Thank you for your query at DoctorSpring.com
I understand your concerns. This is one of the most common problems reported by parents around the world. However, simplistic the problem appears to be, it needs a careful, complex medical approach. My experience with children has made me realize the following basic concepts:
1. Children are going through a phase of their life where they are understanding more and more about their appetite, satiety. They are gradually discovering what constitutes normal intake for them. Most children are able to go through this process by the end of two-three years.
2. Influences regarding feeding from parents greatly influence this learning. Parents who insist on feeding their kids to their own satisfaction may end up overfeeding or underfeeding them. This may be more harmful.
So the basic rule is - As long as the infant/toddler is growing normally, whatever quantity of food he/she chooses to eat is OKAY. In your daughter's case, at 14 months, she weighs 8 kg, which is well below the expected weight for her age and gender. But her birth weight also has been lesser than the average. So, by those standards also, she is below normal. Generally, children triple their birth weight by 12 months (So she should have been 8 kg by 12 months).
So I suggest that we look for causes of under-nutrition in this case. In order to do that, you need to answer my questions:
- What is her height/length?
- How is her development ? Is it appropriate for her age ? Does she stand/walk? What does she speak?
- How are her stools and urine ? Does she have any history of increased urine output or foul smelling, sticky stools?
- Does she have any other chronic illness ? Any cardiac/ respiratory/hepatic/renal illness?
- Why was she born with a low birth weight? Was she prematurely delivered? Why?
- Have you calculated her calorie-protein intake per day ?
- Is there any history suggestive of worms in stools?
- Is there any other relevant medical/family history?
Dr. Saptharishi L G
Patient replied :
Her length /height was 72cms,she looks like small baby with her appearance,she only stands,she speaks well all tiny words,her stools and urine was normall,she born low birth weight because mother Blood group was a negative and father blood group was a positive,she got father blood group so there was a problem during eight month and eminotic decrease during ninth month,so doctor sugusted indused labour (normall delivered with epidural).she had no other health problems.
Thank you for providing the above information. This condition is known as constitutional growth delay and is common in preterm/small for date babies who had some intra-uterine growth retardation (IUGR), in your daughter's case due to Rh incompatibility.
If everything else is normal, we can allow her to catch up with her peers which she is likely to do by the age of two years. The best way to go about now would be to sit down and calculate the actual amount of calorie-protein your daughter is getting per day. This can be done using food labels or with the help of a dietitian/ nutritionist. The calorie of food substances can be found on websites such as CDC (US/European foods) or ICMR (Indian foods).
Making a diet plan for your child with a target calorie intake of 1000 kcal/day and 12 g protein /day would be optimal to start with. After formulating such a plan, stick to the plan for at least 4 weeks and re-assess her height and weight. This will give us an idea regarding her catch-up growth.
Patient replied :
Hello doctor,we have calculated our daughter's calorie intake chart,[idly-80cal,egg-57cal,food-150cal,milk-120cal,cerelc-80,some times 3/4apple if she is woke up in after noon] total calories was 487 cal sir,if she take extra food she is try to womting.
Regarding the concern of vomiting, it can be just habitual, due to small gastric volume (small stomach capacity) or associated with disorder of gastric motility like a gastro-esophageal reflux. At this point, it is difficult to differentiate the causes of vomiting, without any accompanying information.
Please provide details regarding vomiting - frequency, colour of vomitus (greenish or otherwise), number of episodes till date, association with abdominal pain or change in stools, etc..
Is it immediately after feeding or after some time? If it is after feeding, how long after feeding?
Assuming that it is not pathological, we could try gradually increasing the quantity of feeds at the same time making them calorie-dense. Example: Instead of milk, you could make kheer/ porridge/ payasam. That is the same volume of food with much higher calorie content.
Patient replied :
Hello doctor,my daughter has no gastric problems,when she womits there is no greenish and withsh liquid on it sir,we understanded in your previous question she takes low calorie food sir,so please suggest us a high calorie food sir,you are asks womting, example we had gave her a glass of milk she drinks and we inceases the quantity she womits her intake food only sir.
Calorie densification of the food can be done based on local food patterns.
1. 'Payasam' instead of milk; Milk concentrate instead of milk
2. Thick curd instead of 'buttermilk'
3. Avoiding excessive milk ingestion. (half-a-cup twice daily) Milk is a low-calorie food compared to solid feeds.
4. Using 'satthu mavu mix' available as 'Manna Health mix' in south India. (locally prepared multi-grain mix containing dry fruits) - Panjiri in North India
5. Adding oil, ghee to your daily foods.
6. Intake of soya (high protein) food
7. Intake of dry fruits (Cashew, Badam, etc)
For more suggestions, please get in touch with a local dietitian. Modifications of local foods are region-specific.