Can you tell me what a nutritionist does?

[GirlwiththeCurl]

Our pediatrician wants to refer my youngest child (who turned 1 in Dec) to a nutritionist. He, in a pattern similar to L, has gone from chunky baby to way under the 3rd percentile curve for weight. I am still nursing him quite a bit, and he seems to like food but eats very little. He puts it in his mouth and chews it up and then spits it all out. He refuses baby food. :/ I am just not sure what a nutritionist is going to be able to do for a child who won't swallow anything. But I am concerned about his lack of weight gain. I am feeling conflicted about the whole thing.

 

[crohnsinct]

Hmm...I think you should look more for a registered dietician. No knock against nutritionists but RD's have a bit more schooling, have done a lot of clinical rotations and are a bit more qualified to handle complex medical issues.

RD's are very well versed with dealing wit children for whom texture, taste, etc are an issue.

This said, if swallowing is an issue for him you should also consult a speech pathologist. Believe it or not they work with children with eating issues when it comes to swallowing.

A toddler not eating can be a complex issue and will need a team of good people on the case.

I sure hope it isn't due to IBD or any other allergy/IBS/Celiac issues. Have all of those been ruled out? It could be he isn't eating because eating makes him uncomfortable.

Good for you for continuing to nurse him...at least he is getting good nutrition that way.

Good luck:ghug:

 

[GirlwiththeCurl]

Okay, that makes sense. When L was at this point we were working with an occupational therapist to try to get her to eat anything (that wasn't ice cream--ha!). But she wouldn't even put food in her mouth.

Nothing had been ruled out at all yet. I am fearful of testing both because of what they might find... Or that they might not find anything and want to keep testing and testing.

Our pediatrician's comment at his last appointment was that he seems healthy to her, but she would feel better if someone else took a look at him, considering his weight.

 

[my little penguin]

Given your still nursing the kiddo shouldn't be dropping weight
Weight loss is a very very big red flag for any toddler
Can you see Gi and or allergy ?
I understand not wanting to know btdt with my non Ibd kiddo
But his issue ( lactose intolerance ) was a very simple fix but without testing he would have kept losing weight and feeling crummy .

 

[GirlwiththeCurl]

To be clear, he has not lost weight. He just is gaining very little. He is losing percentiles. I think I would rather he see a gastroenterologist, or anyway someone who will recognize possible digestive issues or growth issues. That is why I was asking about a nutritionist, because I wasn't sure what sort, if any, of diagnostics they can do. If I am only going to get advice on how to add calories to food or what he ought to be eating, it will be useless.

 

[GirlwiththeCurl]

I ought to add, he has also dropped percentiles in height. At his highest percentiles, he was fiftieth for both weight and height. Now he is tenth for height and way under the third percent line for weight (16 lbs, 10 oz at one year).

 

[Catherine]

They done any screening? Blood tests? Urine tests?

 

[GirlwiththeCurl]

Nope.

 

[crohnsinct]

I would definitely get him in to a GI. Most ped GI's have registered dieticians in their center or at least work with one. Given your daughter's history I would think an automatic referral to a GI would be a given.

 

[my little penguin]

Nutritionist can only tell you what to feed him and look at a food diary that's it
Nothing more
Only a GI can do screening
Flat lining ( across percentiles as Ds Gi put it ) is always a warning sign in kids

Hope you can get into a Gi soon
Do you need a referral ?

 

[GirlwiththeCurl]

Okay. I am going to talk to the ped again when we schedule L's next appointment. I think they will try to get a referral so that S can be seen the same day as L to minimize our trips.

 

[crohnsinct]

Is your GI far? Ours is about an hour and fifteen away.

At the beginning I did combined appointments but after the first few it was starting to just get to darned confusing with both girls in there and trying to stay focused on one and all their issues and questions and then go to the second etc. I had the added burden of double the time off from school for each of them and as my younger was the newer diagnosis and took more time the high schooler got super antsy.

Just saying you can try it but I found that having separate appointments for each of them kept the GI and I more focused.

