Childhood Diseases

Question
Posted by: Peta | 2011-04-21

Q.

31 month old boy - no weight or heigh gain in 6 months?

Hi Dr
I have posted to you before –  I have a 31 month old boy who was tube weaned 6 months ago. (crycopharyngeal inco-ordination syndrome with laryngeal incompetence, previous anaphylactic dairy allergy that he has outgrown, reflux outgrown, major tactile issues)

I took him for his 6 month post weaning check up yesterday and he hasn’ t grown in height for the last 6 months –  still sitting at 84.5cm and his weight is 11.8kg. Just prior to us tube weaning him, he weighed 12kg and after weaning was 11.6kg –  so has basically gained 200gm since he was tube weaned 6 months ago.

He doesn’ t drink very much at all and when he does it is plain rooibos tea or water (about 200ml a day, plus 100ml milk on his porridge in the morning.). Our paed told us to put him on a calcium supplement of 250mg a day that is to be crushed into his porridge in the mornings. Our paed also told us that since he likes jelly, to supplement fluid intake with jelly and that it is fine to do this. The child doesn’ t like anything sweet so wont do yoghurts, custards, sweets etc

My question is this –  where is my child sitting on the growth charts and should l be concerned? He just seems really tiny if you look at other kids his age. My husband and l are average height (172cm and 168cm respectively) but I don’ t understand why he hasn’ t grown this past 6 months if he is eating so well.

On an average day he eats a BIG bowl of oats, snacks on 2-3 tuc biscuits and a bite or two of apple/fruit, has a cooked meal of veggies and a tiny bit of cut up protein for lunch, in the afternoon will snack on 5/6 pringles chips/ ½  bowl jelly etc. Supper is usually eggs x 2 with a slice of bread or a bowl of cereal –  to get milk in. Over the day he will drink about 200ml water / rooibos tea.

In every other way he is happy and content but l am worried that his brain isn’ t getting enough nutrients or whatever it is that it needs to grow properly.

Should l put him onto pediasure for over his porridge in the mornings and to see whether he will drink this during the day or will this just increase his weight. I don’ t want him to be fat, but want to ensure that he gets everything he needs. And there is NO WAY l can give him a multi vitamin as he gags with strong tastes like that… 

I just don’ t know, l thought he was doing so well but no growth in 6 months surely cant be good?

Thanking you in advance for your assistance.

Expert's Reply

A.

Paediatrician

I am also concerned about your son's lack of progress as regards his growth and weight gain. His weight is well below the average of 13.5kg for boys of 31 months and is on the 10th percentile line, the lowest 10% for boys of 31 months. His height is on the 0.4th percentile line on the boy's growth chart, the very lowest 0.4% of all boys of his age. He certainly is not taking enough fluid or nutritionally important foods in spite of what appears to be a considerable improvement in his appetite since you last posted.I presume that a dietician is advising you.It would be best to consult a paediatric gastro-enterologist in the first instance so as to get some idea of what the problem is as regards your son's poor growth and weight gain.May I suggest that he sees Dr Elizabeth Goddard at the Red Cross Children's Hospital in Cape Town [021 6585111]

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