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health nurse suggested to me that my son is well underweight

I have 20 month old boy/girls twins, I am just back from visiting the health nurse who has suggested to me that my son is well underweight and maybe I sould see a nutritionist to help him gain some weight. He is 9.2 kgs (he as 9kg on 17/12/08) and 79cm`s (he was 77 on 17/12/08), my daughter on te other hand is 9.75kg (8.76kg in dec) and 84cm`s (83 in Dec).

I thought that he was getting enough foods that would help him to grow but perhaps not. An average day meals would include:
- breakfast of Cereal with full cream milk (usually porridge or wheat bix or sultana bran)little bit of watered down juice, they don`t really drink very much of it.
- snack about 10:30 o a plain sweet biscuit or a cheese stick
- lunch is generally a sandwhichwith cheese and meat or quiche or something similar, followed by desert of a tub of yoghurt or custard.
- bottle of milk before their nap
- snack of fruit when they get up (banana`s or pears are their favs)
-tea which is usually red or white meat and veges (potato/sweet potato/peas/crn/carrots/broccoli/cauliflower)
- Bottle just before bed time

My daughter eats pretty much everything on her plate but my son will often only eat the meat at tea (unless we put it on the plate after he has had ome veges) and with snacks he usually just carries them around in his hand nless it is something he really enjoys (like an Arnotts chicken crimpy shap). he usually won`t eat a whole sandwhich but will finish off all of his yoghurt.

Do you think that this is suffcient? I really hope that you cn help me with some suggestions that may help him gain weight or put my mnd to rest that I am stressing too much.

Answer: Hi Nichole, This is an area I have been asked a lot about and have put togeter a fact sheet on it, which is now on my web site (www.sneakys.com.au under the resources section). When someone ays underweight it shouldn`t be confused with `not on the 50th percentie`. If your toddler is healthy and growing well then even skinny kids are lkely to be just fine. Like adults they vary in size and shape. To som extent you may be fighting genetics here, if you or your partner are tall nd slim then your toddler may just be heading to his genetically predetrmined size. If your little one has grown at a consistt rate without any sudden or sliding movements down the percentiles this is moe support that things are okay. From what you have said it sounds lik he has stagnated a little and perhaps slide down the percentiles. Keep in mind they can do this at times and then bounce back. till the trick to weight gain (healthy weight gain) is protein. Medicall most professionals use a high calorie powder (pediasure), personally I look down the protein powder lines (ones specifically made for children such as Kids MetaMeal by Metagenics in Qld) and aprotein balanced diet. You need to see a professional for a script for th powders which ever way you go, I like the kids protein powders because th good ones are a balanced meal support and generally very low reactie, rather than just focusing on fat to increase calories. Keeping allergies in min you could look at adding some ground nuts and seeds (such as sunflower sees, almonds, linseeds, pumpkin seeds etc) into his meals each day, thi will increase fat and protein and essential fatty acids as well as loads o other nutrients. Smoothies are fantastic, use your choice of milk, add a nice yoghurt and some fruit, they are also great as ice-blocks in summer. You can pack a lot into those! Eggs in various ways, scrambled, hard boiled etc are also great. Dairy is a great source of protein too. You could also try mashed potato with cheese and a knob of butter, toppings on crackers suc as cream cheese or almond paste. Other protein foods include fish, meat, nts, beans, seeds, legumes etc. In terms of quantity, about his palms worth ineach main meal. It sounds like he is eating pretty much his full, so you may need to swap some of the oods he is eating that are not so calorie dense, say crackers or if he is eaing more than 2 serves of fruit swap one of these, for the foods noted aboe that are more calorie dense. You could add a supper in also, that`s where he smoothie would fit in. Those extra calories in the day may hep and the supper may be far enough apart from the last meal that he will accept it. Also offer smll portions of food regularly over the day so as not to overwhelm them with abig meal, toddlers have small tummies, plus finishing a plate off is a good mtivator for your both. So I hope that helps, and if you find that you need more help, pop into see a dietitian, nutritionist or naturopath who can really provide you with one on one assistance. All the best, Leanne
Answered: 01 Mar 2009