I do see that you work so I guess that is an added concern and plus for combined appointments.

Hopefully this is an easy fix and you won't have to worry about it for long!

 

[GirlwiththeCurl]

It is about two and a half hours one way for us.

I am not concerned about school right now; L will miss an entire day no matter what. Also, since S is still nursing I can't really leave him all day long... Well... I could. But I think it would be hard on him and my husband. So for now it makes sense to go all at once. If he does get some diagnosis that makes more trips necessary, then I will reconsider.

Also, I'm actually a sahm right now. I am not sure what I said that makes it seem that I am working.

 

[Maya142]

We did combined appts. too when my daughters were younger. It got harder as they got older and became busy high schoolers but since your kiddos are so young, your biggest problem will probably keeping L entertained and a toy or book or iPad could help with that!

We have seen several nutritionists/RD's. All they have told us is how many calories M needed, which was good to know because our estimate had been too low for her to gain.

They suggested snacks and timings of meals but since she has a pretty restrictive diet (low fat, low fiber, avoiding lactose) and is a very picky eater, their suggestions didn't really help all that much. We also worked with them to find a formula that worked for M through her feeding tube, which was very helpful!

So I guess it's useful, but it's more useful once you have a diagnosis and know what's going on. My first step would be a GI, like everyone has said, to figure out why he's not gaining weight. If he has something like IBD or Celiac, just upping his calories won't really help.

Good luck!

 

[crohnsinct]

Heck to the yeah! 2 1/2 hours one way, I would combine those appointments to!

You didn't say anything...I was reading too many different posts at once and got you confused with another poster...That's my story and I am sticking with it :drink:

 

[tots]

I am guessing he like the taste of food which is good, its just when he really eats it it hurts his stomach?

Nursing him is good as it prob dosent hurt !! Goo job to keep that up!

I hope your baby feels better soon!!

Lauren

 

[GirlwiththeCurl]

I took S for his flu booster today and had his weight checked. He actually has lost weight (down two ounces since December). Our pediatrician have him a referral to the growth clinic in Denver, which I guess is the first step for underweight babies to get checked out. From there they will refer him to an rd, gastroenterologist, allergist, or endocrinologist. I think.

 

[GirlwiththeCurl]

Oops! Double post.

 

[CarolinAlaska]

Hi. I'm coming in late here. I'm wondering if your son has any diarrhea or vomiting/reflux. Growth charts were my daughter's first sign that something was wrong way back when she was a baby. Don't let them blow off any symptoms or avoid any workup if they can't find answers. We let my daughter go 12 years with red flags everywhere because some stupid GI told us after normal labs that she was "just a petite girl with big parents". She really didn't have much of a workup at all and continued, sadly, with chronic diarrhea all that time. I told later pediatricians that she'd had a workup and they never pushed the issue although she sat below the growth chart on weight for years. Finally delayed puberty got her a real workup and finally a diagnosis. My main regret was that I didn't push for a second opinion or further workup when she was little. I get that the specialists are far away. I've had to travel up to 4 hours one way to see GI and currently travel 3 hours. Our children deserve our attention for these things. The emotional trauma of undergoing medical tests is concerning, but don't let it become a barrier to finding out what is wrong.

Does your child gag on food? Does he have big tonsils?

 

[GirlwiththeCurl]

S is always constipated and has been since he a couple months old. That never would have worried me at all before I started reading about pediatric IBD, because I am always constipated and feel perfectly happy that way. . However, I have noticed that lately he not only has to work at his bowel movements, but seems to be having pain--at least he acts distressed.

He does tend to choke easily on food, which might be why he spits out food so much, but I don't really know.

We are going to take him to Denver for an evaluation so I guess we will go from there. Other than his weight and constipation he is totally happy and developmentally appropriate, so that is good. Maybe he really just has some texture or swallowing issues that we can help him work on. I don't want to assume the worst, or ignore important things, either. Sometimes I wish I just had a magic ball to help figure everything out!

 

[CarolinAlaska]

Hopefully he'll get a good workup and some answers in Denver