Underweight Babies & Toddlers

Archived Q&A and Reviews


Small baby concerns

May 2008

My daughter is eleven months old and is really small for her age. She was pretty average size when she was born (7 1/2 lbs) and put on weight steadily until about 9 months old. I'm 5'2'' and her dad is 5'9'', so we never thought she'd be particularly big, but now she's hardly growing at all, and is wearing her 9 month clothes, is in the 5-10th percentiles for weight/length, etc. Also she doesn't have any teeth yet, so she's stuck on pureed or mushy foods. And her sleep habits have stopped improving. Its like she's stalled out in her growth, and sometimes I feel concerned.

In other ways, though, she's thriving. She walks holding my hand, climbs on things, picks up rocks and sticks and puts them in her little wagon that she pushes around. She says a few words and uses some sign language, and is very socially engaging, affectionate and full of laughter. Although she's small, her coloring is healthy and she's active and bright-eyed.

Okay, so I shouldn't worry, right? But I keep having these worries surface...basically boiling down to: are we doing something wrong? or is something wrong with her? Then I see how she's thriving in all these other ways, and I think I should just let go of these worries and see her for the perfect little person that she is. Is this what it means to be a parent, trying to balance doing the right thing for your child with letting go and letting nature take its course? Any advice or encouragement for this confused mama? A.

My friend's baby girl has always been small since birth. She's now below the 1% (15lb at age 1). But developmentally she appears healthy and happy. As a parent the weight issue is a huge deal with her. One of my question about this height and weight percentile is how old are these numbers that we are comparing with. Given the number of obese children nowadays, is it critical to measure your child against that? Should it simply be used as a guidline to see how your child is growing? One quote I've read and like is ''It's not important how big you are but how much you know.'' This was from a ''small'' child.

I'd say as long as your child is healthy, where she is on the percentile chart shouldn't matter. Everyone of us is different and we grow at different rates. crystal

No, you shouldn't worry about your petite baby. My first child has always been at the 5th percentile with height and weight. And she's a bright, energetic, happy (albeit skinny) little darling. At her third birthday party she wore an outfit sized 12 months. Now, just 18 months later, she's wearing a 4/5. So most likely, yours too will catch up. But even if she doesn't catch up, no need to worry. At 36, and at 4 feet 11 inches, I still have the body of a 12 year old, and I'm doing just fine. I will add that my daughters also didn't get teeth until they were well over a year old, but that didn't stop me from giving them ''chewier'' food. My 12-month old, who has no teeth, eats small shreds of chicken, ham and turkey; whole corn kernels; whole peas; chopped pears, grapes, and other fruit; shreds of string cheese...I know the eating thing is stressful, especially when they have no teeth, but just try giving her chunkier foods and keep a close eye on her while she eats. You'll be surprised what she'll be able to mash up with her gums. Petite mama

I am 5 feet. My baby was 7lb 4 oz when she was born, and was pretty average at 6 mos. By one year she was in the 1st percentile for height. She is now 5 and is a teeny little bean, she looks more like 3.5 years. She is healthy, happy, and incredibly cute! I was the exact same way as a child. When she was graded as 1st percentile the doctors would look at me and say...''well we know where she got it''.... You should voice your concerns with your doctor but you probably just have a cute little person like I do. The best part is that everyone thinks your kid is a genius because they look so much younger than they are. If you were a tiny bit shorter you wouldn't be worried. I am 40 now and I can tell you that cute ages well too, she's in for a wonderful life! Short and sassy!

Oh, mama, don't worry! Your little girl is just fine, and just perfect. You're the one I'm worried about - you sound like me at that time (first year of the first kid), and I know I was on the verge of some depression. So make sure you are taking care of yourself and getting enough personal time.

That said, here are some things to consider from a health perspective that might reassure you.

First, some kids have to be in the 5-10%th percentile, just as some of them have to be in the 90-95%th. The best predictor of kid height is parents' height, so she may be just a petite person, and that's just fine.

Second, those percentiles are based on formula-fed Caucasian kids. Breast-fed kids weigh less, as do Asian and Latino kids (on average). If any of those factors applies to your daughter, just keep in mind that she may not be as small as you think!

Third, keep in mind is that rates of development (all kinds of development) slow WAY DOWN in the second 6th months compared to the first, and especially in the third six months (i.e., age 12- 18 months) compared to the first year. You're not going to be getting rid of clothes, toys, or anything else at the same rate you did when she was a tiny baby, now that she is almost a toddler. She's not going to grow as fast, or change her eating behaviors or skills quite as fast compared to when she first arrived. Sleep it is own separate thing entirely - as you will soon realize from reading BPN newsletters, plenty of formerly ''great sleepers'' suddenly become poor sleepers, and vice versa, and this continues throughout toddlerhood unfortunately. So I would not put any stock at all in the fact that her ''sleep habits have stopped improving.''

Bottom line - she's perfect, and yes, I do think that a lot of the challenges of parenting are emotional (on the parent's part) - balancing your fears with your kids' desire for independence, and, as you put it, balancing trying to worry/intervene with trying to accept your kid for who s/he is. In your case, I think the latter is definitely warranted. As is a day off for you! :) Mom of 2 perfect (and perfectly small) kids

You sound JUST like me when my son was your daughter's age. I was SO concerned that he ''wasn't growing;'' I totally obsessed about it because he'd dropped in percentiles. They always say your child should ''stay on their own growth curve,'' but you know what-neither of my kids have, and they're totally fine-perfectly healthy-just on the small side. Talk to your pedi, yes, about your concerns-but if s/he isn't concerned, I don't think you should be either. As far as development-your child sounds right on target-perhaps even a little ahead (I'm a home visitor and do early childhood assessments). It's not uncommon at all for a child not to have a tooth by 9 months, and it's totally fine that she eats ''mushy'' foods (you can try really soft finger foods, too). Sleep habits do not ''improve'' linearly as a child gets older, necessarily-sleep varies based on what they're going through in development, their temperament, etc. If someone tells you your child ''should sleep through the night,'' or any other such nonsense, just ignore it. You're a concerned, involved, parent, which is great-and your child is just fine. Easier said than done, but relax if you can! Been there

My girl is also small (1%!) and didn't get her teeth until 9 months. The doctor shows absolutely no concern about this, so I don't either, or I try not to. Someone has to be at the bottom of the growth curve and she's ahead on the developmental curve so I choose to focus on that instead. If you are really concerned, why not talk to your pediatrician? She will probably tell you what you already know, which is that since you and your husband are small, your child probably will be, too. I am small and once I got past puberty, I've enjoyed it. I'm more comfortable in airplane seats!

With the pureed/mushy food thing, I found that even before teeth her gums were hard enough to do some chewing, esp. if I cut things up small. So I gave her veggie burgers, tiny broccoli, cut up apples, Cheerios, etc. Things with texture. What we were eating but cut up small. Those front teeth aren't for chewing anyhow, and she still have only 6 teeth at 18 months (all front teeth). Now she can eat almost anything. anon

As the mother of a small baby, I can relate to your worries. My daughter was IUGR & popped out at just over 5lbs. We had feeding issues, barely missing the ''failure to thrive'' diagnosis a few times, & for her 1st year of life, she was never higher than the 5th% for weight. When she was 11 months, I could still wear her in the baby bjorn, & she could still wear newborn onesies. She got her 1st tooth at 10 mos., and so we too had trouble getting her to eat much more than pureed food for a long time. While all of her other development was right on track, we worried constantly about her physical growth. I am a small woman, but my husband is a big man: we were not expecting such a small baby. According to our ped, the IUGR may mean that she'll be on the small side all her life.

Fast forward to now: my daughter is 2.5, still small, but she is growing at her own rate and the ped assures us she is doing great. I think she may have finally gotten into the 10th% for weight at her last checkup. She still wears some 18 mo. sized clothing, and some of the 2T and 3T things that relatives send just fall off her... but when I see her with other 2 year olds, she does not look disproportionately small. Will she likely be on the small side all her life? Yes. Can I live with that? You bet. She's healthy. That's what matters.

So there's my experience. As for my two cents:

1. If you haven't talked to your doctor in a while (since the 9 mo. checkup?) call and talk about your concerns. The office should be able to do a weight check. I would not hesitate to ask for this. Go with what your ped says. In my experience, they do not fool around when they think a baby is not growing on target.

