How can I fatten up my Kindergartner?
May 19, 2009 5:24 PM   Subscribe

My six-year-old son takes a stimulant medication, and going off it is not an option. In the two months he's been taking it, he's lost a considerable amount of weight. Have any of you faced this with your kids or yourself, and if so, what did you do?

He drinks two Ensures a day, but that's not a good long-term solution. I've tried putting half-and-half on his oatmeal and butter on his noodles, but he's eating so little that it's not helping much. He's smart and understands that he needs to eat more, but he has no appetite at all. He'll eat a few bites for breakfast (before he takes his medication; he's never liked breakfast), not eat anything during the day, and then eat what would be a reasonable dinner if it weren't his only meal of the day.

I've tried tempting him with milkshakes, avocados, ice cream, whatever he wants, and he just can't bring himself to eat it. What he does eat is healthy; there just isn't enough of it. He has a fast metabolism and is very active, so he burns up calories like crazy.

We'll be seeing his doctor soon, so I can run ideas past her.
posted by anonymous to Health & Fitness (15 answers total)
You might have to switch him to a different medication. The side effects for each of the different meds vary a bit from person to person, so another one, or a lower dosage, might work out better.
posted by Ery at 5:47 PM on May 19, 2009

Wow this is exactly my problem, except I am 21. You may not want to add* another medication to his life because of his age, but my psychiatrist greatly recommended Remeron: It is a mild anti-depressant and mild anxiolytic, but has strong side effects of increased appetite, and increased weight gain. It seemed like a no-brainer for me, as all those effects I would want. I was really pleased with it's effects on my appetite.

I would try a few things:

Make him eat as much as he can during dinner, after dinner, and right before bed.
Make him his favorite meal in the morning. (Try making lunch/dinner foods.)
Continue with the Ensures.
Since he doesn't feel like EATING, maybe make him a protein drink after school, or after physical activity.

Adverse appetite side-effects are common, I'm sure your doctor will have some good ideas.

Good luck!

posted by lain at 5:50 PM on May 19, 2009

ADD/ADHD meds usually make the user pretty forgetful about eating - it's like your appetite just goes away somewhere. You'll have to continue to be diligent about getting him to eat - find can't miss foods he'd crawl across the desert for and make sure they're around. He'll eventually get used to the meds and start eating fine again. Be patient.
posted by Lipstick Thespian at 5:50 PM on May 19, 2009

Not your doctor.

Sounds like adderall or concerta or something from that genre. I had the same thing happen to me but I was in my early teens. If it is for ADD or ADHD, you may check with your doctor if strattera could work for your son. Strattera is not a stimulant but it does help with ADD. Comes with its very own list of problems, but that's a whole different story.

It would help if we knew what medication your son is taking, I guess, is what it boils down to. email/message me if you have any additional questions.
posted by ttyn at 5:50 PM on May 19, 2009

I've been taking stimulants for my ADD on and off for most of my life, and this is indeed a side-effect of them: decreased appetite.

A couple of things I'm thinking about in your case: first of all, you're not really clear on where he is weight-wise or where he's going. You say he's lost “a considerable amount of weight,” but you don't say how much— “ considerable amount”could be five pounds or fifty pounds, depending on the perspective. And you don't mention anywhere in your question where he was, weight-wise, before this happened. I'm going to presume that he was an average healthy, active youth.

Whenever I take a break and then start taking the stimulant again, I usually go through a period of a few weeks where I'm adjusting to it. This is exactly what happens when I do: I eat a much smaller amount. This could just be him compensating. It's also possible that he's eating plenty; it's just that he needs less. However, three months is a long time to compensate, and it does sound like he hasn't been eating much.

So: you'll be talking to the doctor. Good idea. There's really nothing we can say here.
posted by koeselitz at 6:16 PM on May 19, 2009

Is it possible for you to allow him one day a week without the meds? You may find that one day allows him to load up on food. Just make sure that what he eats is healthy and not junky. This is what my son's doctor recommended to us. We allow him to eat as much as he want whenever he wants. During the week, we're lucky to get even a quarter of his normal meal in him. On his med free day, he really chows down. He has lost some weight but has been able maintain a healthy level.

Good luck.
posted by onhazier at 6:32 PM on May 19, 2009

I would definitely consider two things: adding on a supplement as mentioned above, and asking the doctor if the dosage or time of dosage can be changed--for instance, if he took the dosage after breakfast, he might at least have more of an appetite at breakfast.

Also, just an FYI: You can save money by using Carnation Instant Breakfast instead of Ensure (my grandmother's physician recommended this when she needed to gain weight).
posted by misha at 6:51 PM on May 19, 2009

Kids with cystic fibrosis need a lot of calories - this is a website with high-calorie meals/snacks that's aimed at kids with cystic fibrosis. The food is probably appropriate for your son as well. Think high calorie - instead of oatmeal with half and half, how about heavy cream?

