Need to gain weight. (long)

[Mishi]

Hi everyone, I took my youngest (Bubbles - her family nickname) for her overdue vaccinations yesterday and found that she was underweight. As in, not even on the graph underweight. Doctors and child health nurses reassured me that she's okay even though she's skinny because she's normal for some developmental markers and ahead for others, but she does need to get some weight on.

Bubbles will eat ALMOST anything I put in front of her and has only one allergy that we know of (Preservative 200). She won't eat most meats except for beef mince and thinly sliced ham. She also won't eat eggs.
The doctor and the nurses are happy with her diet, but I'd like to know if there's anything other than formula that I can give her as most formulas disagree with her. She's 16 months old and needs to gain another 1.75 kg to be on the graph and in the 50th percentile. My husband and I are both short (5'5") and skinny, so it is normal that she and her older sister are too.

Average menu:
Breakfast: Weet-bix with sugar and cow's milk + 200 mL cow's milk afterwards.
Morning tea: Fruit/biscuits/crackers/cupcakes/yoghurt depending on mood
Lunch: 2 slices of wholemeal or mulitgrain bread with margarine and a spread, or thickly spread Philly cheese.
-200mL of milk before her nap.
Afternoon tea: Fruit/biscuits/crackers/cupcakes/yoghurt/crisps
Pre-dinner: Raw veggies while I'm cutting them up.
Dinner: 2 cups+ of fresh veggies as well as an attempt at getting her to eat some meat/protein which is usually rebuffed.
-200mL of milk before brushing teeth and going to bed.

Plus water through the day.

She needs more protein in her diet but I don't know how to get it into her food. Does anyone have any suggestions?

[Supermarket Slave Girl]

My 2 daughters are very skinny, especially my oldest, they were very fussy when they were younger but have gotten much better and now eat like horses but don't gain weight, they're very active kids.

Does Bubbles like spag bol? You can cut mushrooms up finely to hide them if she doesn't like them and they are a good source of protein.

My eldest would be very happy if I put just a plate of veggies in front of her with no meat on it, she tells me she's vegetarian but seems to love it when her dad makes if famous mince pies :lol:

Good luck, don't be too worried, her diet sounds really good.

[Magpie]

If you're worried about her protein, then try slipping her TVP in her cereal or on her yogurt. But it doesn't take much of that to go over her requirements for the day.

If she won't eat meat, don't worry about making her eat it. What beans have you introduced so far? (Heck, if you're trying to get more calories into her peanut butter is a great source of them. And nothing but legume).

[Mishi]

Bubbles won't eat Spag Bol, but I will try her with some mushrooms. Her daddy looooves mushrooms with brown butter sauce so hopefully she'll have inherited that. Her older sister, Jazzybee, won't eat meat unless she's told which animal it comes from.

Bubbles isn't so keen on beans other than fresh green beans (raw and cooked) or cooked broadbeans, but I'm going to see if I can find some fresh borlotti beans and do something with those. She adores peanut butter, Jazzybee keeps handing her the jar when I'm busy with the housework.

Thanks for the suggestions so far!

[Seshat]

A legume + a grain = a full protein set. There's a reason that peasant food tends to follow this pattern.

Try combinations like:

peas or green beans + wheat
peas or green beans + oats
soybeans + rice
lentils + rice
chickpeas + rice
chickpeas + wheat
maize/corn + refried beans or other American-continent beans

Get any cookbook that provides recipes for the peasant food from (almost) any culture, and you'll find great vegetarian recipes that provide the full protein a human needs.
(Unfortunately, the polynesian/melanesian islands didn't have enough space for grain growing, so they had to rely on chickens, pigs and seafood for protein.)

Also, let me second 'don't go by the chart, go by the person'. Your daughter may well just be naturally abnormal. Here's a chart of body condition for animals. (http://vet.osu.edu/1851.htm) I wish they'd do one for humans.
You'll notice that weight-for-height is not on that chart at all. What is on the chart is methods for estimating body fat and muscle mass. Much more sensible, in my opinion.
If your daughter meets the 'emaciated' or 'thin' categories in this chart, then yes, I'd get your doctor's advice about converting the chart to human-condition. But if she's fine... who cares about the score on the scales?

[Magpie]

Looking at your numbers again, I have to ask: how much does your daughter weigh? It looks like she's getting more than enough protein. The complementary protein combo that Seshat didn't mention is that milk products are a complete protein, AND complement grains. I'm seeing a fair bit of dairy, much of it with grain. (And proteins don't need to be complemented at the same meal, within three-four hours is fine).

I can crunch the numbers for you if you're worried, just let me know quantities.

[trailerparkmedic]

I would say dairy, but it looks like she's getting a good bit already with all the milk/cheese/yogurt. I've boosted my protein intake with nuts, or with tofu in smoothies (throw in enough fruit and you can't really taste it). If your doctor is happy, I wouldn't be overly worried. Some kids just grow differently than the charts expect.

[Mishi]

@Seshat: Thanks for the charts, Bubbles scores as being moderate except for 1-2 lumber vertebrae being slightly visible. I'm really hoping that this isn't a sign that she's inherited my joint problems. I agree, it'd be great if there was a similar chart for humans!

@Magpie: She weighs 8.5 kg and she's 75cm tall, so she's scoring as short for her age as well.