2. The teeth are coming in and that will make a huge difference. Until then, and with your ped's blessing, you can try to feed your baby calorie-dense foods. Sweet potatoes, avocado, whole milk yogurt.

3. Don't worry about what size clothes your baby wears. And if she gets to wear her size 9 mo. things for a while? Saves you money.

4. Breathe. Babies grow in fits and starts, and perhaps yours is just tapering off naturally, according to her own schedule. It sounds like this is the case for yours. She sounds perfectly wonderful & healthy. But you want to be sure. So call your doctor. Mama of a wee one

i understand your worry; it's what mom's do best :) i've had my moments, too, about my petite daughter. she is 13 months old has either been in the 3% or not even on the charts for weight most of her life, and the doc says that from a year to 18 months their growth slows down and they tend to eat less than earlier, so i'm not envisioning any huge growth spurt in the near future. however, like your perfect daughter, my girl is progressing in her mental and physical development and is in general a happy and content child. her sleep is all over the map-but always just when i give up or think it's going great, it changes. this seems to be the case with all aspects of concern- a good lesson!

look around and notice the huge variation in size of the people around you- both children and adults. that helps me remember that everyone is different and there is no need to compare. your daughter is growing at her own speed, and by all accounts is wonderfully healthy despite being on the small side of the scale. so, i'm offering encouragement- just enjoy her and don't worry about her size, as long as she's developing in every way.

my cousin had a petite little girl, and, she worried about her weight and was concerned because she could see her ribs, so she started feeding her very high fat, high calorie foods (including lots of chocolate millk!) well, the child quickly gained weight, in the form of body fat, and is now a plump teenager who struggles with her weight. i think it's best to let your daughters appetite be the guide to what she eats/how much she nurses, and trust her own body to call for what it needs. hang in there and good luck! warmly, mom of another tiny tot

I too am a small baby's mom. My daughter just turned a year old last week, weighs 17lbs and is in the 4th-5th percentile for everything. She's not walking yet but crawls, is just pulling up and only says Mama. I get concerned as well but after her one year check up, her pediatrician says she's fine. She actually lost a few ounces since he saw her a few weeks ago (for allergies) and wants her to come in for a weight check in a few months. Even with that, I know she's fine and I've stopped the worry cycle of thoughts I used to have. Her doctor also said that with her starting daycare with another baby who is a little older and more advanced than she is (she's been home with me until this week), her progress (and weight) may jump forward. But even if they don't, she's fine, just a little on the front of the bell curve in everything....at least she's consistent! All I'm saying is that I know EXACTLY how you feel and you just have to remind yourself of what you already know. She IS your perfect little girl. And I love the way you said that this is what parenting is - letting go and letting them be just who they are. I think we all have expectations or fantasies about who our kids will be. In reality, they are who they are. As long as she's eating well and playing and being loved (which it sounds like she gets a lot of), she's fine. And you're a great mom for worrying and wanting the best for her. Enjoy her as she is - soon she'll be running around with her friends and this will be a distant memory. Fellow itty bitty baby's Mom

Your baby sounds pretty healthy to me (and sleep habits definitely do not ''improve'' in a linear way! it's normal for babies to wake more at various times and less at other times as they grow), but there's one misconception in your post that could be affecting her growth. The fact that she doesn't have teeth yet does NOT mean she must eat pureed or mushy food. Most babies are remarkably good at ''gumming'' solid food. You just need to give her things that soften in the mouth (like crackers and dry cereals) or are in small enough pieces to be swallowed whole without choking (like peas or anything diced small). At nearly a year old she should be at least starting on finger foods.

If you've been weaning her, and replacing breastmilk or formula with mostly pureed fruit or baby cereals, she's probably not getting enough calories and fat per ounce in her diet. Try offering her more meat, yogurt and other higher-fat/higher- calorie healthy foods, like avocado. If she's not interested in more calorically dense foods, she's not ready to be weaned. Go back to breastfeeding more often, or if she's on formula increase the amount you offer.

All that said, it's entirely possible that your daughter is simply putting her energy into areas of development other than physical growth. It's common for babies this age to grow much slower or even lose a little weight as they become much more physically active (having learned to crawl, climb, stand and walk). But if she's been dropping significantly in percentiles, do think about whether her diet could be contributing. Not a Fan of Purees

20-month-old has never been above 1% on the charts!

April 2008

My son is 20 months and is only 18-1/2 lbs. He's been underweight since birth, and recent tests reveal nothing abnormal. My husband is very thin, so it's probably genetic - but it's still a worry. He's never been above 1% on the charts! He eats pretty well most of the time, so it's hard to know why he's not gaining. We've encouraged self-feeding, and a variety of foods. We're now focused on a high calorie/high fat diet and are trying PediaSure (1 can/day diluted with whole milk), which I'm apprehensive about but just need to get some pounds on him. Oh, and we're trying to stay ''relaxed'' at mealtime, especially if he doesn't want to eat much. We've thought about talking to a nutritionist... Any suggestions on how to get his weight up without stressing would help! mom of little guy

I don't have advice, just a recipe. Great for the summer.
Smoothie pops: 2 containers Full fat kids' yogurt like Yo Baby A banana a cup or two fresh or frozen fruit (strawberries are great, raspberries delicious if the child doesn't mind the seeds) 1/2 cup orange juice if you have it Blend ingredients in a blender. Poor into ice cube trays or small cups and put a plastic spoon in them or popsicle stick.
My kids love making them and love eating them. susan

My now 2 1/2 year old son was similarly tiny at that age. I put olive oil in everything and he ate a lot of whole wheat waffles w/butter and syrup. I think it helped, but his body still seemed to want to stay at a certain size and wt. He also had feeding issues, but that's another story and it sounds like yours is a confident eater. Try not to worry, and especially if your pediatrician isn't. It's hard, I know! Good luck! Same Story

Getting food into skinny 1-year old

March 2008

My son, now 1 year old, used to be in the 50% percentile in weight. At 10 months, he had slipped to the 5th percentile. We did a weight check a month later, and the doctor seemed ok, but since then we are very stressed about this weight/eating issue. I'm still giving him a lot of breast milk, and we are struggling with giving him enough of the right kind of other foods. He does eat a variety, but is picky and doesn't eat much in one sitting. We don't want to force him to eat more, but we are concerned about him not eating enough. He looks healthy, but especially my husband is concerned about invisible effects, such as brain development. Should I be cutting back more on breast milk so he's hungrier for other food? Any tips on great fattening foods? Any experiences with this type of weight fluctuation? Thanks!

I could have written your post a couple years ago! My son also went from the 50th weight percentile to the 5th. He seemed healthy enough, very active and happy, so his dr just said not to stress about it. We found out that he loved avocados (a high fat, good for you food), so we gave him one every day! Sometimes I mixed them with cottage cheese, sometimes with yogurt, sometimes plain. We also started putting butter and olive oil on all his vegetables and pasta. We bought him higher fat yogurts, milk and cottage cheese. He remained (and remains) a bit of a picky eater, but by the time he was 2 years old, he had moved back up to the 30th weight percentile. The drs always say that the kids won't starve themselves, but it's hard to watch as they drop percentiles! Good luck! Mom of a Growing Boy

You don't have to reduce the amount of breastmilk in his diet. Instead, you could offer him expressed milk in a sippy cup along side his snack/meal. And try to monitor the amount of ''in between'' milk he's getting (especially any feedings *right before* snack or mealtime) to ensure that he's not too full by mealtime to eat.

I had this same problem with my daughter. People always say not to worry about how much they eat so long as they stay on their same general growth curve. But what about when they drop curves? For one thing, the WHO has different growth charts that are based on the breastfed child and I think you'll find the drop in percentile is less dramatic there than the CDC's version. We did finally ask the doctor to run tests, and she checked for all sorts of things and they all came back fine. If you're worried, you could ask your doctor to run these tests (I don't know which ones, but the doctor should know). I would say not to cut back on breastmilk. I don't think my daughter would have eaten more solids if I weaned her, and I feel grateful that I was nursing her through that time so at least she had some minimal level of nutrition. Our daughter did eventually start eating more and has moved up a little in the percentiles.

I lowered my standards of what food I'd feed her. She likes commercial mac and cheese? Never mind I would consider it more chemical than food, fine, let her eat it. I also started adding more sugar and salt to get food to taste better and get her eating things. I don't know if it was the right thing to do, but it hlped. Ice cream is actually a good food, aside from all the sugar, it's dairy and high fat and kids like it. Our daughter finally started eating more. Now that she's 2 1/2 and can talk, she will frequently complain of a tummy ache and I notice she eats less when she has a tummy ache. So I wonder if her stomach was hurting her when she was a baby too and would cause her not to eat.

