toddler growth questions...

[5lilfish]

Taylor and Bailey are just about 2 1/2 (amazing!). Taylor has gone through a long struggle with constipation. After pushing the issue, I got a referal to a GI. At Taylor's 1st appt, the x-ray showed her to be impacted. She was put on Miralax, a fiber suppliment, we had to give her an enema (fun times) and she was sent for blood work.

The Miralax has been working but we've had trouble achieving a balance between having trouble going and been loose. The blood work cam back clean/normal...no Celiac's, no lead problems, no thyroid issues and clean bio-chem results (whatever that means).

At the follow up appt, we went over the blood work and then the doctor switched gears and really harped on Taylor's weight. Taylor only weighs 22 lbs. She is not on the chart. The doctor was very condesending when telling me that she considers Taylor to malnourished and that she was listing Taylor as Failure to grow. When I asked what we were concerned about (meaning..what could be causing this..not why was this a problem), the doctor got snippy and said that if she didn't get the proper nutrients she could have stunted growth and stunted brain development...and she said this like I was stupid. She gave me some calorie boosting powder to add to her food and recommended pediasure (which neither of the girls seem to like).

Here's the thing...Taylor has never been on the growth charts. She was born at 4.5 lbs. Her pediatrician said that it could take 5 yrs for her to jump onto the charts. He has never been concerned because her head circumference is in the 50th percentile and, at least up through her 2 yr appt (our last well visit...of course, that was 5 months ago) her curve has paralleled the normal growth curve (even though she is under the line for 5th percentile). Plus she (and Bailey) have hit every developmental milestone well ahead of normal. Hell, they are 2 and they talk in 7-8 word sentences, they know all their shapes, count to 10, sing full songs and have wonderful cooperative play for their age. Also, at birth Taylor was 1.5 lbs smaller than BAiley and 1 inch shorter. At 2 yrs old, Taylor was 1.25 lbs lighter than Bailey and still 1 inch shorter.

I'm not sure how worried I should be. This GI was quite caught up on this, but she only has a small picture to look at. She has only seen Taylor twice and those 2 visits were only 6 weeks apart. I did try to tell her that Taylor was never on the charts but that didn't seem to phase her. On one hand, it's not like Taylor suddenly dropped off the charts. On the other hand, what if the reason she was small to begin with is because there is something wrong? If that was the case, though, would her development be so normal and what about Bailey (her identical twin).

I should add that both girls eat pretty well. Bailey eats more than Taylor. There have been times I wished Taylor would eat more but then there are times she devours food. She also eats a nice variety. I guess being babies # 4 and 5, I stopped being too stressed out over each meal. It seemed to me that over the course of a day/week, both girls were eating ok.

Any thoughts would be appreciated....thanks.
Jess

[golfgal]

Does the GI doc know she is a twin and was a premie (or at least small at birth?). I wouldn't get too worked up over it if your pediatrician isn't worried. 22 lbs at 2 is pretty small but some kids are just like that. How tall are you and your DH? My sister is all in a twit because her kids are small--but she is only 4'11" and her DH is only 5' 4" what does she expect?

[5lilfish]

She does know she is a twin. I tried to tell her that Taylor was small from birth on. She was not a premie (37 weeks).

My DH is 6 ft. I am 5' 5" but I am tall in my family. My mother is just shy of 5 feet tall. Also, 2 of my first 3 kids are twigs. My 12 yr old son is 5 foot and only 77lbs. This is the first year that I haven't had to buy my 9 yr old slim pants. Slims are a little tight on her now but regular pants are big...she needs a belt.

I don't want to blow the doc off...she did worry me, but she also was pretty rude and she didn't listen to me at all. I just want to know my peanut is ok.

Thanks...
Jess

[diznygirl]

Your peanut is okay.

Although you should listen to what the expert has to say, you can weigh it against what you know about your child and what your regular doctor has said.

With childhood constipation problems like this, it results in a failure for the body to properly absorb the nutrients. Usually it's not diet related - it's child related - meaning they hold it in cuz there are better things to do than poop, like play. Use the Miralax religiously for a few months, stay on top of the BMs, and eventually it all works out okay.

[zachnsamsmommy]

I can totally relate to where you are coming from, and your frustration.

First, twin growth can be 'behind' for quite some time. Also, my ped says to look at the overall growth curve. Like, if she has always been 20th percentile or less, than low numbers on the curve are normal for her. I really don't think there is a reason to worry about her growth right now.

