2 year appointment

Sasha had her two-year old doctor appointment today.
In the past, Sasha has had weight troubles. At her last doctor appointment, she had weighed in at below the third percentile for her age.
Fortunately, it appears our troubles are gone for now. Praise chocolate milk and brown rice!
Sasha weighed 24.5 lbs, which was the 25th percentile according to our doctor's charts.
She is 35.4 inches tall, which is the 50th percentile.
So she's doing great with her weight! Now I can concentrate on getting nutritious food into her, instead of a 'food at all costs' free for all like it has been the past few months. Basically, if Sasha would eat it, if it had calories she could have it. Now we can afford to start getting picky again.

The appointment went well. We almost overslept, so we had to rush really quickly to the office. We were late. My husband didn't have time to shower so he had to stay home. I know he really wanted to be there with us. He feels like Sasha needs him, especially when it comes to shots and he wants to be there for her.
I talked to Sasha in the waiting room and explained to her that she was seeing The Doctor, and I tried to explain a little of what she could expect. That The Doctor would look in her ears and her eyes and her nose and would listen to her heart. I think she understood a little.
So when the nurse came into the exam room, Sasha did not get upset at all. This was a new nurse. Well, we've never seen her before. This nurse was wonderful! The nurse gave Sasha easy to understand commands, and Sasha obeyed. She told Sasha to sit on the scale, so Sasha did. When the nurse told Sasha to lay down to be measured, Sasha happily complied.
Bloodwork needed to be done for anemia and lead testing, and a tb test. The nurse said it's easier to take blood from a child's toe than a finger. She washed Sasha's feet (which Sasha loved!) and gave Sasha a book to read. Sasha read the book and didn't care at all that the nurse just jabbed her toe with a needle and milked it for blood. For the TB test, the nurse told Sasha that she was putting a bubble on Sasha's skin. Sasha loves bubbles, so she was fine with that. She watched the nurse put the needle under her skin, and with no objections observed her new bubble. She proudly showed it to us. Not a single tear shed. Damn that nurse was good.
The doctor came in next. Sasha was fine with the doctor and her inspections. She gave the doctor a cheerful "Hi Doctor!".
I addressed my concerns with the doctor. I was concerned about Sasha's abdomen. Her belly button turned from an innie to an outie with all her weight gain, and Sasha has been constipated. She screams and cries whenever she goes poop. The doctor dismissed my concerns.
More shots. This time, vaccines. The nurse returned to give Sasha two shots, both in the upper legs. I had to hold Sasha down while the nurse gave the vaccinations, and this time Sasha cried, because they hurt. The nurse put bandaids on the owies, and Sasha was again happy. She pointed out her owies and her bandaids and even called them her "Sasha's pwize" (prize). Bandaids made it all better.

My husband sent me some text messages when it was vaccine time. He felt like he wanted to be there for Sasha. He said he felt as though she was upset. Those two have a special bond.

Sneaky Chef

I read the Sneaky Chef book by Missy Chase Lapine. Good reading. Definitely got some ideas on how to feed my picky little toddler girl (and picky husband). The book had a list of foods that children will eat, and that list alone was worth the price of the whole book to me.
So I decided to give some of the recipes a try.
First I got a ton of fresh veggies:
I got 3 bunches of spinach, some sweet potatoes, a few heads of broccoli, a head of cauliflower, some carrots, some zucchini, and some frozen blueberries.
Each recipe called for steaming the vegetables, so I was a washing and steaming machine. Then came the pureeing. I pureed according to the recipes. I also saved the veggie water from steaming to use as vegetable broth, which turned out well.
ABOVE: Clockwise from top left: White puree, spinach broth (in blue pitcher), carrot broth (in white pitcher), purple puree, orange puree, and green puree in center.