Good luck. It's kind of scary when a child won't eat and drops in percentile. I would say it's probably fine and your child will not starve himself and he'll eventually start to eat more. But do monitor his weight and if he loses weight again, consider asking the doctor to run tests because there are physical conditions that can cause kids to lose (or not gain) weight.

One other thing, look up ''occult UTI'', apparently that can be a factor in eating and weight gain. Websites will list other symptoms and you can see if that might be what's causing it. I thought it might have been in our case until the urine test came back negative. sarah

I think that the LAST thing you should do is stop breast- feeding! Everything I've read says that breast milk is the best, especially for skinny kids. Is he not eating at all, or just very little? If he really wasn't eating, he'd be losing weight. Maybe you want to check out a book: http://www.amazon.com/MY-CHILD-WONT-EAT-International/dp/0912500999/ref=pd_bbs_1?ie=UTF8=books=1204703569=8-1 Good luck! Pete

I have finally read the much-recommended ''How to get your kids to eat...'' book by Ellyn Satter and I will enthusiastically recommend it to you. It directly addresses all your questions and her answer is yes, by cutting back the milk, your child should eventually eat more food and that you can provide some healthy, calorie-dense choices. Read the book! anon

Maybe I'm not the most qualified here, because my 1-year-old is also skinny and we're in the same boat. However, we are making a bit of progress, so I'll share what I've learned so far.

First, it turns out that he doesn't like bland food, and I had been making some wrong assumptions by serving him food that lacked flavor. Turns out he prefers flavor. Pasta WITH sauce. A tiny dot of ketchup on potatoes, eggs, or even broccoli increased his interest - he had previously refused eggs and potatoes until ketchup was introduced. I had a nice, rich soup that I thought might be too spicy for him, but it turns out he loved it. I mixed in a spoonful of plain yogurt to tone down the heat a little, though. If I'm trying to get a vegetable into him and he shows no interest (in our case, it has been green beans, peas and spinach) I puree it with plain full fat yogurt, and he scarfs it right down. We're into a lot of finger foods and self- feeding these days, but there are times when it seems not much is making its way from tray to mouth. On those occasions (a few meals per week) I puree some and spoon feed him, no big deal. I keep a little electric coffee grinder handy for pureeing things in small amounts, though I wonder if something like a magic bullet might be easier to clean. Plain full-fat yogurt is my standby. Good for adding flavor to vegetables, a dipping sauce for any food, and adding a familiar flavor and smooth texture to almost any puree.

Second is variety. At some point in every meal, he begins to lose interest and just wants to finger-paint or throw food off the tray. Previously, I thought that meant he was full, and ended the meal. However, I've since learned that he was just bored with the current course, and if I switch to a different course, or add dipping sauce (yogurt, salad dressing, or a little dot of Mayo or Ketchup) or move on to a ''dessert'' course such as fruit, I find renewed interest and he keeps eating.

Third, offer plenty of between-meal and after-meal snacks. For some reason, my little guy never lets me know when he's hungry. Yet when food is presented, he gets excited and interested, so I've learned to ''remind'' him about eating. An hour or two after a meal, when he's sitting on the floor playing, I'll bring out fruit, toast, applesauce, bagel, crackers or cheerios.

Fourth, peer pressure. He's in daycare, and our daycare provider has observed that he gets very interested in foods that he sees the other kids eating. If you're not doing daycare, you might want to experiment with picnic playdates. My daycare provider also uses cookie cutters to make shapes out of cheese and bread.

Here are some healthy, high-calorie foods that are some of our favorites: Avocados, Full-fat yogurt (and if you puree avocados with the yogurt, it makes what I call ''baby guacamole'' and little guy loves it!), high-calorie fruits like bananas, frozen peach slices (also great for teething), Whole grain toast with butter or cream cheese (we like Alvarado St. Kids Bread), Whole grain frozen waffles with butter (we skip the syrup), bagels with butter or cream cheese (especially when teething), Yams - baked, boiled or fried, Hummus, pasta however you like to make it for yourself, and I did an experiment modifying a banana bread recipe - left out all of the sugar, added just a little molasses, and let the bananas supply most of the sweetness, and made it into mini muffins. He loves those. We also give him whatever meat we're eating, cut up into pea-size or smaller pieces (kitchen scissors are very handy for this). When I make hamburgers, I make a finger-shaped one for the baby. It fits into his fist perfectly.

I feel like I'm starting to get the hang of this, but only recently, and I feel like I need more variety in my menu offerings. I am looking forward to reading the other responses in hopes of more ideas! L

We had a similar problem with our son.. and he's finally plumping up at 2yrs! My strategy: try not to worry, offer food often, focus on full-fat dairy products and put butter on EVERYTHING! anon

The best way to gain weight is... EGGNOG! It was my favorite food when I was little and I was a very picky eater. Skinny no more

I had that same problem with my son when he turned 1. He actually fell off the chart and was off for a while. We went to see a gastrentrologist who prescribed him an anti- histamine. Next thing we knew, he gained 3 pounds in 1 month. Right now, he's in the 5% tile which is okay and his weight gain is not as significant the first time but we're happy with his progress. We were also scheduled to see an endocrinologist but the GI doctor said it was unnecessary because it was not hormone-related.

I also tried forcing, pleading, and chasing my son around but in the end, he'll eat when he wants to eat as much as he wants to eat. When he's hungry he'll eat. I provide ample opportunities and choices for him. We also give him ice cream whenever he wants, butter and/or olive oil anything we can, and supplement with Pediasure (recommended by the Nutritionist we also saw).

Remember that when they start crawling they are more interested in moving and not eating. Even now, my son cannot sit still for more than 5 minutes. I know this is situations-specific but I hope it helps a little. In the end, if you're both uncomfortable with his lack of weight gain, tell your doctor. Anonymous

Two things: Regarding breast milk, the higher-fat/higher-calorie milk comes out later, so nursing longer on one side should help add weight to the kid. Nursing more often and limiting kid's water intake may help. You need to drink lots of water to produce milk, and get enough rest. Sometimes they need a quiet time to nurse.

Once he starts toddling, the kid may be too busy to eat. I fed mine on the playground as he ran by (you have to bring enough food for new friends). And, to the horror of my friends, I fed him like a cat, leaving food out for him. But that's later - at one he can barely eat by himself.

I noticed that finicky eaters had mothers who insisted on good table manners.

Hope I'm remembering correctly from so long ago. At one my kid ate hardly anything but Cheerios, frozen peas, breast milk, and a very brief (two month period) of eating babyfood. He was fat, but I hung out with a mom of frighteningly finicky eaters. I hung out with mothers of finicky eaters.

Small 9-month-old is too busy to eat

Sept 2007

i need some help with a very busy 9 month old. she is extremely small - less than 5% on the charts. she was born normal size, but we are struggling with getting her to eat. she isn't starving, she just can't bring herself to focus on food during the day. here is what i think is going on and what i need advice on:

she has a 2 year old brother who she adores. she watches him constantly. she really wants to walk, too, and is excited she can stand up. so when i put her in her chair to feed her, she gets a few bites in (since she is obviously hungry) then once she has enough to curb the hunger she starts to stand up - even when strapped in! she is thin and tall and works herself out of her straps. i put her back down and gently say, ''no, no.'' but she can't stop. she doesn't have the capacity to understand that. all she can see is her brother and she wants to stand.

the problem is, she is so hungry and makes up for the calories lost at night with 2-3 bottles. my husband is tired (i can't get back to sleep after the bottle so he is doing it. oh yeah, she cut me off the breast a few weeks back since it was taking to long - even in private).

i am just having a tough time with her and sometimes i get really frustrated since any type of food or milk is a balance of keeping her involved in a game, but not too excited so she gets distracted. anyone else have this issue and were you able to solve it? my son was sleeping thru the night already by about 6 months and i can't deal with it much longer. she is really sleeping well (weissbluth baby at two good naps -one at 9am and 1pm then bed before 7pm, up for day at 7am), so it isn't a nap/sleep issue (she goes right back to sleep after late night bottles). just a calorie issue. thanks. beth

I could have written this! My son wouldn't sit for a second in his highchair. I actually had to tape the straps together so he wouldn't fall out. Nothing worked and like your child he was pretty tiny and he has an older sibling whom he adores. Solution? I took the tray off of his chair and pulled him up to the table (just like big sister) and he has been eating in his chair with little problem. I also give him his own spoon to eat with which he loves as well. He now eats with us with little problems. Good luck. eat up kiddo!