The constipation might be a small cause for worry. Food allergies or sensitivities can really affect the GI system. A sensitivity or allergy usually causes loose stools, but can cause constipation (like a milk protein allergy).

I'm no 'expert'...but I do have a child with similar issues. My DS is 2 1/2 (May 2007), and he is only 33" tall and 26"...about the 2nd perc. for height and 5th perc. for weight. My ped is concerned about his growth b/c he was at the 60th perc. for both at 9 mos old. So falling perc. is a reason to worry, constant perc. usually is not.

And my DS also gets Miralax almost every day. We think he has some food allergies or sensitivies, but he has not been checked by an allergist yet. He also has eczema, which also points to some kind of allergies.

My only other suggestion other than what you are doing, is maybe checking with the GI doctor about possible food sensitivies.

GL, but it doesn't sound like you should be too worried.

[dis-happy]

Stick with your ped and try not to worry about what the other doctor said. My ds has similar growth issues and has been tested for several things by different specialists. Tests have ruled at most everything. The ped seems to think he is just small and what they do at this point is planned watching (the endo has a name for it, but basically it is sit back and watch the growth for awhile). We do supplement with Pediasure (have you tried the different flavors? my ds likes the strawberry and I mix it 50-50 with whole milk) and I think it helps. He did have some growth the last two times we checked, yay! I try to sneak in extra calories where possible too, ie. whole milk, extra butter in the potatoes.

[PollyannaMom]

Stick to your guns and your regular ped's advice! We had the same sort of thing when DS was little, but we were new parents and scared, and listened to way too much from the "specialist". We let DS, who when he was little liked healthy foods best, become a junk-food lover and develop bad habits - because we were afraid if he didn't gain, they'd call social services on us or something! We're still paying for it in picky eating and bad mealtime routines now.

[The Mystery Machine]

You are describing my 13yodd as a toddler.

My dd ended up taking daily injections of growth hormone from K-5th.

Growth hormone is not just about height. It is your childs appetite and weight.

Also the constipation causes you not to be hungry in which you do not gain weight and it is a vicious cycle.

So, my suggestion to you is to really really focus on getting the constipation under control and try to find ways for your child to eat as healthy as they can.

Then keep monitoring your child's growth at your reg. ped's. You said that your child is going up the curve, so that is good. However there is a min. growth per yr. I think it is 5cms., it has been awhile. Ask your ped.

If your child starts to fall off of their curve, then you start monitoring every 3 mons. and then if they level off that is when you take them to an endocrinologist.

When my dd started growth hormone, it was like the floodgates were opened for her and she could eat and gain weight. She is done now. Children with growth issues do not grow very long (esp. girls they can be done by 5/6th grade), so keeping an eye on it is imperative.

[sacall]

I also agree with you Ped, but would listen to some of the things the GI doctor said. As long as Taylor has been on the same growth line (even though it is not on the line) that is a good sign. I was told "failure to thrive" was when they started to fall below their growth line. This is what happened to my daughter.

When my daughter started having problems (she was 10 a the time), we had to go in every three months for weight checks. For her, she went from 25% weight to below 3% for weight - that is why they were so concerned. However, she had always been around the 25% for weight.

Some suggestions for gaining weight, like some other posted said - whole milk, real butter, real dressing (mayo, salad dressing, etc.), carnation instant breakfast, pediasure, things like that to get more calories.

Stacy

[laughinplace199]

My DS has some similar issues with weight. He just turned 3 and weighs 26 lbs. His ped and I were actually excited because DS has finally moved up to the 4th percentile for weight.

DS has always been below the growth curve. Our ped says that as long as he is parallel to the growth curve, we shouldn't worry. DS just has his own growth curve.

We did have him tested for some allergies and celiac, but everything came back negative. He's just small.

It sounds like your DD is just fine if she is staying consistent on her own growth curve.

[Shmily1]

I think your DD is doing fine and you should not listen to what that GI said about her weight. Not all babies grow at the same rate, and not all babies eat the same amounts. She WILL eat when she is hungry. What kind of milk does she drink? When DD18 was little, about the same age as your DD's, she could only drink skim milk because other milk made her constipated. Now that she is older and we know about chiropractors, when she is constipated, she goes to have her lower back adjusted... 30 minutes later, she's all cleaned out! DS19 and DD18 both wore the same size clothes for a couple years. Now, he's 6'2" and she's 5'1"! Don't let the GI bother you. You know what's best for your DD and every child is different, even if they look alike