Is your child underweight? Your doctor would have told you, right?
Maybe not. In my pediatric nutrition practice, I am often the first person to capture underweight status or even growth failure in a toddler, child or teen who has seen multiple providers, from the pediatrician to gastroenterologist to allergist and so on. But this is really important for kids!
Why is being underweight a big deal? Is it ok to be a little underweight? The truth is, once kids slide into growth impairments, it throws a lot of other stuff off kilter for them:
- Their immune systems don’t work as well. They get sick more often, stay sick longer, and have more complications from infections than kids in healthy growth status.
- Kids struggle more to behave, learn, focus, or sleep, and will often experience more anxiety, less self regulation, and more mood swings.
- Growth impairments will skew many lab tests, leading to rabbit-hole searches for cause. Thyroid, metabolic panel labs, urine nutritional microbial and organic acid (OAT test) ,and liver function measures can drift out of range, even with mild but chronic growth impairments. I’ve seen this send specialist doctors on a goose chase for exotic problems that don’t exist and treatments that don’t work, because they don’t even assess much less correct growth and feeding. Often, literally, kids just need more food, better food, different food, or different macro ratios.
This can happen even with mild or moderate growth impairments. In other words, kids don’t have to be severely underweight for this stuff to go wrong.
When kids finally hit bottom with that failure to thrive (FTT) status – meaning they fell to fifth percentile for weight for age – this will create a leaky gut. Many parents ask me about leaky gut, and use restricted diets in hopes of fixing this. But, without enough nutrients and energy from food for the child’s gut wall to maintain its integrity, it can break down and become more leaky. Many circumstances may injure gut tissue and create the leaky gut scenario – and being underweight is one of them. The younger a child is, the more vulnerable they are, when dropping off expected growth pattern.
Pediatric providers generally won’t intervene on or even mention a lagging growth pattern unless your child is really, really underweight, as in – heading for the very bottom of the growth chart. Why not? There are several reasons why this can be true:
- Your insurance may not pay your doctor to intervene on a growth impairment other than failure to thrive (FTT), a severe and entrenched problem in which a child has fallen to below the fifth percentile for weight for age.
- Your doctor may not know that dropping just fifteen percentile points off expected growth pattern, for either weight or stature, actually means your child is underweight or undernourished.
- Your pediatrician may not know how to calculate your child’s ideal body weight, expected weight, or expected height, or doesn’t have time to do it.
- Your doctor doesn’t have time to scrutinize, integrate and explain all the growth data in a brief visit, including all the things that impact growth, from your kids’ food intakes to energy level to genetics.
- Your doctor isn’t sure how to help you fix the problem, or why it’s happening in the first place, if they notice it.
- Your doctor lacks training in nutrition and how to use food for health.
Because I work with kids with problems like allergy, autism, severe picky eating, FPIES, inflammatory bowel conditions including Crohn’s disease, or all sorts of circumstances in which they don’t eat well, it’s common for me to find that a child is indeed underweight. Many parents who contact me have placed their kids on over-restricted special diets on their own, and don’t realize their kids are underfed and malnourished, even with all the best efforts at feeding well. But it can be a relief to know exactly what and how much food your child needs to grow, feel, and function better.
Usually, parents are downright surprised at what a difference something as simple as the right food intake makes for their kids.
This quote is straight out of clinic today from a mom regarding her fifth grader. Before nutrition intervention, he had severe attention and focus issues for which he’d been unsuccessfully medicated. He had accidents at school (smearing, pooping in his pants). He got sick often with colds. He was unhappy or frustrated often. After nutrition care, mom said this:
“Looks super healthy, I’ve never seen him this healthy. He seems more like a regular kid. He is thriving. He is growing like a weed. He is happy.”
This boy is off stimulant medication, using the bathroom independently and not having accidents, and has not had any infections for months, for the first time in his life.
What would your pediatrician do for these problems?
He would do what had been done for this child, and failed: Give methylphenidate (stimulants like Focalin, Ritalin, etc) for inattention and hyperactivity; Miralax for the constipation; antibiotics for the infections; and a “he seems fine” shrug for the moderate drop off of expected weight for age.
Nutrition care is not a replacement for medical care – and vice versa: Medical care is not nutrition care. They do different things, and require different skill sets. Strong nutrition in kids makes them healthy; prescription drugs mostly avert acute problems. Neither replaces the other, both are important for kids – but, unfortunately for kids all across the US, nutrition is not a big player in pediatrics nowadays.
Is your child underweight? Is it impacting their health? It’s easy to find out. There are well established criteria for determining things like expected growth pattern for a child, and how to restore it if lost. There are many tools at my disposal too, to sort out what foods would best serve your child, what foods you might really need to avoid, and what foods you really may not have to worry about. If you’re not sure, schedule an appointment and we can just find out!