Pediatric Dietician

Before we could go see the endocrinologist, we had to go see a dietician. I honestly scoffed at this, since, despite our best efforts, Elli still isn't swallowing any solid food of any significance. Since she still exists primarily on breastmilk, I wasn't sure how much good a visit to a dietician could be. Once again, I was pleasantly surprised. (Are you seeing a recurring theme here?)

The dietician had me keep a food log for 3 days before we went to see her. I kept track of everything I presented to Elli for food, as well as what she actually ate. I also kept track of how often and when she nursed, as well as the duration of each nursing session.

The dietician was very encouraging. She explained that the bloodwork results that we had received (low pre-albumin levels and low insulin-like growth hormone levels), when they occur together, almost always indicate that the child simply has a lack of calories, particularly a lack of protein. (Although it's discouraging as a mom to find out that you aren't feeding your child enough, it's more encouraging than finding out that they have a deficiency of growth hormone and would need shots, which was a possibility, given the growth hormone result. )

She then looked through my food log and said "Wow...it looks like you spend most of your day just trying to feed your daughter." I laughed and said, "Well, yes, it sometimes feels that way!" She said that it looked like Elli was nursing plenty, and that she should be getting plenty of calories from that to sustain herself, and she said that, if Elli isn't swallowing, there's not a lot of ways for me to increase the calorie/protein intake. She said that, because Elli is so active, she probably is just the type of child that will struggle to get enough calories to make up for all of her movement.

So, she basically said that we should just keep doing what we've been doing, and eventually Elli will turn a corner and start swallowing. When that happens, she said to feed her the highest calorie foods I can find - add oil to her food, add butter to everything, mix instant Carnation breakfast into milk to add protein, make "super milk" by putting dry milk into whole milk, feed her ice cream, etc. So, when you see me feeding my 1-year-0ld ice cream, don't think I'm being a lousy mom. :-)

She also said the delayed bone age was actually a positive result - if her bone age had shown 11 months instead of 3 months, and she was still this small, then we would have to be worried about stunted growth. Instead, she said that Elli will likely catch up to others once she starts getting enough calories.

She also said it was not a surprise that Elli started getting up to nurse in the middle of the night again at around 6-7 months old. That's about when she started getting more active, so she started needing more calories. Since she didn't take them in via solid food, she had to add the calories somewhere, so that explained the nursing in the wee hours.

Before this appointment, I had been very discouraged after being told that she needed more calories. As it was, I was getting up 2-3 times a night to nurse her, plus nursing her 5 times a day, plus trying to feed her 3x a day with solid food (which wasn't working). Finding out that all of that wasn't enough made me very disenheartened, because I didn't know what else to do! Being told by the dietician that I was doing the right things and couldn't really be doing anything else for her was very encouraging!