Health

Beyond picky eaters: Coping with underweight kids

Dec. 14, 2012 at 6:17 AM ET

Weston Carmann
Courtesy of the Carmann family
Weston Carmann, 3, is a smart, lively toddler who's on track developmentally, but weighs much less than other kids his age.

Minda Carmann is looking forward to the holidays, but the Colorado mother of two says she’s also bracing herself a bit for the festive gatherings.She knows that when well-meaning family members, casual friends, even strangers, see her oldest son, Grant, 6, folks inevitably will say:  “My, he’s getting so big!”

And she also knows that when they see her youngest boy, Weston, 3, they’ll ask if she’s sure she’s feeding him enough -- or they won’t say anything at all.

“I’ve heard all the comments,” said Carmann, 35, of Castle Rock, Colo. “He’s just a tiny dude. That’s just how Weston was made.”

At 34.5 inches tall and barely 25 pounds, Weston is the size of an average 1 1/2- to 2-year-old. Like 3.5 percent of U.S. kids ages 2 to 19, he’s underweight, a condition barely recognized in a nation where two-thirds of children and teens are overweight or obese, according to federal health figures.

But for Carmann and other parents struggling to help their little guys and gals put on pounds, having kids who are too thin is just as much -- if not more -- of a worry.

“As a mom, you get so defensive. You want to say, ‘I feed him,’” said Carmann. “This has become my entire life, to get this kid to grow.”

The problem goes way beyond having a “picky eater” -- a kid who only wants white noodles or grilled cheese, for instance. Weston and others often are kids who refuse to eat, or who eat so little that it leaves them lagging behind their peers on standard growth charts, said Dr. Nancy Krebs, medical director of clinical nutrition services at Children’s Hospital Colorado.

“I call it being underweight or being short stature,” explained Krebs, who sees some 400 kids a year, typically babies and toddlers. In Weston’s case, he is so small, he doesn't even register on the charts for his age, his mother said.

Parents of these kids are understandably concerned -- often desperate -- about getting their infants and toddlers to eat, Krebs said. They worry that the children won’t get enough nutrition for proper brain development, or that they’ll never catch up to others in height and weight. 

That can create a difficult cycle where parents try to get their kids to eat more -- and the kids respond by eating less.

“If growth starts to falter, it escalates,” Krebs said, adding later: “Some parents become intrusive and force-feed.”

Weston Carmann and his family.
Courtesy of the Carmann family
Minda and Troy Carmann said they've worked hard to help both of their kids, Grant, 6, and Weston, 3, grow up healthy.

Krebs said her first job is to screen kids for illnesses that can cause slow growth -- cancer, celiac disease or gastrointestinal disorders, for instance. After that, she offers parents reassurance that their kids will be smart and healthy -- because most will -- and strategies to help them break the cycle of food refusal.

“I spend a lot of time explaining that if they’re mildly underweight, there’s no crisis looming,” she said. “They’re not losing any brain cells.”

In Weston’s case, the worry started early -- he didn’t grow on breast milk -- and continued. That was a marked change from his brother, who grew quickly as a baby and has always been big for his age, Carmann said.

Weston is a smart, lively, social boy who has hit every developmental milestone -- and still stayed small.

“As a mother, all you want to do is make your baby grow,” Carmann said. “I became very obsessed.”

But that obsession -- to the point of following Weston around, popping food in his mouth -- seemed to make the problem worse. When rounds of pediatricians didn’t help, Carmann sought out a specialist.

Krebs' advice was surprising: Carmann and her husband should make Weston sit down at the table for regular meals. They should take away snacks and sippy cups between meals because even a few Goldfish crackers or a swig of juice can give a toddler enough calories to refuse further food.

They should let Weston decide how much food to eat when it was available. And they should make mealtimes as stress-free as possible.

That’s easier said than done, of course. Carmann worried on a recent morning that Weston’s breakfast was a bite of waffle and spoonful of yogurt.

“Mealtime is just really intense,” she said.

But, too slowly, Weston is growing. Doctors have said he’s healthy, just small. And Carmann said she’s learned to cope with the comments from people who can’t help pointing out her son’s size.

“I’ve had every mother in the preschool class pull me aside and say, ‘How old is he?’” she said.

On bad days, such remarks bother her deeply, Carmann says. But on good days, she takes them in stride, figuring that Weston is a happy, healthy boy who doesn’t seem to know he’s little.

“I have no problem having a tiny kid, if that’s how God made him,” she says.

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