ABOVE: From left to right, From left to right:
Orange purees: carrots and sweet potatoes
Green Purees: Spinach, peas, and broccoli
Purple Purees: Spinach and Blueberries
White Purees: Cauliflower and Zucchini

I tried a few recipes that used the purees.
The brownies didn't turn out so well. My husband didn't like them but Cassie did. Sasha, my picky toddler, wouldn't touch them. I didn't mind them. You sure couldn't taste blueberries or spinach in them! I think I'll skip the wheat germ next time as it gave it a strange consistancy.

The meatballs were a disaster. Nobody liked them. I made spaghetti with meatballs, and the meatballs were mushy. The wheat germ gave it a terrible texture.

The meatloaf, however, was a hit! Cassie and I both really liked it. My husband (who is as picky as my toddler) didn't hate it, which is saying a lot.

I would probably get more use out of the purees than the recipes. This is sort of like when I was making homemade baby food, and I'd occasionally throw a cube of kale baby food into my chicken noodle soups. I could see myself using the purees, but probably not sticking to the exact recipes in the book.

More weight gain

Whatever Grandma (and Dada) was feeding Sasha the past few months, it's been working well. It appears that Sasha has gained another pound. That means she has gained at least 5 pounds during her 3 month trip. Amazing.
Sasha actually has grown some chubby thighs and cheeks. She is still in the 40th percentile for weight, if the scales were accurate. This was the same scale that measured her at 19lbs when she first arrived in Montana, so she's been consistently weighed on the same home scale. She was weighed a few days before her return flight home, and she was at 24lbs.
I know that Grandma had a whole area of the pantry that was specifically Sasha's Shelf. All the foods on it were easily accessable and Sasha could just walk into the pantry to grab what she wanted. I have followed this example, and set up a little shelf in our kitchen. It is now Sasha's Shelf. In it, we have some tons of toddler-appealing snacks, such as yogurt fruit snacks, some pistachios, some cheerios, some goldfish crackers. I forget what else.

I am also trying to observe my husband and stay a bit more hands-off for now. He's been with her for the last few months and knows all the little tricks to get her to eat, so it's probably best if I just try to learn from him. Hard for me to do sometimes, but he's great with her and it's best for Sasha.

Tonight for dinner, we had meatloaf and mashed potatoes. Sasha sternly requested rice instead.

Eating again

Eating!

Thank goodness she's eating again. The past few days, she's been a little eating machine, and I dare say I think she might be plumping up a little! It could be my imagination, but she looks taller and chubbier to me, and her feet look bigger.

Yesterday, she ate four whole meals. And not little ones either. She had a smorgasbord breakfast (noodles, cereal, grapes, bread), she ate a second breakfast with my husband. She ate a pancake breakfast at IHOP for lunch, and she ate some noodles (high protein noodles drizzled with flax seed oil and parmesan cheese) and crackers for dinner.

I know it's not my imagination that the two pairs of size 5 shoes we bought her last month are already outgrown. She had finally outgrown her size 4 shoes last month. So wow, she went through size 5 in less than a month. Time to go shoe shopping again. It looks like a growth spurt!

The Chocolate Milk Diet

My darling toddler has forsaken solid foods for chocolate milk and juice.
We are having such a difficult time feeding her. She is refusing everything. We try to offer her foods and she hits our hand and turns her head away. We are very worried.
I figure her 8oz boxes of chocolate milk are 200 calories each and I lose count of how many she drinks a day. About 4? Then her 6.5oz juice boxes are 100 calories each and she drinks several of those a day. So she's getting enough calories. I do give her a multivitamin daily, and also a gummy omega-3 fatty acid supplement.

In her defense, she is still teething. I am hoping that is the source of the problem. If her teeth come in and she still has eating troubles, I am going to be very scared for her. I think we are going to need professional help, and our pediatrician has been useless.

We're getting desperate. Any ideas appreciated. So far, if it doesn't come in a juice box, she won't take it.

Eating woes again

We seem to be having troubles getting Sasha to eat again. She has hardly eaten the last week or two. My husband and I are starting to worry. We fought hard to get her weight up and I fear she is starting to lose weight again. We are going to have to start putting fats in her foods again to boost her caloric intake.

