|My two extremes, from the same genetic stock|
I somehow got blessed with two kids on opposite ends of the growth spectrum: Mikko through toddlerhood was a happy 150th percentile kind of guy, and I just let him keep on growing. He was barely eating any solid food before he was two, so I knew it would all even out, and it did. He'll always be a tall and hefty kid (around the 80th percentile now for both height and weight), but that's his body type.
|See how sickly he is? Sad.|
This is not only weird — it is a trifle concerning. He comes from a family of generally larger-than-average people with a few skinny minnies. So he could just be one of those recessives, right? But his naturopathic pediatrician is cautiously concerned, because here's how nutritional deficiencies can manifest:
First goes the weight, then the height, then the development.
In other words, the weight's already gone. He's already demonstrating that he's atypically short (genetically speaking). So is his developmental progress next?
Whenever I talk about this with other parents, I get the blithe reassurances I gave myself (and others) about Mikko: Every body is different. Somebody has to be on the small (or large) side! You don't have to be average to be normal. If he's meeting developmental milestones, he's fine. As long as he seems healthy, he probably is.
I'd say I have about 90% confidence that all the above is true for Alrik: that he's just a short, slight fellow who's perfectly healthy.
It's that 10% of uncertainty that's killing me.
What if he has an underlying health issue that I'm glibly ignoring? It makes me glad we had him tested for cystic fibrosis in his newborn heel stick, for instance, because I've lost friends to that wasting and respiratory disease, and that makes me jumpy. I've been looking at photos of toddlers with celiac and comforting myself that although his legs and arms are skinny, they're not that spindly, and his toddler gut just looks like a normal pooch, not a gas-filled starving-child's potbelly. But what if?
When we saw the pediatrician last year, she wanted us to put Alrik onto a formula of whole cow's milk, almond milk, carrot juice, and oil. I thought this was very odd. I really couldn't see how drinking such a mixture would be better than continuing to breastfeed — and wouldn't pushing that on him limit and replace his nursing sessions? Breastmilk is fattier and more caloric than whole cow's milk, and much fattier than almond milk and carrot juice. It has more nutrients than all of those liquids. I do give him cod liver oil as a supplement, however, since on a spoon seems a more reasonable delivery method to me than mixed in with milk. (Blech! For my part, I can't stand the fish breath it gives him, but he laps it right up.)
Based on my own research into how people gain weight, I understand that it's the amount and type of carbohydrates we load into our bodies and how it affects our blood sugars. So it doesn't make sense to me that people (including the ped) say to sneak avocado or peanut butter or oil into everything — dietary fat intake isn't what makes people fat. At the same time, I feel awkward emphasizing or feeling great about his scarfing down French fries and potato chips. (Yea … um … weight gain?)
So we emphasize nutrient-dense foods whenever possible, present a variety of options, remind him to eat (because he does get distracted easily), supplement with oil and whole-foods multivitamins, and continue the breastfeeding. I don't make food into a battle, and I don't push him to eat past what his hunger is telling him, though I do frequently offer bites when I notice his interest flagging. He's not what I'd consider a picky eater (at least compared with his older brother!), so he willingly eats a wide variety of food, though the amounts vary — some days, a plateful, and some days, a couple bites and he's off. It seems like we're doing things (mostly) "right" — but he's still small.
He also, by the by, seems incredibly healthy. He rarely gets (only minor) illnesses. His stools (oh, you know you wanted to find out!) seem normal to me — passed easily and regularly. (Wait — you didn't want to know? My bad.) Energy-wise, he never sits down and never stops moving. He's constantly doing his Power Rangers moves (highly entertaining) and racing after the kitties and helping out around the house (anything at all you're doing is fair game). He also still naps for several hours and sleeps fairly well through the night. (Fairly well. He is a cosleeping, breastfeeding toddler, after all.)
Developmentally, he talks really well for a 2-year-old, based on my experience (both in vocabulary and clarity), and he understands both German and English. He mostly speaks English but can break out some German if the occasion calls for it. He's learned a lot of sign language, though I'll admit his verbal abilities have made us deemphasize signing with him. He counts to eleven, which surprised us, since we're neglectful parents who leave our second born to figure out everything on his own. (Heh heh.) He is openly affectionate and happy, participates in imaginative play, and interacts well with other people (if we acknowledge he's a two-year-old, ha). He has good balance and gross motor control (he's got a wicked throwing arm) and is getting more and more dexterous with fine motor control. I say all this not to brag (as if — weird that sometimes it can seem braggy to describe what your child does) — for instance, Mikko was much less advanced in all these categories at the same age but caught up. I'm just saying, there's nothing developmentally that makes me worry: He's sick, and it's affecting his development!
Some hard data below. Seriously, note what terrible parents we are with the second born — so many months we didn't bother to measure! Oh, noes!
|Mikko's height chart, 0-24 months, and his weight chart — he broke it. He was actually above the chart.|
|Alrik's height chart, pretty consistent (you can ignore the outlier), and his weight chart, dipping|
So: What to do? Ignore it? Get him tested for something — but what? (Possible medical causes of "failure to thrive" include GERD, liver disease, metabolic disorders, thyroid disorders, type 1 diabetes, CF, and celiac.) Do a trial elimination diet to see if there's something he should or shouldn't be eating?
As far as that last one goes — oy. Sam and I eat grain-free, and we keep a mostly grain-free house. However, the boys are very much not on board with this plan, so they eat grains outside the house. Mikko's first thought on rising is, "Where can I get grains today?" I kid you not. I keep floating the idea of having the kids be at least gluten-free for awhile so I can see if it helps Alrik's growth at all, and no one's having it. I think we'd need a confirmed diagnosis of something dire to spur the family as a whole onto a new eating path.
It's (past) time for his two-year checkup, and I keep hesitating about going back to the naturopathic pediatrician. For one thing, I feel sheepish we didn't actually give the weird milk-juice formula a go, even though I disagreed with it philosophically and nutritionally. For another, I just really hate going to the doctor. I pretty much always emerge feeling like visiting was a colossal waste of my time and money. I'm sure having my dear child jabbed and poked with needles and who knows what else if we decide to get him extensively tested will ultimately result in feelings of regret.
Unless: Unless there is something wrong. And then I'd feel regretful at some other time, if we find out down the road that there was an underlying illness we were closing our eyes to. Maybe it's when he's 5'4" as an adult that he'll read us the riot act for not acting sooner. Didn't we see how skinny he was? Didn't we feel concerned that his height was so far below the norm for our family?
Ah. The guilt and responsibility of the mother.
|At least it makes him easier to hoist!|
What would you do? Do you have experience with mini-sized children? Was any course of action recommended, and did anything particularly help spur growth? Were there any complications you collided with or successfully avoided?