My daughter was very busy as an infant/toddler. She was in the 3rd percentile for her weight and barely ate anything. I tried coaxing, distraction, reading during meals but she ate what she ate despite my best efforts. I was worried about her being so skinny and worried about passing on my own food issues by ''forcing'' food on her. The best advice I received was from our pediatrician. He was never worried about her size. (She was perfectly healthy and developing fine.) He reminded me that babies and toddlers are instinctual creatures and will not starve themselves. I eventually decided to trust in these instincts. My daughter is almost 3 now and has gained and grown beautifully and still is not that interested in food. I think your baby will eat when ready and hungry. All you can do is continue to offer food and model good nutritional habits! Mother of a Bean Pole kid

My baby was busy too. You either need to set strictly enforced meal/snack times with her on your lap or you need to do what I did--follow the baby around and pop food into her mouth when you get the chance. This isn't as much work or as dangerous as it sounds. Now my baby is 4 and sits at the table and eats well. Some kids are just busy. If she really wasn't getting enough to eat, she would be sick, listless and unhealthy. hs

Underweight 14-month-old - Pediasure Alternatives

May 2007

My 14-month-old is 5th percentile for height but 2 pounds below the minimum target weight. I met with a nutritionist at Kaiser who said that I need to increase my child's calories by 110-260 per day to catch up. She mentioned that Pediasure would be one of the supplements I could give, in addition to a higher-calorie diet, with lots of fats. My question is, are there alternatives to Pediasure? It's just that I looked at the ingredients and it's so full of sugar, which I'm trying to keep low. Anything out there without too much sugar and no trans fats? Skinny Petite Mom

Our son was also underweight when he was 13-15 months old. At that age he only wanted to nurse and had eczema and a number of food allergies. We increased his weight by feeding him homemade foods and smoothies with a high fat content -- eg. avocados mixed with bananas and rice milk or cereal. We also used ghee (as a non dairy fat) liberally. Our child is allergic to nuts so we weren't able to use those; however if your child can eat them, they are also a good source of fat and protein. They can be liquified and used in good tasting smoothies. sympathetic

Olive oil in/on pretty much everything was my answer. My daughter was not on the weight chart until age three while always falling near the top (75% plus) in height. She had a milk sensitivity during until 13-months, so I was pretty limited (no cheese for her) in what I could do...make scrambled eggs in a pan with olive oil, toss in some chunks of avocado...the perfect breakfast (or lunch or dinner). Always use regular milk -- don't go to 2% at age 2.

Pediasure has about twice the calories of milk, if I remember correctly (we did use it for a while when the milk sensitivity went away -- it became an addiction that took a while to break - and my daughter still won't drink white milk unless it is from her cereal), so it really doesn't take that much to get the calories up.

My daughter is now 4 and is about 25% on the weight chart (still slim enough to wear '9-months pants' to soccer, but big enough that my doctor doesn't give me grief. -been there there's a thread/''tribe'' at mothering.com forums, called ''Parents of 'small' or 'skinny' babies'': http://www.mothering.com/discussions/showthread.php?t=92716

pages and pages of discussion of dealing with slow growth and small size and medical obsession with ''disease-ifying'' it, as well as looking into the issues that might contribute if there IS a problem (allergies, celiac disease...). my rant on pediasure is post #297. cheap oils, corn syrup, cooked milk protein and vitamin/minerals. and it gets them used to the idea of a ''milkshake'' being good for them.

good for high calories: oils: olive, coconut (my kids will eat it off the spoon), cod liver oil (comes in flavors, now, peach, orange, lemon), flax seed. foods: avocado, coconut, dried fruits, nuts, cheeses, salmon.

and try supplementing in water with trace minerals. i use ''ConcenTrace.'' http://www.traceminerals.com/products/drops.html just 2 drops/8oz, i slip it into their cups or the water jug on the table, and they (5yo and 2yo) don't notice it anymore (initially the 5yo did). i also add it to cooked cereal, soup, pancake batter, ...anything that has liquid cooked into it. it is utah sea salt with the sodium removed, so it has all the trace minerals that are lacking in our soils today (food today has ~25% of the mineral content of food grown 100 years ago). signed: mama of little/skinny babies

Worried About My Small Toddler

March 2007

My 21 month old boy is on the small side (20/30th percentile). He's been small for his age since 6 months and I have always worried about his size even though he's fine medically. I'm looking for some reassurance here. Will he always be tiny? Has anyone had a small toddler that has shot up later? My family is on the small size (me= 5'2'') but my husband is 6 ft tall. Our Doctor says there is really no way to know and that he is right on track developmentally regardless of his small size. Its just so hard when EVERY little boy his age or several months younger is much bigger then him. It breaks my heart. I sometimes think its because he doesn't drink much milk. He never did--even as an infant he just didn't guzzle it down (bottle or breast). These days it's around 6 ounces a day at most. But our Doctor says milk is for calcium, not growth. He eats/sleeps well and is developmentally right on target, but I can't help worrying that he will grow up to be a tiny man. There's nothing wrong with that --most of my male relatives are shorter. I just wish I met other boys his age that are his size. Any moms out there with ''little boys''? Advice and reassurance would be great. -Mom of a Little Guy

We have a ''vertically challenged'' boy as well with a Dad who is 6'2'' and Mom who is 5'5''. We were surprised that he hasn't broken out of the 25 percentile, meaning that he will likely be between 5'5'' and 5'8'' as an adult (he is 4 1/2 now and on track or advanced in every other area). I know that many people worry so much about height (correlation with success has been proved in many studies) that they even consider growth hormone - I don't think you're in that category since 25% is still a normal range and administering growth hormone is a very invasive procedure (that only works in certain cases).

If it's helpful, I broke my concern down into two issues: 1) Is there a health problem (besides not drinking enough milk), such as lead poisoning or an undetected illness? 2) Will his height negatively impact his self-esteem/success etc.? Make sure you check with your pediatrician and maybe ask if you can do a lead test and/or bone scan (to see how the bones are growing) and that might quell your concerns about #1. Also, a friend of ours mentioned that height often skips a generation; our son has a grandfather who is 5'8'' (and a male cousin who is also 25%), so that may be the reason.

For #2 - we're finding that even though our son is shorter than all of his peers (except one or two girls), he still commands great respect from friends, perhaps due to his verbal abilities, sense of humor, and high energy level. We even coach him on what to say if people call him ''baby'' - ''Actually I'm four and a 1/2 and will be five in August. How old are you?''

Also, there's still the possibility of a big growth spurt later on! I hope this is helpful! Good things come in small packages

I don't have any encouragement, since my son is younger than yours, but can just empathize. Mine started out small, gained lots of weight quickly, and then dropped off so that he's now proportioned small and skinny at age one. His Dr. says he's fine- he's active, eats well and is developmentally on target-but I hate when people think he's younger than he is or I see him next to chubby, larger babies. I too wonder how it would be (more so than with a girl) if he stays small like this, and I worry about it. I guess some kids just have to be at the lower end of the curve, but I can totally relate to what you're thinking. I was always teased for being short as a kid myself, but it's no big deal to be a short adult. I just didn't think since my older child is on the large side of average that I'd also have a ''skinny mini.'' mama to tiny tim

All due respect--your pediatrician says your boy is healthy. Take joy in that and lose your hang-up about his size. You are risking the very real possibility that you will teach him to feel inadequate about his body. That could be devastating--with many unintended negative consequences for your son. If your son is destined to be ''shorter'', wouldn't you rather he be a confident, self-assured ''shorter'' man? By the way, you cannot accurately predict adult size based on toddler size. Offer him a variety of nutritious foods and he will naturally grow to his largest possible size. --sympathetic sister of a ''shorter'' man

Oh yes, there are other small children out there. Our 2.5 yr old son is consistently in the 10th percentile for weight and mid range for height and it's hard to find pants for him. He is perfectly healthy. Us parents are rather slim and average height. Being European I've never quite understood the competition and anxiety around the growth chart figures. It sounds like your little one is doing great, why worry about abstract numbers? We all come in all shapes and sizes and that's part of the beauty. Lightweight