18-month Well Baby Exam

We had Sasha's 18-month well baby exam today.
She weighed in at 19lbs 7oz, and is now 31 inches long.
She grew an inch in height, and gained 7oz since her last weight check. She was 18lb 8oz at her 15 month well-baby exam so she's gained just an ounce short of a pound since then. Yay! I was hoping that she had gained more than that but oh well. She's still at the 3rd percentile for weight, and she's halfway between the 25th and 50th percentile for height according to the doctor's charts. I'll have to look up her height and weight for age on the World Health Organization (WHO) charts as our pediatrician is not using those.
Sasha fell asleep in the car on the way to the doctor's office and was sound asleep as I carried her in. So she had a rude awakening when she was in the exam room and we started undressing her. She waved hello to the mean nurse. (She's not mean, but she's the one that ALWAYS gives Sasha the shots so Sasha is very suspicious of her). She's been more sociable lately so I wasn't surprised although my husband thought Sasha would hate the nurse on sight.
Sasha protested during the weight, height, and head measurements. She kept yelling "BYE BYE!" at the nurse, as if to say "go away!". The nurse left, and after a few minutes the doctor came in. We had the female doctor this exam and Sasha said "Hi!" to her a few times.
The doctor mostly talked at first, then she did a thorough exam, which Sasha did not like. The doctor listened to Sasha's chest with a stethoscope, stuck a popsicle stick down Sasha's throat until she gagged, and felt Sasha's spine and head. Again Sasha started yelling "BYE BYE!" at the doctor between sobs.
The doc discussed the foods and drinks that Sasha consumes. She told us to cut back on Sasha's juice intake, as she believes it will help Sasha to eat more. Made sense to me actually. She asked us how much milk/dairy Sasha had a day and said she should get between 16-24oz a day but not more than that.
Then it was time for the shots. We had a dtp and a polio shot. One in each leg. I held Sasha down for those shots and my husband cringed at each one. For this exam, we did what we usually do. I was the parent that held her down for all the mean stuff, and my husband was the one who picked her up and comforted her afterwards. He got to be the good guy and I was the bad guy.
Sasha slept well when she got home. She was cranky in the evening and went to bed earlier than I thought she would. But otherwise no other effects from the immunizations.
We will be going back for a weight check in 3 months, otherwise she won't have another well-baby exam until she's 2.

Snow Day

We had a little bit of a blizzard, and so today was a snow day. No school for Cassie. She spent the day at home. Today she actually did wish she could go to school.

Sasha had another non-eating day today. I barely got one single spoonful of rice into her and that was borderline forceful getting that spoonful in. She refused her juice boxes. She nursed like twice. I don't know how this girl survives at times. I get so scared sometimes when this happens. She didn't eat much yesterday or the day before either but each day she's eating less.

Follow up exam

We had Sasha's follow up exam on Monday. The exam where we re-weighed her and checked her iron levels for any anemia or nutritional deficiencies.
She gained weight! She's up to 19lbs. She has good iron levels in her blood. She's been given a clean bill of health. If she is skinny, she's just a skinny little girl, but at least she's a healthy skinny girl.
I am relieved.
We are still going to make more effort to push foods on her, although honestly we were doing that all along.

High Calorie Foods for Toddler Weight Gain

I spent hours doing some research into high calorie foods that can help me out with Sasha's underweight problem. She's finally eating, and I want to make sure that every bite counts.
I'm no expert. Just a desperate mother of a toddler who won't eat and is losing weight instead of gaining. Here's what I found and what I am doing.
First, I had to make sure that she's getting all the vitamins and nutrients she needs. She is now agreeably taking a half of a chewable flintstones vitamin every day so I don't have to worry about those nasty vitamin drops. The flintstone vitamins have more kinds of vitamins in them anyways. However they are lacking in CALCIUM, so I still have to make a special effort to get calcium into her every day.
Second, I needed to know exactly how many calories I should be getting into her every day. For that, I thank this website: http://www.silverscriptwellness.com/topic/calneed
I used it to calculate how many calories Sasha needs each day. She weighed 18lbs 8oz at her last doctor visit, and she is 30 inches long. Therefore her calorie needs were as follows:

She needs at least 595 calories to maintain her current weight and activity level.
Of this, 395 calories are required to meet her body's basic energy needs. That amount (your resting energy expenditure) is what she'd use up if she did nothing but lie in bed all day.
To gain about one pound per week, you'll need to bump up to 1,095 calories per day.

