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Care and Feeding?

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  • Care and Feeding?

    K1 is having trouble putting on weight. He is losing weight and the pediatrician is concerned about failure to thrive. He is tall and much slimmer than his friends. He is a picky eater and looses interest in food quickly due to his sensory and ADHD issues. Also, his very much needed ADHD medications suppress his appetite. He mostly eats fruits. He will drink some milk and will eat cream cheese (but no other cheese). He does not eat veggies. I can occasionally get him to eat small amounts of ground beef or chicken but he’s mostly interested in the chicken skin. He’s taking vitamins and I force him to drink protein shakes. He’ll drink maybe one 8oz shake/day. Just now, for lunch he ate 1/4th of a tortilla with cream cheese spread and about 2oz of the protein shake. How do I fatten him up aside from feeding him donuts all day?

    Meanwhile, K2 and Lambie eat a wide variety of foods including vegetables and lean proteins. K2 eats a very healthy diet and he’s been in the 95th percentile for weight his whole life. He weighs more than K1. Lambie has a big appetite. She has a sturdy build and chubby cheeks, also in the 90th percentile for weight. K2 and Lambie both participate in 3 sports and are generally more active than other children their age. My husband and both of our parents have difficulty maintaining a healthy weight so we are trying to teach all the children to eat a healthy diet of lean foods. How do I go about fattening K1 up while avoiding extra calories for my other children who need to slim down a little.


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    Last edited by MrsK; 07-05-2018, 02:10 PM.
    Wife and #1 Fan of Attending Adult & Geriatric Psychiatrist.

  • #2
    My guess is that it’s the adhd meds. I’ve seen this many times. Perhaps he would benefit from a non-stimulant med?


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    ~Mom of 5, married to an ID doc
    ~A Rolling Stone Gathers No Moss

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    • #3
      Originally posted by PrincessFiona View Post
      My guess is that it’s the adhd meds. I’ve seen this many times. Perhaps he would benefit from a non-stimulant med?


      Sent from my iPhone using Tapatalk
      IDK. This medication works really well for him.


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      Wife and #1 Fan of Attending Adult & Geriatric Psychiatrist.

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      • #4
        MrsK — how would he do with a shorter-lasting med? I ask because my kids have a liquid suspension that wears off about 7-8 hours after dosing. While this allows for some “fallout” on behavior 🙈, they do get hungry and then have healthy appetites for snacks (fruit, protein shakes, veggies) and then dinner. It has helped DS2 to not lose weight.

        So far, stimulant meds make the biggest difference and I’m unwilling to give them up. ❤️ You said he takes Focalin in the past, correct? What’s the treatment time length on that drug?


        Sent from my iPhone using Tapatalk
        Wife to Family Medicine attending, Mom to DS1 and DS2
        Professional Relocation Specialist &
        "The Official IMSN Enabler"

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        • #5
          Originally posted by Thirteen View Post
          MrsK — how would he do with a shorter-lasting med? I ask because my kids have a liquid suspension that wears off about 7-8 hours after dosing. While this allows for some “fallout” on behavior 🙈, they do get hungry and then have healthy appetites for snacks (fruit, protein shakes, veggies) and then dinner. It has helped DS2 to not lose weight.

          So far, stimulant meds make the biggest difference and I’m unwilling to give them up. ❤️ You said he takes Focalin in the past, correct? What’s the treatment time length on that drug?


          Sent from my iPhone using Tapatalk
          He takes 10mg of slow-release focalin in the morning. That lasts about 5-6 hours for him. He is very focused within about 20-30 minutes of dosing but instantly looses his appetite too. Then it wears off after about 5-6 hours and he has a rebound. He becomes tearful, impulsive, loud, distracted, gets into conflicts, runs around on all fours, literally. (Clearly, he needs this stuff.) He is rebounding right now but still hasn’t eaten anything. The pediatrician wants me to get a “good feed” in and then give him another dose to keep him steady until bedtime.


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          Wife and #1 Fan of Attending Adult & Geriatric Psychiatrist.

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          • #6
            And I agree, the meds make a dramatic difference. He can’t read or dress or do homework or anything without them.


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            Wife and #1 Fan of Attending Adult & Geriatric Psychiatrist.

