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is this advice from maternal health nurse strange?

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#1 maryanneK

Posted 19 June 2019 - 02:41 PM

saw the MCHN yesterday with my just turned 1 year old
He's quite little, and has been since he was a few months old. Since then he's been fairly consistently on the 5th percentile for weight. He's happy, healthy, active and growing - just still on very small end of the scale.

So yesterday she was talking about fattening him up a bit - she recommended cutting down the milk and increasing solids, and making sure to include plenty of fats and carbs in his diet.

So far so fair enough. But then she said to add butter to everything as an easy way of adding fat/calories? like, adding butter to vegetables?  I understand using full fat dairy, and not restricting fats and oils like we might in our own diets....but I thought a better recommendation would be to add healthy fats like avocado, even olive oil...to include lots of full fat natural yoghurt, full fat cheese and milk, etc? Even nuts (ie peanut butter, no allergy issues here) and those kind of healthier fats?

Is butter an odd thing to suggest? Its not like he's starving and desperately needs calories. If he needs more fat why would she suggest butter, which as far as I know has zero nutritional value?

WDYT ? (just realised this should probably be in the WDYT section!)

#2 seayork2002

Posted 19 June 2019 - 02:45 PM

I think I heard something about doing this at weaning event I went to when DS was little, the info was not for him specifically but it was at the talk bit

#3 Ozquoll

Posted 19 June 2019 - 02:46 PM

I don’t much buy in to the healthy vs unhealthy fats thing, except maybe for trans fat, but anyway, I don’t see why you need to fatten him up at all! He’s healthy, he’s maintaining his percentile, everything’s good 🤷‍♀️.

#4 hotsonfornowhere

Posted 19 June 2019 - 02:47 PM

We were advised to add butter, oil or double cream to everything we could for my son - but he was diagnosed as failure to thrive at around 18 months old by a pediatrician.

#5 Lunafreya

Posted 19 June 2019 - 02:51 PM

I think it’s a bit odd unless he’s underweight. And it doesn’t sound as if he is.

He might be a tall skinny boy like my DS that eats loads.

#6 Islander

Posted 19 June 2019 - 02:56 PM

I understand that this is fairly standard advice for children/infants who need to gain weight (failure to thrive, required to be ‘big enough’ for an operation etc). Given your child hasn’t lost weight and there are no health concerns for weight, my guess is the child health nurse has overgeneralised the advice.

#7 Caitlin Happymeal

Posted 19 June 2019 - 02:57 PM

Our paed has given us this advice too (but our daughter is a lot older) Shes consistently underweight though and has now dropped off the percentile for her weight. Shes 9 and has always been small.

Butter isnt a bad thing as such. If she said margarine id be a bit "huh?" But butter - eh. Its a decent sort of fat. She may not advise nuts/avocado sort of things because of the risk of allergies, even if that doesnt apply to your child - it might be a broad policy.

#8 ipsee

Posted 19 June 2019 - 03:00 PM

Butter isn't an empty food - it is made of full fat milk, which kids need, rather than lo fat etc.

I saw a paediatrician for my baby who stopped growing and she recommended chocolate milk and sweet custard, as well as adding butter to everything.

I went with the butter and oil, and didn't have to resort to chocolate milk.

#9 EsmeLennox

Posted 19 June 2019 - 03:00 PM

If you're including full fat yoghurt, cheese and milk, I fail to see the issue with butter, :shrug:, it's not the spawn of the devil. Especially for an active child.

I had a baby on that end of the scale... they don't have much in reserve, so to speak, and can very easily go from being 5th percentile to well underweight if they become ill. Ask me how I know. It took me a long, long time to get my son to regain weight after being sick. I added butter and cheese to everything for a while there.

Edited by EsmeLennox, 19 June 2019 - 03:00 PM.

#10 Lunafreya

Posted 19 June 2019 - 03:07 PM

I prefer full fat Yoghurt. Pot set. Many yoghurts are skim milk with vegetable thickeners added

#11 JoanJett

Posted 19 June 2019 - 03:23 PM

When looking at percentiles for toddlers/kids, it's also important to look at the correlation between the height/length percentile and weight.  That's where the trend in their BMI can be useful.

For example, if your child is stable on the weight percentile, but crossing percentiles for heigh/length, just maintaining the weight percentile could be a concern.  But if your child is on one of the lower percentiles for height/length, they're more likely to be "small".  It does mean they have less reserve, as mentioned by a PP.

As for how you calorie load food, if you want to increase their weight, it's often about nutritional density and getting the biggest impact from a small change, particularly if appetite is an issue.  A little bit of butter can go a long way for calories without them having to eat more "bulk".  It's commonly recommended by Paediatric Dietitians.

I would guess she's probably pre-empting the "busy" toddler phase with her advice -  activity levels go up and fussy eating often starts to rear its charming head and they can slim down quite quickly.

Edited by JoanJett, 19 June 2019 - 03:49 PM.

#12 Oriental lily

Posted 19 June 2019 - 03:35 PM

Butter is just another full  dairy product which is great if gaining wait is a goal . It's also very palatable making things like veggies extra yummy . Butter got it's bad name due to being high in saturated fat but the jury is out if dairy of the full fat kind is responsible for things like high cholesterol.  I really don't think it's a factor a baby has to worry about .

#13 Holidayromp

Posted 19 June 2019 - 03:48 PM

To be honest I would take that ‘advice’ with a grain of salt.

A good MHN is very hard to find and I have had many a WTF with them before ditching them altogether when my eldest was about sis months old.

As long as he is following a steady growth pattern who cares?!!

He doesnt need to be loaded up with all that crap.

