Growth and Lack of Appetite

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Dr. Alan Greene

Sunday, January 24, 2010

QUESTION: My 4-year old daughter is 38 inches tall and weighs 27.5 pounds. She hasn’t been eating much for the last year. Now I’m lucky if I get a meal into her. She has started losing her hair and is not gaining much. At age 4, isn’t she off the charts? What can I do?

ANSWER: Even most very picky eaters get plenty of calories every day, but one of the reasons we follow growth curves is to be sure that is true for an individual child. 27.5 pounds for a girl who is 4 years old puts her below the 5th percentile for girls her age. Her height is about the 25th percentile for her age, meaning she is taller than about 25 out of 100 healthy girls her age. Even though she is shorter than average, her weight for her height is also below the 5th percentile.

Five percent of healthy, well-nourished girls are at or below the 5th percentile. Still, her low weight could indicate that she is not getting the calories she needs or that she is losing calories somewhere (such as protein in the urine) or that she is burning too many calories (from some underlying condition).

A doctor should carefully consider any child who is below the 5th percentile – especially one who is having other symptoms, such as hair loss – to whether this weight is normal for that child or a sign that something needs to change.

Often pediatricians are a great place to begin, but if any questions remain, pediatric gastroenterologists often have a good perspective on this issue. Endocrinologists also look into growth issues, but they are usually best if the height is the first one off the charts. Either way, a visit to a nutritionist may also be wise, both to evaluate what your daughter is actually taking in, and to suggest ideas for increasing her calories, if that is appropriate.

In the meantime, a good chewable multivitamin with minerals can provide a safety net for the major nutrients. I suggest choosing one without added chemical colors or preservatives.

Looking for kid-friendly recipes? Try a few from Eat Healthy:

Nutritious Nuggest and Veggies with Creamy Dipping Sauce

Meatball Sliders

Alan Greene, MD, Clinical Professor of Pediatrics at Stanford University School of Medicine, Attending Pediatrician at Packard Children's Hospital, and Senior Fellow at the University California San Francisco Center for the Health Professions. He is also founder of DrGreene.com, and author of Raising Baby Green and Feeding Baby Green.

The opinions expressed here are solely those of the author and not necessarily those of Healthy Child Healthy World.

Posted by Lawrence on 01/07/2011 at 01:03 PM

That is scary. It’s got to be hard to watch your child lose hair! I just can’t imagine. The gum with vitamins in it sounds like a good idea until a doctor can really get a look at the child. What about those V8 juices. there are some that taste very sweet and I’m sure kids would like it while getting better nutrients.

Posted by Judy Converse MPH RD LD on 01/30/2010 at 09:25 PM

This is one of the most common problems in my pediatric dietetics / nutrition practice. Children who don’t eat enough to sustain expected growth do need intervention; growth impairments if left untreated can trigger cognitive impairments, insomnia, behavior problems, or even problems with bone density.

One of my most reliable tools to restore and re-invigorate appetites in children is to balance bowel flora. Most kids I meet who have weak growth have skewed findings on stool cultures - that is, they lack the types of healthy bacteria we need in the gut to help us digest and absorb food, and fight infections. This is most critical for infants and young children. You can easily give youngsters probiotics (get professional guidance on potency and strains) that will restore bowel flora. Once this is normalized, kids invariably eat better and grow better, in my experience.

I also always rule out insufficiencies for zinc and iron, two minerals that can impede normal appetite when depleted.

There are lots of tricks and tools available to help infants, toddlers, and children eat the way they need. Don’t blame yourself - in 10 years’ practice, I have never met a parent who didn’t understand what their child should be eating. Parents usually do offer good foods! When kids refuse to the point of not growing normally, you need professional help. This is my area of expertise, and I welcome any questions.

Posted by Erica on 01/26/2010 at 10:20 AM

I have a 5 yr old that is the same way. She is 38 pounds and 39 inches tall. Everyone we meet says “oh she is so petite”, I tell them that she is small but mighty.

Some days she eats really good and some days she doesn’t want anything. She has this bad habit of wanting just snacks to eat. I have incorporated healthier options. She likes fruits and veggies. I guess it is trial and error. I hope her appetite improves as she grows.

There is hope don’t give up. Provide your children with love and understanding, support what they need and want and they will blossom right before your eyes.

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