Eleven Years Old and Underweight

Dear Dr. Cason,

My grand child is 11 and weighs 55 lbs, short (familial) , he eats little but has large normal bowel movements. He had symptoms of ADD and has difficulties learning. Because of his weight he has never been on meds for very long. He has kept some babyish habits(sucking fingers and playing with clothing labels).He has been extremely healthy and has done well in sports. His parents have found that he seems to be doing better since he does triathlons and eats better after swimming. His mother is obsessed with keeping her weight down and is also very thin, she maintained herself on a fat free diet while pregnant. The father was also low weight, ADD as a child . We feel that his poor intake maybe related to his lower functioning . He gets easily frustrated and cries.
Any input would be appreciated.
Thank You !

- BR


Dear BR,

At 11 years of age 55 lbs is certainly low, but it is difficult to tell exactly what is going on. It is good that he is active and eats well at times. I am assuming with the mention of the extreme health issues at homes that there may be some restriction in what foods are available to him. By no means should a child be on a fat free diet or carbohydrate restricted. But even if he has a variety of food available to him, given his home environment, he may be picking up some unhealthy habits. It is not completely uncommon to see eating disorders in young children- boys included.

Also with your mention of some young child like behaviors- sucking fingers and playing with clothes tag,there may be a developmental issue such as pervasive developmental disorder. Remember that very frequently children can fit a certain diagnosis such as ADD when really there may be an other diagnosis to be considered. Often children who are very sensitive in general can have oral aversions. Textures, taste and temperature can play a large role in what they prefer to eat.

I suggest taking him to a developmental pediatrician. If there isn't one available then take him to his pediatrician and ask for a consult. They should be able to tease out what issues are at play here and give you a better idea how to help your grandchild.

Good luck and let me know if you have any other questions.

Sheila Cason MD

Medicine Mondays:Essential Fatty Acids and Children,

Hi Everyone,

Welcome back to Medicine Mondays.

Each Monday I'll post the answers to questions that I have collected over the week. If you have a question please feel free to send me an email or leave me a comment. I welcome every comment and hope to help answer some questions. Just remember that my advice is not a substitute for a physical exam and medical advice that your family doctor can provide.

Dear Dr. Cason,

For toddlers, is there a given amount of fatty acids they should have for good brain development? Are supplements available and ever necessary?With my daughters dairy, egg, and nut allergies, the fatty acids she can intake are limited. She eats a lot of avocados. What are other good sources?- Anonymous


Dear Anonymous,

When people talk about consuming fatty acids they are most likely referring to essential fatty acids (EFAs) They are called essential fatty acids because they cannot be made in the body from other substrates and must be supplied in food. These fatty acids are called Linoleic Acid (Omega -6) and Alpha-Linolenic Acid (Omega - 3).

In the body, essential fatty acids are primarily used to produce hormone-like substances that regulate a wide range of functions, including blood pressure, blood clotting, blood lipid levels, the immune response, and the inflammation response to injury infection.

You can get these EFA in supplements but since they are nutritional supplements and therefore not regulated by the FDA, there is no specific guidelines about what a safe amount is. I generally recommend that parents feeds their kids good healthy foods that will supply the EFA and don't worry about additional supplementation found in capsule form.

Most people forget that while eating Omega- 6 and Omega- 3 EFA are important what is more important is eating the right ratio of Omega -6 and Omega-3. Marion Nestle in Her Book, "What to Eat" points out that

Although these two essential fatty acids differ, the enzymes that work on them are exactly the same. This means that when you eat a lot of linoleic acid, Omega- 6, it can compete with the alpha-linolenic acid, Omega-3, for the enzymes that turn the alpha-linolenic acid into EPA and DHA, the two longer omega-3 fatty acids that seem especially good for health.

This means that it's important to eat the Omega -6 and Omega -3 EFA in the right ratio to prevent this competition. Nestle suggests eating balance of 6:1. Oils that have a good balance of Omega-6 to Omega- 3 are Flaxseed oil at 1:4, Canola at 2:4, Soy at 7:1 and a fairly good balance of these two EFAs can be found in Olive Oil at 9:1.

Most people get enough Omega- 6 without even trying. Examples are- Safflower oil,walnut oil, grass fed cow milk, olive oil, palm oil, sunflower oil, soybean, peanut oil and sesame oil to name a few. What they need to focus on is increasing their Omega- 3 intake.

Examples of food that have a good amount of Omega- 3 are oily fish, walnuts, flax seeds, pumpkin seeds, canola oil and soy. Omega eggs are also a good source of Omega-3 fatty acids and you can find them in your grocery store. The hens that lay these eggs are fed on healthier feeds, which results in eggs that contain omega-3 fatty acids. For a child that is allergic to nuts and eggs, I would focus on taking in a balance of salmon, flax seeds and canola and soy oil.