My younger son is very small as well, possibly a lower percentile than yours. He's three years old now and is the smallest in his class BY FAR. Right now I'm really enjoying how tiny he is because I can easily carry him and he's so darn cute! I'm not worried about him because he has a fabulous personality and tons of confidence. My husband is 5'4'' and he does not have a bit of a Napoleon complex. He's very athletic, is very charismatic, and does not have negative feelings about being short. Please don't worry about your son, if you have bad feelings about his stature, he will too. Mama to mini man

When one of my best friends was hospitalized, her two girls came to stay with our growing family. When it turned out that she'd be hospitalized for a very long time, I became her girls' guardian. One girl, like her dad, was very tall. My friend called her younger girl ''The Hummingbird Child,'' so our growing family continued to celebrate our tiny new child. Both girls grew up smart, honorable, hard working, and pretty. Now, both these delightful women have completed college, had significant careers, married wonderful men (6'2'' daughter married 6'7'', 5'2'' daughter married 6'0''), and given birth to really great children. Our ''hummingbird child'' has a really short daughter, another ''hummingbird child,'' who, like her mom, is 100% comfortable with being short, smart, and a really great person. We hope you CELEBRATE the JOY of having a WONDERFUL CHILD and don't worry about how ''big'' he/she is ! GrannyAnne

Please don't worry too much about your toddler being small. My husband was on the smaller side until 10th grade then he shot up a whole foot in one year from 5'2'' to 6'2''. I'm serious! Then he had to deal with being SUPER skinny and gangly. He had chunked up a little before the growth spurt too, and remembers feeling self conscious about that due to comments in the family. Please don't fuel any self consciousness in your child. I know people of all shapes and sizes that are happy and productive people as adults. And people of all shapes and sizes who aren't. Most of this has to do with how their parents raised them to be in the world and how they were supported as emerging human beings. *Husband was once a shorty

If your child is in the 20-30 percentile, he is really NOT tiny! It seems you happen to know mostly larger children, but by definition, at least 1/5 of boys his age are even smaller. Think of it this way - in a kindergarten class of 20, he'll be bigger (on average)than at least five other kids. If he's growing ''on/near his curve'', he's just fine. And as others have said, there's really no way to predict adult size at this stage. Lastly - even if he does end up to be a shorter-than-average man, I'd hope you'd love him all the same. R.K.

One-year-old has hardly gained any weight in the last 6 months

Sept 2006

My daughter turned one year old recently. She was of normal weight at birth, and had a normal weight gain till six months when I started adding solids and also moved into our own apartment (previously with my parents). She settled well, so there are no anxiety problems - I just mentioned the change for completeness. Her appetite has been pretty poor and its only now that she is taking some food without my pulling my hair out over it. However she has hardly gained any weight in the last six months. The pediatrician says to wait some more time before investigating, as her activity and milestones are normal. My feeling is that if I can get her to drink milk thrice a day, it will help, but I just don't seem to be able to do it. She has a peculiar habit of falling half asleep first - she sucks her thumb while I rock her in my lap - and then latching on to the breast. She has been doing it since about a month of age. Anyway, I tried giving her the bottle before or after the breast but she pushes it out. Also, as the time taken to fall asleep is so variable, I have not been able to maintain the right temperature for milk. Have tried sweetened milk, milk with chocolate flavour Bournvita, cold milk, Lactogen, everything I can think of. She doesn't yet drink from a cup, but I have still tried that. She doesn't like the taste, thats all. She doesn't even take any juice. She used to like yogourt but has stopped for a few months now. Cheese is the only thing she seems to like, and it makes a part of each meal of hers. I just don't know what to do. I have no problems with continuing to breast feed but I don't think it is enough, and she has the feeds down to three or four times a day anyway. I wanted to stop her sucking her thumb too, but that is a secondary issue. Does anyone have any suggestions? At wits' end

My son also has weight gain issues, and the transition from liquid diet (breastfeeding) to solid diet was especially stressful for us. So, I wanted to share with you a few things that have worked really well for us--my son gained over a pound between his 12month and 13month check ups. From your posting, it was unclear whether or not you are letting your child self-feed finger foods. Part of the refusal over the bottle might well be a matter of your daughter wanting to express her independence. Anyhow, after getting some good advice from BPN, I started putting my son in his high chair with four or five pieces of cut up food in front of him. An egg scrambled with milk and cheese (cooked in the micro for 1 minute) cut up into 1/2 inch squares is his normal breakfast (he often eats the whole egg this way), plus some banana. He also really likes toast with cheese and butter melted on it, again cut up into 1/2 inch squares. Home-made mac and cheese spooned out in little clumps has worked great also, and meatloaf often is readily accepted too. But he does NOT drink much at all during the day. He'll take a few sips of milk, or a few sips of water from my cup, or a bit of juice here and there, but definitely he gets his nutrition from FOOD. That just means I have to serve him really fatty, nutritious food all the time. At one year of age, you should also be expecting your daughter to be getting most of her nutrition from food, rather than liquids. It was a frustrating transition because he wouldn't eat well and wouldn't drink well either at first, but it only took about three weeks of me cutting back on breast feedings and other liquids for him to become a champion eater. Good luck! Been there...

One is fine to start using sippy cups. You don't say if she is walking yet. But chances are when activity increases so will her appetite. breast milk and solids are fine for children. my daughter never liked cows milk, except for little sips of strauss's organic (which tastes good even to a non milk drinker like me!). Rice milk in small amounts is fine, too. get the enriched, unsweetened kind. older children are efficient nursers. i wouldn't worry about milk or teaching bottle use if you child is eating and nursing at one. think cups and introduce more solids. anonymous

Sorry about the feeding problems! You may wish to try Silk brand vanilla soymilk, which seems for many babies to resemble breast milk the most in taste. (It's also widely available (Whole Foods, Albertsons, etc.) Also, I don't know if you've tried a sippy cup or a regular cup, but if you haven't tried it, the Avent sippy cup with the ''transitional'' soft spout might be useful, as it can be sooothing for teethers to chew on, much like a thumb. Finally, and as a worrying mom myself I know this is hard, if your pediatrician isn't worried, try to relax and not stress about what your daughter eating or not eating. If you keep offering her different kinds of healthy food every day, it is extremely likely that she will eat enough for her nutritional needs. anon

Thanks to all of you who responded. Feels good to know that I am not alone, and I will try out the suggestions outlined. Sometimes my daughter is pleased with finger foods, and at others, she doesn't want to eat at all, but perhaps I ought to be more consistent in offering her these, and I haven't tried the eggs before. She is now 14 months old, and walking for more than 3 mths, but has gained only 1.3 lb in six weeks. Still its an improvement. She seems disinclined to even take breast feed now, so maybe it will dry up on its own, and she will switch to food/milk. Keeping my fingers crossed!

Tiny one-year-old son

Sept 2006

My one year old son has never been bigger than the 25th% for height, but has gradually dropped to the 5th. This is quite alarming since his dad and I are both 6 feet tall and his 3 year old brother has always been at the 90th. Also, he's always been a lackluster eater so his wt. stays around the 25th and he has a number of food allergies. His pediatrician isn't worried as he's still in a ''normal'' window/pattern. One friend who's a nurse recommended we see a pediatric endocrinologist. I'm hoping someone out there can share their similar experience (w/their now 6'5'' son!?) so I can worry a little less. cv

Our first child who is now 2 1/2 years old was always (and probably still is) in the 5th and 25th percentile for height and weight. Our second baby, who is just a few months old, has always been in the 75th - 90th percentile. Go figure! If your pediatrician is not worried and if your child has continuously been around the same percentile, he/she should be OK. It's when your child either goes up or down drasticallly in the percentile range that you should be concerned anon

I don't have a 6'2'' son (yet) but I wanted to tell you that my son sounds a lot like yours when he was 18 months old. He started at the 25th % for weight at birth and just kept dropping until he was literally at the 0th % at about 18 months. His height did the same, though not as dramatically. I was a little worried but the dr. said not to be worried that as long as he was following the same general arc on the growth chart, all was well. His development was on track, so I let it go.

Well now he is 3 and is 50% for weight and 70% for height. Somewhere in there, he caught up.

So my advice is that if your baby is on track developmentally and the growth is following some general arc on the chart, let it go for a bit, especially if you're not worried. If you do start to worry at any point, you can always go see a specialist but it doesn't sound like you're at that point right now.