Next I tried to calculate how many calories she was getting. This was hard. After searching around I found this really neat website: http://www.calorieking.com/foods/

It told me the amount of calories in different foods, but I could get the amount of calories in different sizes so it was actually really helpful.
Let's see, she eats about 1/2 cup of brown rice mixed with lentils a day (108 calories), and about 2-3 juice boxes (100 calories each). Plus she nurses about 4-5 times a day (about 60 calories per nursing session). I calculate a total of 548-708 calories a day. Barely enough to maintain her weight. Not enough to gain any weight at all. She needs MORE calories. Much more. But she's not going to take more bites so somehow I have to find ways to pack more calories into the bites she does take.

I spent a few hours trying to find the most calorically dense foods. To do this I made a chart of the amount of calories various foods had per ounce and also per tablespoon. This is what I came up with:
food per oz, per other measurement
tofu 41,
whipping cream 98, 52/tbsp
butter 204, 102/tbsp
half&half 40, 20/tbsp
sour cream 61, 26/tbsp
milk whole 19, 9/tbsp
breastmilk 20,
avocado 45,
brown rice 32, 108/half cup
potato 26, 57 half cup
sweet potato 26, 57 half cup
lard 252, 126 tbsp
flaxseedoil 251, 120 tbsp
oberweis choc ice cream 79, 230 half cup
jelly 71, 50 tbsp
peanut butter 169, 95 tbsp
carnation 103, 130/packet
whipped cream 73, 8/tbsp
Hershey's Ready-To-Drink Milk, Chocolate, 2% Reduced-Fat, 8oz box 200 calories!

Basically it seems that fats are the most calorically dense foods I could think of.
Sasha eats mostly brown rice all day every day now, and chugs down a few juice boxes. I am thinking of doing the following:
1. Replace a juice box or two with higher calorie juice box containers of other stuff than juice, like chocolate milk. It has to come in a juice box or Sasha won't drink it. Hehe!
2. Butter everything.
3. Replace milk with half-and-half, or in some instances, even whipping cream. These are very very high in fat. Babies and toddlers do need fats in their diets, especially skinny little ones. I just have to be careful to make sure she's getting protein and carbohydrates in her diet as well so she's not on an all-fat diet.
4. Offer the occasional spoonful of peanut butter or even jelly/jam if she'll take it.
5. Ice cream and whipped cream! I got a can of that pressurized whipped cream and had my older daughter try to teach my toddler the joys of whipped cream. So far, unsuccessful. She giggles at her older sister with a mouth full of whipped cream but won't eat it herself...yet.
6. Make a super thick high calorie very rich drink with 8oz of half&half and some carnation instant breakfast. If you can get this into your toddler, there's 445 calories in this. Good luck. This tastes like heaven. It tastes like melted ice cream. Sasha wouldn't take more than a few sips of it.

I'm sure there's plenty more ideas but that's all I can think of for now. Basically don't let any bite go into that toddler's mouth that isn't dripping in butter, cream, or an oil of some kind.
These are the desperate measures of a mother of an underweight toddler who is losing weight. Once the weight starts to get closer to a normal range, I'll stop lacing all her foods with fats.

Please, if anyone has any other ideas or suggestions, or anything that has worked for you in a similar situation, please feel free to leave a comment. Or commiserate and share your experiences.

Vitamin D?