I'm thinking of adding some cream to her milk, I just worry about the saturated fats so I'm going to have a look at the new Philly brand cream. The nurses blamed her activity levels, but there's no way to slow her down. She's always busy playing and chasing her sister + the dogs. Playpens are out because Jazzybee and the dogs would 'rescue' Bubbles. :shrugs: More chocolate?
Thanks for the help and reassurances, it's made me feel a lot better!

[ParkingWitch]

Silly question, If you just look at the weight for how tall she is (without considering her age) how close does that come?

[Seshat]

Starving people and animals don't have the energy or muscle mass to run around like a mad thing.

[Mishi]

@ParkingWitch: That was actually a really good question to ask, I just hunted out the W.H.O guidelines, and she's in the 15th percentile weight-for-height.

I looked at the Philly cream and it states on the container that it tastes like the cheese, so I'm not going to add that to her milk! Bubbles is now trying to get away with skipping her daily nap, she's much to busy figuring things out.

[Magpie]

@ParkingWitch Bubbles is now trying to get away with skipping her daily nap, she's much to busy figuring things out.

My husband tried that as a child. There was an argument that he didn't need naps, and it was such a waste of time. (I believe his mom let him try not napping one day, and he still refused to take a nap, despite being clearly tired). And I knew these stories before we got married... *shakes head*

[RecoveringKinkoid]

Geeze, I got nothing. Looking at her diet, if she ain't gaining weight on that, she's just gonna be a skinny kid. If she is otherwise healthy, I would not worry about it.

[42_42_42]

If she's actually eating the food at the meals, then it's not that she's filling up on milk. Absolutely she should be drinkng whole milk, not 2% or skim and the yogurt should be regular, not lowfat. I'd use a nut butter on her bread instead of margarine (peanut butter, almond butter, cashew butter, nutella). Also, see if she'll eat hummus and pita. Most little ones will eat chicken nuggets, which you can make yourself by cutting boneless chicken meat into bite size pieces, dipping in milk and then coating with cracker meal and baking in the oven or pan frying. Would she maybe drink a smoothie of banana, tofu and yogurt?

I wouldn't become too worried unless the doctor is. He obviously doesn't think it's caused by anything wrong or he'd be checking for things. You could always ask for a referral to a nutritionist.

Some little ones just don't have a lot of body fat because that's the way their genes are.

[RecoveringKinkoid]

Nobody needs to be drinking anything but whole milk. Not to keep weight off, because drinking that skim crap won't do that. It is just nasty.

[Seshat]

Check the 'pad' areas of her palms and the soles of her feet. The area that doesn't have actual muscle, but is cushioned with fat. If she loses that padding, it's serious.

But since she comes up as 'moderate' in the cat/dog condition scale, and has the energy to run around and do a lot of play exercise, I think she's just naturally skinny.

It's good for you to be concerned, and I'd suggest monitoring her condition. But I wouldn't actually worry. Just monitor her energy levels and diet as you would any other child, and if she starts to get unduly tired, or want to eat too much or too little, take her back to the doctor.

From what you've said, my vote is strongly for 'she's a statistical outlier, this is her normal and natural body shape'.

[Mishi]

I'm going to go with the "This is normal for her", thanks for the support, you are all awesome!
Along with healthy fat on her hands and feet, she even has dimples on her elbows, a little double chin and cute chubby cheeks, that's why it was such a shock to find out that she's classed as 'underweight'. She now adores mushrooms, discovered liverwurst over the weekend and has still been avoiding napping. We only drink whole milk, skim is gross!

@Magpie, I was also told those sorts of stories about my husband before I married him :lol:

Thanks again everyone!

[Mishi]

UPDATE: Miss Bubbles has gained around 500 grams AND has grown 4 whole centimetres in the last month. More porridge, mushrooms and more junky food (Lots of Nutella and chocolate biscuits) have made the difference. She's now in the 50th percentile height-for-age and the 3rd percentile weight-for-age. She's now back on the graph! She still prefers eating heaps of veggies and fruit which is great. :D

[BarbieGirl]

If you're still concerned with her getting egg protein I have a yummy recipe.

it's called hootenanny/puffpancake.

6 eggs
1cup flour
1 tsp vanilla
1 cup milk
1/2 tsp salt (unless butter is salted)
1 cube butter (I use margarine and will sometimes just use half of this)

melt butter in 9X13 baking dish in oven while heating up to 425*.
In blender blend eggs flour milk and salt and pour on top of melted butter bake for 25 mins. serve with syrup, pwd sugar, jam etc.

My boys LOVE this and they are 2 and 4.

[NotSoInnocent]

All -four- of my heathens have been classed as "underweight". Now ask what their percentiles have been throughout their lives...

Birth-2 years = 75% height, 20% weight
2-4 years = 75% height, 25% weight
4-6 years = 80% height, 20% weight
6-8 years = 75% height, 25% weight
8-10 years = 75% height, 25% weight

Tall and SKINNY!!!

Me? I'm 6' (183 cm) tall and my weight is generally around 150 lbs (68 kg).

Again... Tall and skinny. ^_^

It's genetic.

[Solumina]

Back when I was underweight smoothies full of cream and/or yogurt with some protein powder were my best friend. I could never have much at a time but I would make up a big batch and have a bit here and there through out the day. Once I started doing that it only took me about two months to put on the 15 that I needed to get the doctor to stop being concerned. I don't know how well that would translate for a little one though.