Good luck! Been there

Underweight 9-month-old

Dec 2005

my son recently had his 9 month checkup. he weighed in at 18.5 and 28.5 inches. it put him at 15% for his weight and 50% for his height. no one is concerned but me. our ped said not to worry...PLEASE CAN ANYONE HELP. he is our second, and i am totally lost as to what to feed him. we are super healthy, organic eating, but my lil guy will have his good days and bad days. for a day or two he'll eat really well, and then he'll fall off for a few days. he'll only have a couple of bites and than he gets frustrated. and then i give him something else, and again a couple of bites and he's frustrated. any advice would be gladly accepted....PLEASE. i am running out of ideas for food and snacks! he is teething, doing well w/ it. he is learning how to walk and he is super active. he is a very happy baby, except when he wants to eat and when he's tired.... go figure. thanks and i can't wait for the responses!

Your child is not underweight. Those growth charts are an average of children's growth patterns. Some kids are at the high percentiles, some kids are at the low percentiles. My first child has always been 50th percentile for both height and weight, but my second was in the lower percentiles for both. She weighed 17 lbs at one year. She was just a small kid. Now she is 5 years old, happy, healthy and 50th percentile for both height and weight. As long as your child is thriving, and not going down to 10th, 5th, 1st percentile in successive months, he's probably fine. Besides, count your blessings -- bigger babies are harder to lug around! Been There, Done That

I know that you are worried, but everything looks fine. He sounds like a perfectly normal toddler. Most toddlers eat lots on one day, and then not much on another. I have heard many times that we should try to make sure they have a balanced diet over a week (because they don';t eat much on some days) not over a day. My son (15 months) eats like crazy some days, and then not much on others. His 2.5 yr old cousin is 90% percentile for height but only 10 or 15% for weight. She is happy, intelligent and active (and skinny!) and only eats sometimes. Such is life. You say your son is super active, healthy and the doctor is not worried, so it sounds like he's doing great! Also, from everything I hear, there are so many health risks to being OVERweight that perhaps you should be happy that this is something you won't have to worry about! As for what to feed him: give him whatever you are eating. If you eat well with a varied diet, then he will be introduced to all sorts of yummy interesting things. We give our son whatever we eat (except for really spicy food which will make him cry) and he likes most of it. Also try: avocado, veggie burgers, niman ranch hot dogs (with no nitrites), veggie booty, different cheeses, yogurt, cottage cheese, cucumber, steamed veggies, tons of different fruits, veggies from soup, pasta with yummy ingredients (chicken and veggies), etc. Please relax. Things sound fine. Anon

My daughter (now 2) has always been 75% height and 10% weight. I've never been worried and her pediatrician says she is growing/doing fine. Pushing food on a child who is full just makes food a battleground which can lead to all sorts of other problems. From what I understand, the concern is if a child has a sudden change in percentile i.e. she always weighs in at 50% and she suddenly weighs in at 10%. As long as she is eating healthy foods, maintaining her position on the growth charts, and your pediatrician isn't concerned, it sounds like she is getting what she needs. Lisa

You sound really scared. But really, if your ped. is not concerned, maybe you can relax. A friend once told me a story of taking his infant son to the pediatrician, where he weighed in the 10th percentile while his height was in the 90th. He asked the pediatrician if they should be concerned, and she laughed and asked if he was concerned about his own perentiles--he's very tall and thin and absolutely healthy! Remember that healthy people come in all different shapes and sizes! As I understand it from our pediatrician, if your child is growing--both in weight and height--that is much more significant than actual percentile score. Try to relax and enjoy your baby-- he may just be a thin one. Carolyn

Regarding your worry about your ''underweight ''9 month old. Our first child weighed in, regularly at 40-50th percentile for height and under 20th percentile for weight until he was well into elementary school. We were, at times, concerned but we were also reassured by our pediatrician. He was a skinny, wiry boy. We took out his baby book this past week and were laughing about the growth chart. At almost 25 years old, he is now a strapping beautiful man--tall and lean and healthy. I join your pediatrician in not worrying about your son. If your pediatrician is correct and unconcerned then I will assume that your son is healthy. In that case, I would make mealtimes much less important so there is less frustration for all of you. Barry Brazelton, MD, a beloved author and pediatrician suggests not getting into food struggles and not worrying about nutrition. He says that children need a minimum of nutrients including (for a 2 year old) only the following for a daily diet: 2 cups of milk or its equivalent, 2 ounces of meet or one egg, one ounce of fruit or juice and a multi-vitamin. This is not very much food. For a 9 month old, even less would be required. Our kids need less food than we think. What they need most is a relaxed attitude from parents so they don't need to use food as a tool in their inevitable struggles for independence. Your child will learn to feed himself and this must be his skill to master. Be careful to not get locked in a power struggle around food. He will win. I know this sounds difficult, but you must become relatively uninterested in what he eats--neither anxious nor praising. Learning, as parents, to manage our own anxiety around kids and eating is a very worthwhile struggle and will extrapolate to many other places where children need to be encouraged toward self-reliance. Good luck! Heidi

My little girl is also underaverage in weight - she weighed only 15pound 5 ounces at her 9 month appt and was a full term baby and is healthy. The ped was generally unconcerned too and I'm trusting her experience. Like your son, my daughter is VERY active (walking at 9.5 onths) so she's burning a lot of calories. She's hittin gall her developmental milestones on target or a little early so her weight is not a problem with physical or mental development. The one note her doc did say was to increase her fat intake so we now add cream cheese or olive oil to many dishes before serving her. tall mom to tiny one

My son is almost 11 months old and weighs a little over 17 pounds. He is healthy, active, developing well, and we are not worried that he is small. If your little guy is doing well and your pediatrician isn't worried, then he is just fine. For the first year of life, a baby can live healthily on breast milk or formula alone. Solids are for fun and learning, not a main source of nutrition. So relax about his eating and enjoy his small size while it lasts. The way I see it, some babies are at the bottom of the growth curve, just as some are at the top. It's all normal. Besides, think of how much money you are saving on baby clothes. ;-) Mommy of another little guy

WHY ARE YOU WORRIED? 18.5 pounds and 15% is NOT underweight!! He's fine! Everyone is trying to tell you that, but you don't want to believe that- why not?! You will absolutely create a weight problem in your child if you don't have a reasonable understanding of normal- he's in the normal range! He's growing, he's gaining weight, your pediatrician says not to worry so let it go. He's not going to starve. If his growth pattern changes, then worry, but really, stop worrying about food and him. My daughter was 3% at 12 months, 3% at 24 and 36 months and then 98% at 4 years and remains there 3 years later. I have two other children with completely different growth patterns and eating patterns and the only thing I know is that worrying does absolutely not good. Offer food choices and if he seems to go days without eating, so be it! He's fine! Don't create a problem!

My son spent the time between 6 months and 2 years at the 25th percentile for weight and the 75th percentile for height. He grew a lot. Some days he ate a lot, some days not so much. He was active and happy, pretty much on target developmentally (although kind of a slow walker). He was still ''underweight'' for his height. The pediatrician said not to worry.

And the pediatrician was right. Somewhere in there his weight caught up to his height. Now he's 4, and his weight and height are both at about the 85th percentile. He eats almost everything. He's an amazingly healthy kid (I've been sick more times this last year than he has).