I've been thinking. File this in the thinking myself into paranoia category, but I'm starting to wonder whether a vitamin D and calcium deficiency might be a problem for us.
Sasha has been breastfed from the day she was born. She's not eating food very well and never has. She will not drink milk. We are a night shift family so our exposure to sunlight is VERY infrequent. This all is the perfect setup for Rickets, a vitamin D and calcium deficiency.
The thought crossed my mind when I noticed Sasha's belly is a little bit distended outwards. But she doesn't seem to have any other signs of a deficiency that I can tell...no bowed legs, her teeth keep coming in okay. But a deficiency can exist months before there are physical signs and symptoms. I think I can reasonably assume that Sasha has a deficiency of vitamin d, considering she has no current source of it.

I guess it's something that I need to keep an eye on though. I started to give her vitamin drops today. As I mentioned in my previous post, I'd prefer she get her nutrients from natural sources but since she's not eating I don't see much other choice. I will be glad once Sasha is old enough to eat children's chewable multi-vitamins, or if she ever starts eating again.

Recovery from Recovery

Sasha is feeling better it seems. At least she's in a much better mood and not so crabby. She doesn't seem to have a runny nose anymore. I think she's beaten whatever cold or flu that was ailing her. She is still not eating and her diapers are very strange looking (won't go into detail but trust me it's nasty) so I think her belly is still getting rid of something. Maybe a gastrointestinal bug?
I wish she would eat. She's been nursing like a newborn again and not eating food. Today for the first time ever, I had to force her to take a dropperful of vitamin drops against her will. I'm afraid that she might be suffering from nutritional deficiencies. I wish there was a better way but if she's not going to eat I'm going to have to give her the vitamin drops. I'd prefer that she get her nutrients from food.
If she's feeling better, I'm going to have to cut her back on her nursing sessions. I fear that her frequent nursing might be causing her appetite loss. I tolerated it while she was ill but now it's a habit that I have to break again. I am hoping her appetite will pick up once her nursing is cut back. Easier said than done, however. I know that cutting her nursing sessions back will mean lots of temper tantrums, whining, and a very crabby upset little girl. I have to keep offering her foods, even though she refuses, somehow without turning it into a power struggle. That's a delicate balance. I hope I have the strength. It's going to be a long weekend.

Meanwhile, my husband is feeling ill again. Didn't he just finish recovering from being sick? Blah can we get a break?

Toddler Weight Loss

We are concerned about the weight loss Sasha has experienced over the last three months. At her 12 month exam, she weighed 18lbs 14ounces, and at her 15 month exam, she weighed 18lbs 8oz; so she has lost 6 ounces. I suppose that might not be much, but it's a weight loss when she should be gaining. She used to be at the 50th percentile for weight for her first 9 months, but now she's dropped below the third percentile for her weight at her age.
I know that toddler growth slows down after a year of age, thus requiring less food. But Sasha was always a picky eater. Actually, she just didn't seem to like the eating concept in general. But within the last few weeks or so, Sasha has finally started eating.
I wasn't surprised that her gain wasn't as large as most children should be. But even before her well baby exam, I knew that we would not see much of a weight gain. The loss of weight was a surprise to me, however.
My hope right now is that because Sasha is actually increasing her food intake by leaps and bounds lately, that her growth rate is now increasing. I don't know if it's enough to make up for what she hasn't gained before, but she is definitely improving. Of course, the doctor didn't seem to understand that she was already on the increase.

For now, I think our plan is to continue to offer her foods many times a day. Instead of three meals a day, we do a bunch of mini-meals and try to keep her constantly grazing.
Despite the doctor suggesting we wean Sasha, I really don't want to do that during the middle of the cold and flu season. She gets extra immunological benefits from nursing. Several times I have seen her fight off colds and flus that have laid my husband out and I attribute that to the benefits of nursing. I am encountering a lot of sick coworkers, and I am afraid that I am bringing some extra germs home to my family. So I do not want to wean her now. Instead, I am trying a new tactic. I do not nurse Sasha until after she has eaten all she can at a meal. Then I top her off with a nursing session. She always has room for milk and regardless of how full she is, she never ever refuses nursing. It's like her dessert, lol.

