rules are different for your son because his needs are different. Typical recommendations are not a “one-size-fits-all” thing and should be tweaked to a child’s needs if necessary. Along the same line, to get a few more calories into a 6-year-old without requiring them to eat a larger volume of food, which they probably wouldn’t do anyway, incorporate some extra fat. It can be a huge help in situations like this, but do it wisely, in ways that encourage him to eat healthful foods he also needs. Stir-fry those veggies, top the broccoli with some cheese, use higher-calorie veggies like beans and potatoes, and it’s OK to add some butter or to fry them in vegetable oil. At snack time, if he can eat nuts and dried fruit, they’re super-concentrated with nutrition but also healthy fats and they’re a good source of calories in a small volume. Nut butters are also fantastic, so spread them on whole grain bread or slices of apples or pears for higher-calorie healthy snacks that kids tend to like.
Now, a word on his sports performance. It may not be due to his weight and I confess, your comment hit me a bit hard, because I wasn’t good at team sports either — ever. Some kids just aren’t. He may be better at individual sports (I was) or maybe he’s an average kid who should be encouraged to do sports he likes, so expose him to everything you can: swimming, track, gymnastics, whatever, and make sure the objective is for him to enjoy what he does.
Regarding the 19-month-old, he’s a concern. His weight is way below the 5th percentile. He may be 19 months old, but his weight is closer to that of a 9-month-old. While our pediatrician is correct that some kids are just skinny, this level of thinness needs to be addressed. First off, consider having his feeding skills evaluated. If kids have difficulty chewing age-appropriate foods and textures, swallowing, etc., then they’ll either take a long time to eat and get “feeding fatigue”, resulting in overall less consumption or they’ll tend to avoid or refuse those difficult foods, producing an unbalanced diet. Secondly, you mentioned bottles. If you haven’t already, get him off those bottle feedings as soon as you can. If kids stay dependent on bottle feedings they often will displace more calorie-rich solid foods. At this point, he needs solids first, then allow liquids at meals. Not sure what his length is, but if he is not growing appropriately, that certainly needs to be addressed, but if he is and he’s just thin, that can be OK but only if possible cause of underweight are ruled out. With this level of underweight, you my need more frequent visits with your child’s pediatrician for monitoring. A referral to a pediatric dietitian might also be useful. Meanwhile, I’d also add some extra fat to the foods he eats as well. Omit the nuts of course, but children under age 2 have a higher requirement for fat anyway, so even more reason not to limit adding extra fat to the diet of a thin 19-month-old.
Hope this helps!
Keith-Thomas Ayoob, EdD, RD, FAND
Associate Clinical Professor
Department of Pediatrics
Albert Einstein College of Medicine
1165 Morris Park Ave. 4th Floor
Bronx, NY 10461
718-430-3970 ext. 6412