I think if you just keep on as you are -- offering him milk or formula, and healthy food, at regular intervals (including whatever it is you've noticed he usually likes) he'll be fine. Really. Americans get a little too worried about underweight kids, unless the child's weight is steadily falling off the curve (meaning the percentile doesn't stay steady, but keeps getting smaller -- if your child's weight stays at the 15th percentile he's developing steadily). Karen

Your ped is right--your baby is not underweight. Every baby can't be at the 50th percentile, right? At 9 months, my son wasn't even on the charts and now he's a wonderful, normal, healthy 4-year-old. And now he is actually around the 50th percentile. No need to worry. anon

Hey there, Sorry to hear that you're stressed about this. My son is eleven months old and is about a pound below the first percentile for weight - 16lbs 3 oz at a checkup at almost 11 months, about 10th per. for height. His doctor was slightly concerned at his 9 month checkup, but completely satisfied at this most recent one. Granted, kids can be underweight for lots of reasons, but if your doctor is saying don't worry, I wouldn't worry. In our case our son was born 2 1/2 weeks early (at home) at 5 lbs 10oz and has just remained small. His dad and I were both really little kids, and have grown up to be normal size people. Because our pediatrician had some concerns, we have spent a couple of months focusing on getting lots of calories into him. He's a wiry little kid and isn't all that interested in food, though he doesn't seem to be picky. We may not be as organic and healthy as you are, but here are some of the things we've had success with: Adding butter or oil to almost everything (this was the pediatrician's suggestion) Whole fat yogurt High fat cheese (i.e. cheddar, not string mozzerella) High fat meats (kosher hotdogs, ham, dark-meat poultry) Avocado Hard boiled egg yolk Juice and formula/breastmilk during and between meals Feeding three main meals and several snacks each day Beans, potatoes, sweet potatoes or squash, with butter or oil mixed in. Basically, we've aimed for calorie-dense foods. I'm currently working on getting him to eat more finger food, but find that he doesn't eat much unless I spoon feed him baby food. We do a lot of baby food meat with butter mixed in. We mainly give him healthy snacks, but do not shy completely away from things like cookies and the occasional doughnut hole. He loves banana bread. These suggestions may not all work for you, but I hope some help. Good luck, and try not to worry. al [at] davepmiller.us

Hi, I just wanted to reassure you about your son's weight. If the pediatrician has checked him and hasn't found a problem, try to relax. Kids have different body types. My daughter was almost the same at 9 months - just over 29'' and 16+ pounds. She was about 40% for weight and 85% for height (or so), and below the lowest percentile on the weight/height ratio. And now, at six years old, she's pretty much exactly the same. I just checked the CDC and saw that she is at 5% on the ratio chart, at 42 pounds and 46.5''. She's just tallish and slender, and I really think that no matter what she ate, she'd stay that way. She's not skinny - she looks and is very healthy - it's just her body. And I wouldn't be surprised if your son is similar. Trust your son, and trust your pediatrician, and give yourself credit - your son is doing fine! Nancy

Rest assured that there is nothing wrong with your son's weight. My now 22 month old daughter has consistently been in the 15th percentile in height and weight since infancy, while developing very well the whole time in all aspects of development. My very experienced pediatrician, who's been at Kaiser for over 30 years, explained to me that the important thing is consistency - that children don't jump all over the charts in height and weight over time, rather that they grow consistently within whatever percentile is right for them. My 15th percentile kid is healthy, strong, energetic, growing steadily, developing very well for her age. She fluctuates in her appetite, depending on growth spurts, teething (which can drastically decrease appetite in kids), how busy she is doing other things, her mood. I've been told several times by different people that children won't overeat, nor will they undereat - so I trust that she knows what she needs. I can recommend a great book called Super Baby Food by Ruth Yalon. She explains that children actually need a lot less than we think - between 12-24 months, that can be as little as 2-4 tablespoons of food per meal. She also has great meal and snack suggestions. Babies and toddlers have stomachs that are still very little, and their digestion is still developing. And they are still learning how to eat, which can often be frustrating and more challenging for them than we might think. Your son sounds like he's doing great, thriving, healthy and totally normal. Honestly, I wouldn't worry. I wouldn't say he's underweight at all. Mom of another smaller and healthy kid

Low weight 14-month-old twin

Jan 2005

I have twin 14 month old girls. One girl is a great eater and the other hardly eats anything. I am very worried about the picky eater as she is barely 20 lbs. I feel like I must be doing something wrong and would like to hear about other toddlers eating habits and schedules. I still give my girls an 8oz bottle of milk upon waking and then breakfast usually about 1 hour later. When is the right time to stop the bottle? Could this be contributing to not eating solid foods? Her usual breakfast consists of 4 bites of either french toast, waffles or cereal. The only fruit and veggies she will eat is out of a jar. I would love to hear from other mothers who have a similar issues...... Sandra

Where does your lower-weight daughter fall on the growth chart? how does her weight compare to her height? Weight alone is not telling... a month ago, at 15 mos, my daughter was 19 1/2 lbs, and was in the 8th percentile for weight, 50th for height. She looks absolutely normal and I'm not worried in the least. Nor is my pediatrician. Is your pediatrician concerned? My best advice is to get the book, ''Child of Mine: Feeding with Love and Good Sense,'' by Ellyn Satter. It helped me immensely in understanding infant and toddler eating, and how every body type is different. The message is basically: you are responsible for WHAT foods you offer your child and WHEN they are offered, and your child is responsible for WHETHER and HOW MUCH to eat. The last thing! you want is to express displeasure or discomfort while feeding your daughters-- you want to relax and be happy with as much or as little as they eat--at this age, their bodies know how much they need. Specifically to your question, you might want to offer food simulataneously with the morning milk, to give your daughter(s) a chance to eat food to satisfy their hunger, instead of filling up with milk. Not that there is anything wrong with getting lots of milk, but she may be picking at breakfast because she isn't that hungry at that time, since she just drank 8 oz of milk. I offer my 16 mo. old daughter milk in the morning and have her breakfast (usually fruit and toast) ready within a few minutes after that, usually before she has time to finish her 6 oz cup of milk. I then offer more milk and a snack about 2 hours later, or sooner if she wants. Then, I make her lunch after her nap, followed by ! another snack and milk in the late afternoon, and finally, dinner. That schedule allows my daughter the opportunity to eat about every 2 hours. Some meals/snacks she eats a lot, other times, not so much, and sometimes, not at all (which is why I don't slave over her meals! just keep it easy). Best of luck. A Relaxed Feeder

18 month old under weight

Sept 2004

Our 18 month old daughter has never been a very big eater, and ever since going from formula to solids has been VERY picky about what she eats. For a time I was very frustrated by it, but she is healthy and happy, so I am trying to ''go with the flow''. Here's the problem: At her 1 year appt she was at the 30th percentile for height and about the 10th percentile for weight (she weighed 18 lbs.) She came in the next month for a virus and was just a few ounces away from 20lbs. When she came in for her 15 mth well-child check she had lost about a pound and was down to 19lbs. This put her between the 5th and 10th percentile. I should also mention that she was walking well by this age and is VERY active. Her doctor put her on two cans of Pediasure a day to help her gain weight. I was fine with that since she does not eat much at one sitting and does not like a wide variety of foods (even though we have tried to expose her to many different things.) I felt the supplement was needed to help maintain good nutrition.

She just went in again for a weight check (she is now 18 mths) and has gained about 1 lb. Her height right now is 30 1/2 inches. Her doctor says she should weigh at least 23lbs and has told me to give her exclusively Pediasure, no milk and no water as far as liquids to drink.

Should I really be concerned about this? I like this doctor, but my daughter is healthy and her height is progressing fine. Her father was very thin as a child and didn't put on much weight until after 35. Both grandmothers are also very thin. Our child is smaller than some of the other children in her daycare, but I think she is just petite. She does eat chicken nuggets and fish and likes different kinds of fruit. I think she is eating better then she has in the past.

I don't want to go against my doctors advice, but I'd like to hear some other opinions on this. Danielle

My 17-month old is underweight as well, but the pediatrician is not overly concerned, even though she dropped off the weight chart months ago. She is just 20 pounds now. From observing her, he says that she probably just burns off every calorie that she eats (I am not sure that she has actually stopped moving for more than a few seconds since she was born -- kidding. She is very active, though.). My pediatrician suggested that I give her pediasure instead of milk and try to sneak extra calories into food whenever possible (making a hamburger? don't grill it...fry it in olive oil). Other Mom's who have encountered similar situations have suggested milk- shakes or ice-cream as afternoon snacks rather than always reaching for raisins or other healthy foods.

Another pediatrician in my daughter's practice sent her in for a bunch of bloodwork and other tests. All of which came back normal. -not stressed

I would not worry. My daughter went from 50% at birth to about 10% at 18 months. She has never been a big eater. She was 17lbs at one year and now is 21lbs at 18 months. Her doctor said as long as she stays on the same curve (whether it is the 50th percentile or the 10th) that is a good sign of growth and development. He said he would not be concerned unless she fell off her curve consistently. My daughter seems very happy and healthy despite her low weight. We do have to make an effort not to force her to eat though. It is hard but we want to let her decide for herself how much to eat. Good luck. Judy

My daughter is 16 months, and probably just weighs over 18 pounds (at 15 months, she was a few ounces shy of 18 lbs)...she has never even made it on the charts for weight (under the 3 percentile) since she was a couple of months old. She is in the 50th percentile for height. But, she is exceedingly active, happy, and healthy. Although we've worried about it on occasion, our doctor has never felt concerned. As long as she's ''progressing'', he's very happy with her development. He has even warned us that she might not gain more weight (or even lose a little) over the next few months. He has never suggested changing her eating habits (she's a fairly typical toddler, I think -- some good days, some bad) or drinking something like Pediasure. Personally, when it comes to eating, I think you should trust your instincts -- if your daughter seems happy and healthy to you, she probably is. You may want to get a second opinion from another doctor. Unless there's some other underlying health concern, your daughter may just be petite. Petite mom and baby

Our situations are similar, so I completely understand your concerns! Just yesterday, I received information that might shed some light on the mystery of my son's inability to gain weight; possibly something you'd want to look into.