I do want to keep trying to give her nutritional foods, but I do admit it has sort of become a feed-Sasha free-for-all, where we give her anything that interests her. Sweets, high fat foods, anything that she'll eat. Bad foods are better than no food at all, right? I am hoping that we can curb this after we get her weight problem under control so we don't develop some bad eating habits.

Articles I am reading on how to feed picky toddlers:
Dr Sears- FEEDING TODDLERS: 17 TIPS FOR PLEASING THE PICKY EATER
Dr Sears- IS YOUR CHILD GETTING ENOUGH TO EAT? HOW TO TELL
kellymom- Nutrition for nursing toddlers
Boosting Calories in your Child's Diet

Toddlers like mine and their mother's takes on the problem:
Mothering your nursing toddler
Berkeley Parents Network- Toddlers Not Eating

15 Month Well Baby Exam

We had Sasha's routine 15 Month Well Baby Exam on Tuesday.

In her past exams, she usually started crying the moment she sees the nurse. The nurse at the pediatrician's office is the same nurse she sees every visit from the time she was a week old onward, so she recognizes her as bad news. This time, Sasha didn't cry immediately upon seeing her and was mostly cordial at first. We stripped her down to her diaper and she was amused with that. She likes to play with her belly button, so any time she's got no shirt on, she's a happy belly-button picking girl. Sasha also found the scale in the exam room to be a fun toy. She liked to step on and off of it like it was a fun wobbly step. When the nurse came back in the room, Sasha happily stepped on the scale for her. The nurse seemed confused at the weight, 19lbs, and decided to try to weigh Sasha on the scale in the other exam room. That other scale is the scale Sasha had always been weighed on in previous visits and was the baby scale... you know the kind that weighs in pounds and ounces and sits on a tabletop.
The baby scale said Sasha weighed 18lbs 8oz. This was concerning. At her 12 month exam, Sasha weighed 18lbs 14oz. This meant she lost weight instead of a gain. Not good. Sasha doesn't seem to have gained much weight since she was 9 months old.
I've had a difficult time transitioning Sasha to solids, as I've mentioned in previous posts. She kept refusing to eat. Only in the last three weeks has Sasha shown even the slightest interest in solid foods. So I wasn't surprised at the low weight but I wasn't expecting a weight loss.

The nurse measured Sasha's height, and she did gain an inch of height. She is now 30 inches long. Sasha protested the height measurement process by screaming and crying.
The nurse left and the doctor came in the room. He was very upset about the weight loss and about Sasha's weight. According to his growth charts, Sasha is now below the third percentile in weight for her age. He kept saying "No this is not good". He started insisting that I wean Sasha from breastfeeding and implied that nursing is no longer a good source of nutrition for a toddler after a year of age, and that nursing ruins her appetite. I'm not sure what to think of his statement, but I gues that's for another post. He said that Sasha is malnourished, that we were retarding her brain development, and kept saying "This is not good".

Usually, the next pediatric exam wouldn't be until 18 months, but he wants to see her in one month to do a more thorough evaluation of her weight and nutritional status. He is going to do some bloodwork on her at that exam to check if she is anemic or if she has any malnutritional deficiencies.

The doctor continued his examination, under much protest from Sasha. He is very thorough in his examinations. He checked her abdomen, bones, joints, fontanelle status, and had us make her walk so he could observe her gait. All that was good.

They wanted to administer two shots at this visit, the mmr shot, and the chicken pox vaccination. The MMR shot has my husband nervous, with all the accusations of links to autism, but we did allow her to receive the shot. I refused the chicken pox vaccine. I suppose I could write a separate post on that but it is not required by law and I would prefer she get the chicken pox instead of the vaccine.

After the shots, the visit was complete. Sasha was quite mad at that mmr shot. I know it hurt. We set up an appointment for one month from now, and for her 18 month well baby exam. We shall see how her weight is at her evaluation next month.