Can you talk to his teacher? It sounds like he might be willing to eat some lunch, with encouragement from someone. Maybe you could ask him to help you pack lunch, so he's excited about it and wants to eat it, even if he's not really hungry.

You might want to talk to his doctor about whether it's okay to NOT give him fruits/veggies until you get his weight back up - if you give him calorie-dense foods only, he'll get more calories per bite than he would with less calorie dense foods. Definitely check with the doctor though, as I'm not sure of the nutrition needs of a young kid.
posted by insectosaurus at 7:00 PM on May 19, 2009 [1 favorite]

Does he dislike breakfast, or just breakfast-typical foods? If it's this much of a problem, give him some substantial morning meals.

Also, I've found that no amount of amphetamine salts can withstand the power of a truly delicious sandwich. For me, it's smoked turkey, sharp cheddar, pickled red onions, roasted red pepper, and chipotle mayonnaise. Toasted so the cheese is all melty. If you can find your son's Zen sandwich, it might help.
posted by Jon_Evil at 7:04 PM on May 19, 2009

My 14-year-old grandson is on ADD medication AND has cystic fibrosis. Not to add to your problems, but you may want to have your son tested for CF, as the eating problem may only be coincidentally connected with the stimulant medication.
posted by Joleta at 7:16 PM on May 19, 2009

You could give him pills with oil in them, supplements. Also, I don't know if you want to do this, but there are a variety of medications that cause weight gain as a side effect, for some reason it changes the way the body handles the food that it ingests.
posted by MTheresa at 7:17 PM on May 19, 2009

I want to very strongly recommend that you consult with the prescribing doctor about the fact that this particular medication is not, in fact, "working". Having a great attention span (I am presuming that this is an ADD or ADHD treatment) is not a tradeoff for continually losing weight and putting his vital organs in danger.

I work with several children who have been diagnosed with ADD/ADHD. In most cases, it takes a few tries with different medications to find the right dosage of the right substance. Please don't feel pressured by any doctors to keep your son on a medication that is not making him healthier (especially if this is a family practice doctor or pediatrician, and not a psychiatrist).
posted by so_gracefully at 9:26 PM on May 19, 2009 [1 favorite]

Yeah, stimulants can really do a number on appetite. When I was taking them, I figured out that I had to maximize breakfast in any way I could because it was the one time of day when I was hungry. Does he just not like eating in the morning? Or does he just not like typical breakfast foods? Sometimes for me it was helpful to have extra-flavorful things in the morning (one of my favorites was extra-sharp grilled cheese on sourdough with mustard, but I don't know how a kid might take to that.) I have also found that it's much easier to eat a lot of something if that something combines both sugar and salt. It doesn't have to be much of either--trail mix, toast with salted butter and jam, salted peanut butter and jelly on a waffle, sweet potato fries, etc.

If he's not eating his lunch at school, check with his teacher to see if it's possible for whoever supervises lunchtime to make sure that he eats something before getting up to play. Recess will always trump lunch if you don't feel hungry to begin with.

Best of luck to you both.
posted by corey flood at 11:45 PM on May 19, 2009

I think Koeselitz's point is an important one - how much weight has he lost, and where is he now in the range of healthy weights? I was fairly skinny as a child, and I've known autistic children who were painfully thin (they tend to be very picky about what they will eat, and often survive on very unbalanced diets as a result), but otherwise healthy and active. There are some health problems with being underweight, but plenty of children go through phases of being very thin at that sort of age. I have friends whose oldest boy was very slight at six, and three years later he has filled out and is a normal weight for his height. If the doctor doesn't think your son's weight is a problem, don't worry about it - I think parents often worry too much about their children not eating enough (my mother certainly did), and it usually isn't a cause for concern.
posted by nja at 12:47 AM on May 20, 2009

Nth-ing talking to your doctor. You may be able to find a medication that has fewer appetite effects, but to be honest this is par for the course with ADHD medication. If changing the medication doesn't work, you might want to look at a referral to a dietitian, so they can help you work out a diet plan that covers the bases of 'nummy enough to tempt child without an appetite', 'enough calories for growing' and 'actually nutritious'.

Also, make sure that his height and weight is being monitored frequently if you have concerns, and plotted on height and weight centile charts - they give an idea not just of where your child is, but a range of where they 'should' be going.

If you find your doctor's dietary advice unhelpful (there are some docs out there who appear never to have tried to feed a child!), see if there's a local ADHD parent support group - as I said, this is a really, really common problem with ADHD medication, so there will be people there who've been through this and have ideas.
posted by Coobeastie at 4:50 AM on May 20, 2009

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