A little background: I'm 5' and my husband is 5'6S. We both come from petite families; my mother-in-law is 4'10S and my sister-in-law, who's 16, is also very tiny for her age (she could pass for a 13 year old). My son is almost 22-months old and he's barely on the growth chart; his stats are 29'' and (almost!) 16lbs. (still facing backwards in his carseat!). He's not a very picky eater and also extremely active; he just can't seem to put any weight on. He is most definitely healthy and happy, so in order to not excessively worry, I'm constantly repeating to myself what I keep hearing from others: Rhe'll eat when he's hungry - he just has small genes - he'll plump up when he's older - be careful what you wish for, etc.S

Since infancy, he's been through a series of regular visits (and tests!) with specialists because his pediatrician is (obviously) concerned about his growth and made the referrals. The endocrinologist we see at CPMC in SF seems to be fine with his gradual, albeit slow, growth; outside of his physical size, he's healthy and developing RnormallyS (language, motor skills, etc.). She feels that his size could very well be genetic, and he may have a late growth spurt (as late as the end of high school). The gastroenterologist, however (also at CPMC), isn't as comfortable with his slow growth and prescribed the same routine as your daughter's: no milk, exclusively Pediasure. Taking the milk out of his diet has been difficult as he's finally drinking more and more without our asking. When we started the Pediasure (with literally a splash of it in his milk, in an attempt to wean him off of it), he refused it completely and didn't drink anything but water for two days! After experimenting with different flavors, we found that he likes chocolate, so although he's not drinking the 16oz. that the specialist would like or completely off milk, he's at least asking for Rchocolate milkS more regularly. Now, it may be my imagination, but in those few days, he actually did feel a little heavier! We were still in the process of trying to get him to drink Pediasure exclusively when we received some news -

Yesterday, the results of his allergy tests came back and it turns out that he's allergic to egg whites and milk! He's not highly allergic to the point where he'd break out, but because his allergies are in the low-moderate levels, it's enough for the gastroenterologist to suspect that the internal reactions are affecting his digestion/absorption of nutrients/calories, and possibly, inhibiting weight gain.

What this means for my little man is that he, for this Rtest periodS of two months till he sees the specialist again, cannot have the things he loves (that contain whey, lactose or casein): mac & cheese, cheese, yogurt, scrambled eggs, pizza, ice-cream, pudding...the list goes on. It's a consolation that there are soy products and such that we can use as substitutes, so we'll see what happens.

Like you, I don't want to go against the doctor's advice, but because my son is healthy and RnormalS otherwise (and also because I'm still in shock from this news!), I can't help but be a little reluctant. The way I look at it though (as the information slowly sinks in and I accept it), this RplanS won't hurt because he's still eating and getting calories and nutrition. He will definitely not like this change in his diet, but if it helps unravel the mystery of his weight (or lack thereof), we'll all just make the adjustment. If nothing happens, then back to the drawing board.

I'm probably being more dramatic about the news of his allergies than I need to be, and I realize that it could be worse, but, wow, those test results were so unexpected! I think it's just going to take a while to sink in. Perhaps your daughter may have a similar allergy? Worth researching if you have the time. Here's a link I've found helpful: http://www.foodallergy.org/

Good luck and please feel free to email me!

Healthy(!) little guy's mom, Anna

Underweight 10 mo. old refuses food

June 2004

We have a 10 month old boy who has been falling off the chart since he was 2 months old. He is below the 3rd percentile now for weight.His height and weight were both 50th when he was born and his height is still average. Neither my husband nor I am petite. He is hitting all his milestones just fine and is very active.

He seems to have had reflux as an infant but was not diagnosed at the time(breastfeeding was always very erratic and uncomfortable for him and he never took the bottle). He wasn't interested in starting solids for the longest time and so we didn't push him. But since his growth was slowing, we finally started to worry around 8 months old when he still didn't want to eat solid food.

When he finally decided to start eating solids he would sometimes eat pureed table food (two bites) but mostly only wanted finger food. However, with anything that doesn't completely dissolve, he would gag and vomit all that he had drank/eaten. He now eats only two things: Trader Joes Vegie Sticks and Cheerios. Both dissolve completely. We have been referred to the nutritionist, gastrointerologist, and the pediatric occupational therapist (but the appt. is not for another 6 weeks!).The GI has told me to wean and has him drinking (from sippy cup)high calorie soy formula with added calorie booster so that what he does drink will be very high fat/calorie. She also prescribed prilosec for the suspected reflux.

I have a feeling, due to his inability to handle anything that doesn't completely dissolve,that he has some sort of texture sensitivity or oral motor problem going on. Has anyone else out there experienced these problems, in this combination? Any suggestions regarding very fattening finger foods that dissolve?

I am no expert, but I would be very careful about weaning your child from his main source of nutrition. Did the GI say exactly why you should take that away? I would most definitely get a second opinion before doing something that can't be reversed. anon

My niece (now 2) had similar symptoms. Although she did not have a problem with weight, or taking a bottle or liquids, she did have a very tough time with reflux and with solid foods. It turned out to be some type of problem in the ear canal. This caused a fluid build up and contributed to the reflux. She has recently had tubes put in her ears - and now is doing great! Ask your ped. if a check up by an ear-nose-throat would help? meg

I have a similar problems with my now almost 2 year old toddler. Since she started taking solids at 6 months of age, she started falling off the charts. She's been off the charts since she was about 10 months old. She never took the bottle either and her pediatrician ran a bunch of tests on her to find out why she has a lack of appetite. One of the things he considered was reflux as well. She was put on Zantac. It didn't make a difference in her lack of appetite so we just determined that was not the cause. To this day, we still don't know the cause but think it may be because of all her food allergies and eczema. Anyway, to try to help you out here, we were put too, on a high calorie formula called, ''Elecare'' but all her doctors (pediatrician, allegist, GI) advised me NOT to wean her, that the formula would be IN ADDITION to her breastmilk since breastmilk was one thing she always took. Some high calorie foods that I can think of which dissolve are: slabs of butter, maple syrup on waffles, mashed up avocado, or how about if you help chew up some of his food before putting it in his mouth and all he has to do is swallow? You could also make some beef soup and make sure he drinks the broth with the fat in the soup. He'll get all the nutrition plus the high calories. Feel free to email me if you wish. may

How can I monitor my baby's weigth & height?

Dec 2002

Dear all, I am trying to monitor the growth rate of my son, almost 4 mos, who is brest-feeded. I am interested in checking his weight and height on a 1 wk basis. However, it seems that the only scales available are at the pediatricians premises. Does anybody know where I can find a place where to check my baby (e.g. pharmacies, ....) without taking an appointment to the doctor?

The Nurture Center store in Lafayette has an infant scale. People go in there all the time just to weigh their babies. Julie

Here's what I did: we spent somewhere between $20-$40 (I forget exactly how much) on an infant scale at one of the baby shops. Rather than weighing our baby weekly, I weighed him daily (at the same time, without his clothes or diaper), and averaged the weights over a week, since these scales are not as accurate as those in the pediatrician's office. I don't know if I would be as careful with monitoring a new baby's weight as I was with my first child, but watching him grow did make me feel a lot better. Karen

Hi, I gather from your email address that you are connected to UCB. They have good scales in the locker rooms in Hearst Gymnasium and in RSF, for example. (You weigh yourself with the baby, and then without the baby, and finally determine baby's weight using subtraction. While you are alone on the scale you place your baby on a blanket on the floor. Or you ask someone to hold her/him - people often love to do that.) If you are not a member they may still agree to let you in for 5 Minutes to weigh your baby, or maybe you know a member who can do it for you. However, when it comes to babies, don't put to much weight into numbers. Julia

I knew someone who monitored her baby's weight by stopping by the post office frequently and using the scale in the lobby. She said it worked well... Gayle