Need advice about failure to thrive

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I have a nephew that was born at 4# 1oz on 4/02/01, he is just over 3 1/2 yrs, and only weighs 26#. You can see every bone in this kid's body. He won't eat "food" unless you make MAJOR efforts to get him to eat. He'll eat sweets, and regularly requests them, but when it comes to foo, he's not interested. He is manipualating his Mom into giving him only what he chooses to eat. She unfortunantely avoids any kind of confrontation with him, which I know is a major part of the issue. What concerns me most, is I have tried every idea I can think of to try and get him to eat. I have only had marginal success. I have repeatedly suggested he see the pediatrician, and my sister-in-law just maintains the Dr. tells her he's fine, which I am having a really hard time believing. I would like some better info or criteria to refer to when trying to encourage her to get him evaluated, and or any ideas to try to get him to eat. It doesn't matter what kinds of foods, or preparation types or anything. He will eat cake, ice cream, cookies etc. and absolutely refuses any knid of regular food. Is this really something I should be concerned about ( gut instinct says so ) ?

I have a 5 month old, and he is almost 20#, He's a big kid, not fat at all, just tall, and solid, and my nephew is only a few pounds heavier.

Just FYI, I only have the opportunity to directly do anything about restricting the junk food intake on Sundays ( after church ) which is our weekly family day. Yesterday, my father-in-law tried to express his concern to his daughter, and she flipped out and twisted his words into " You're just telling me I'm a terrible Mom ". A little background here is in order. My sister-in-law is 30, is 5'6" and only weighs 90-95# herself, has 2 children from different dads, and is divorced from the mentally/physically abuser father of this little guy. He is in prison for the next 6 years, at least, for drug related theft issues. He broke into my house, his aunt's house, and my in-laws all in one day to get something he could sell for crack. She is also being souly supported by my in-laws, and always has been, there is some kind of lower IQ issue with her, that they have chosen to support her, mostly for the kids' sake. They are not there 24/7 with him like they were with the older nephew ( 11 yrs ), and can't control the situation more directly.

Anyhow, sorry for rambling, but I want some opinions. I don't want to push any harder than I have if there is just a lack of discipline/behavior issue. I know that's the case. But, if there is something that we as a family need to intervene, medically, I would really like to know.

Thanks, and Happy Holidays :)

Well we finally got the little guy to the DR and he has a bone growth study which showed his bones are growing at the rate of a 2 1/2 y.o. They also did bloodwork which my sister-in-law told showed some things wrong, but she didn't know what. He is being referred to a specialist. The DR also added pediasure to his diet. I'm suspecting pituitary/thyroid problems.

Anyhow, I just wanted to update all of you that responded and offered your opinions. Thank you all :)

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