Too Skinny

We went to the girls' regular pediatrician in March for a routine re-evaluation of their ADHD meds for the year.  While there, it was noted that Katie was significantly under weight for her age and height, and had, in fact, lost 3 lbs. since the start of the school year.  At 8 and 1/2 years old and 4'3", she weighed only 47 lbs., giving her a BMI of only 12.73.  The pediatrician referred her to a nutrition specialist to see if there were any food allergies at play, keeping her from gaining sufficient weight,

Scrawny little thing

and/or what other measures should be taken.

Katie has always been an extremely picky eater, though I'd never been able to directly link it to anything related to sensory processing.  Many kids with SPD have aversions to or other problems with particular food textures, avoid crunchy things like chips, or mushy stuff like yogurt.  Others have problems with particular flavors, certain spices etc.  I'd never noticed any pattern like this in Kate though.  Lately she just plain wasn't hungry, she said.  I made meals which she barely ate, though she did tend to graze in general if allowed, eating little bits here and there.  As long as it was healthy stuff I didn't mind this too much.  I wondered if possibly her sensory system sends out the FULL signal before she really is, causing her to honestly think she's full and can't eat anymore at the moment, but then come back for more in a short while.

In preparation for our consult with the nutritionist I tried to start a food journal of what Katie ate and when.  When I asked her what she'd had for breakfast at school that morning, she told me she hadn't gone to breakfast.  When I asked about the day before, she hadn't gone then either.  All school year I had assumed she was eating breakfast at school because it was provided to everyone at no cost and I knew she got there in plenty of time.  Turns out she hadn't been eating any breakfast since fairly early in the year, claiming she just wasn't hungry in the morning.  Closer discussion of what she ate for lunch revealed that though she always took lunch, she rarely ate more than a few bites of any of it.  She was not taking anything for their afternoon snack time anymore either, again because she said she just didn't want it.  No wonder the girl is a twig!  I had no idea she actually ate so little! (Again feeling like a crap mother!)

I wondered if the Concerta for her ADHD could be suppressing her appetite, and planned to ask her doctor about it if no other solutions were found with the nutritionist.

After talking with us the nutritionist didn't feel testing for celiac disease or other food allergies was necessary at the time, but coached me in ways to get her to consume as many calories as possible.  I got her Ensure Plus nutrition shakes to drink in the morning in place of breakfast, since she didn't mind drinking, but didn't want to eat anything solid in the morning.  The last few weeks of school she also took her lunch to the nurse's office to eat where there would be fewer distractions and she wouldn't be tempted to be so busy socializing that she'd forget to eat.  By the end of May she'd gained 3 lbs. and early July was up to 51.4 lbs.  The nutritionist was satisfied that she was gaining sufficiently with these more conscious dietary changes and didn't feel any further testing necessary.