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            • #7
              MrsK,

              Some doctors prescribe a low, short-acting dose to ease rebound. When the long acting wears off, the child takes a short acting. I have several patients where this was instituted. It didn’t work for one of them, but was successful for the others. Obviously, I’m not a doctor. Just sharing my experience.


              Sent from my iPhone using Tapatalk
              ~Mom of 5, married to an ID doc
              ~A Rolling Stone Gathers No Moss

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              • #8
                Originally posted by PrincessFiona View Post
                MrsK,

                Some doctors prescribe a low, short-acting dose to ease rebound. When the long acting wears off, the child takes a short acting. I have several patients where this was instituted. It didn’t work for one of them, but was successful for the others. Obviously, I’m not a doctor. Just sharing my experience.


                Sent from my iPhone using Tapatalk
                Yes, we’d been doing that. He was taking 10mg of short acting Ritalin after school. It takes a little of the edge off but it’s not nearly as effective for him. Also, the school day is longer than 6 hours so he’s struggling through the last hours of the day, especially when he is taking the meds 30-50 minutes before the start of the school day. We are trying to determine when to give him a 2nd dose at school. Today, he had the focalin at about 8. He’s been crashing since 2 and he’s tearfully fighting with K2 right now. However, I’ve been trying to get him to eat something or drink a protein shake since 1 and he is simply not eating so I can’t give him a second dose. If he doesn’t eat lunch, I need him to eat dinner.


                Sent from my iPad using Tapatalk
                Wife and #1 Fan of Attending Adult & Geriatric Psychiatrist.

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                • #9
                  Originally posted by MrsK View Post
                  Yes, we’d been doing that. He was taking 10mg of short acting Ritalin after school. It takes a little of the edge off but it’s not nearly as effective for him. Also, the school day is longer than 6 hours so he’s struggling through the last hours of the day, especially when he is taking the meds 30-50 minutes before the start of the school day. We are trying to determine when to give him a 2nd dose at school. Today, he had the focalin at about 8. He’s been crashing since 2 and he’s tearfully fighting with K2 right now. However, I’ve been trying to get him to eat something or drink a protein shake since 1 and he is simply not eating so I can’t give him a second dose. If he doesn’t eat lunch, I need him to eat dinner.


                  Sent from my iPad using Tapatalk
                  Would you be willing to try new stimulant meds? I know I know, don’t mess with a good thing (I get it from personal experience). However, you said it isn’t lasting long enough through school.


                  Sent from my iPhone using Tapatalk
                  Wife to Family Medicine attending, Mom to DS1 and DS2
                  Professional Relocation Specialist &
                  "The Official IMSN Enabler"

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                  • #10
                    Originally posted by Thirteen View Post
                    Would you be willing to try new stimulant meds? I know I know, don’t mess with a good thing (I get it from personal experience). However, you said it isn’t lasting long enough through school.


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                    Yes. The doctor says there is a 12 hour formula too but he wanted to try this first.

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                    Wife and #1 Fan of Attending Adult & Geriatric Psychiatrist.

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                    • #11
                      We had a member here who really struggled with her kiddo's meds and lean build. I won't name her in the public area but I could link you to her thread in the Call Room. He was 8 going on 9 when she posted, so right around K1's age I'd guess. Very similar issues (though I'm not sure if he was actually losing, just dropping on his charts more than the doc wanted to see...)
                      Alison

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                      • #12
                        Originally posted by spotty_dog View Post
                        We had a member here who really struggled with her kiddo's meds and lean build. I won't name her in the public area but I could link you to her thread in the Call Room. He was 8 going on 9 when she posted, so right around K1's age I'd guess. Very similar issues (though I'm not sure if he was actually losing, just dropping on his charts more than the doc wanted to see...)
                        Yes, please link me. And you are correct. K1 is 8.5yo.


                        Sent from my iPad using Tapatalk
                        Wife and #1 Fan of Attending Adult & Geriatric Psychiatrist.

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                        • #13
                          What about adding something to his foods to increase the calories? We used DuoCal with C, and it's honestly tasteless and odorless, and it dissolves well.
                          Allison - professor; wife to a urology attending; mom to baby girl E (11/13), baby boy C (2/16), and a spoiled cat; knitter and hoarder of yarn; photographer

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