If you have any concerns - see your gp.  I find some ‘advice’ from that lot can be quite dangerous.

#14 YodaTheWrinkledOne

Posted 19 June 2019 - 03:49 PM

View PostOriental lily, on 19 June 2019 - 03:35 PM, said:

Butter is just another full  dairy product which is great if gaining wait is a goal . It's also very palatable making things like veggies extra yummy . Butter got it's bad name due to being high in saturated fat but the jury is out if dairy of the full fat kind is responsible for things like high cholesterol.  I really don't think it's a factor a baby has to worry about .

If you are using proper butter (not margarine or a butter-oil spread), I don't see that it's much different than using full cream milk, full cream yoghurt, full-fat cheese, etc.

When serving veges, a quick swish with butter won't hurt (eg. corn on the cob, steamed beans and carrots). Mashed potato with lots of butter and milk.

Butter cake! (I use 1/2 - 2/3 cup of sugar, rather than the full 1 cup the recipe recommends)

Use butter on sandwiches/toast/toasted sandwiches.

Butter would be a very effective way of increasing calories  without substantially increasing the food "bulk", if that makes sense.

ETA: Keep in mind that someone has to be at the lower end of the scale, just as someone has to be at the upper end of scale. Provided your child has a healthy appetite, eats well, is healthy and hits most other milestones without much concern, I would continue as usual. My daughter was *always* above the 99th percentile for weight (and height). She still is, at 12 yo (taller than most of my adult female friends). Never had a GP tell me that I should restrict her diet or change what she was eating.

If you have any concerns about how your child is tracking in terms of his weight or other milestones, see your GP.

Edited by YodaTheWrinkledOne, 19 June 2019 - 03:55 PM.

#15 Lunafreya

Posted 19 June 2019 - 03:51 PM

Can I advocate for home made cheese sauce with cheese, butter AND milk? Great to cook veggies in like cauliflower and broccoli

#16 Jersey Caramel

Posted 19 June 2019 - 03:52 PM

We had similar advice from a paediatrician for one of our DSs who has always been 3-5%ile. We took him to a paediatric dietitian and she said that she would prefer us to calorie load with olive and other plant oils, nut butters, cheese (as this has fat but also calcium,  unlike butter), full fat yoghurt. We did add butter to some things too (make sure it is unsalted).

#17 YodaTheWrinkledOne

Posted 19 June 2019 - 03:56 PM

View PostLunafreya, on 19 June 2019 - 03:51 PM, said:

Can I advocate for home made cheese sauce with cheese, butter AND milk? Great to cook veggies in like cauliflower and broccoli
potato bake with cheese sauce usually goes down well with kids too

#18 CallMeFeral

Posted 19 June 2019 - 04:05 PM

So, setting aside the issue of whether he needs to gain weight at all, which I have no idea of...

Butter is awesome. There's nothing bad about butter (apart from that it's fat, but fat is what you're after so it's not bad at all). You've probably gone through that era where butter was thought of as evil (and devil spawn margarine was touted as healthy) but there's not much evidence for that. Butter is literally the fattiest part of milk - it's no more harmful than milk except for just being even fattier. If you're comfortable with the full fat milk and cheese etc - that's basically diluted butter (not exactly but you get my drift).

#19 TheGreenSheep

Posted 19 June 2019 - 04:33 PM

We were given the same advice for DS1 when he was eating like a sparrow and smallish, starting to slide down the percentiles. As a teen he is now on the 75% for height and 40-50% for weight. Hasn’t changed but at least he eats everything in site...
I actually only buy low fat milk, it’s a taste preference. Everything in my fridge is full fat, including butter, cheeses, yoghurts, ice cream etc. Funny now I think about it but I stopped buying low-fat when the kids were little and haven’t felt the need to change.

#20 QuirkyMum

Posted 19 June 2019 - 05:02 PM

Cutting down milk (even full cream and 4.5% one) to an absolute minimum and giving a child solids instead is a sensible advice.
If child drops off charts and is sent to a pediatrician, this is the first thing doctor will suggest.
"Add butter to everything" is a standard suggestion as well. Organic butter is actually a very good fat as well as avocado and oily fish and nut butter and eggs and many other good sources of fat.
Back in the day I was told to fatten everything up. Cooking sausages? Choose cheapest ones with higher fat content. Choosing salad dressing? Pick fatty mayo and drizzle with olive oil on top! Plus add butter/alternatives to morning porridge with jam and plain pasta and steam broccoli etc.
I didn't follow advice to buy cheapest sausages...
OP, one thing I can suggest is to cook stock ( boil whole(!) chicken (organic if you can) with some salt and bay leaf and peppercorns), keep all the fat, freeze in small portions. I use bonne maman jam jars, put some of the chicken in each jar and fill with stock. Whenever I need to add water to grains/veggies/any meal, I use stock instead of water. It adds up.
You are supposed to limit milk because milk fills them up easily
but it is not a complete meal for them nutritionally. If child has no appetite, it is easy to just give milk, they will become full and will continue NOT to eat proper food. I found that when child has no appetite and I give some stock to drink, they usually drink it because it is slightly salty and has flavour. Yet it won't fill them up (but add calories) and saltiness actually brings the appetite, so you can usually get then to eat proper food. Win-win!

#21 BadCat

Posted 19 June 2019 - 05:19 PM

Yeah, I'd ignore it.

As long as your child is healthy I'd just fed them what you would normally feed them.

They tried to get me to fatten up DC1 when they were tiny.  It's bollocks.  The only way I could have done that would have been to force feed.  The kid is still rake thin at 20 no matter how much fat and carb they eat, but not short.  Some kids are tiny.  End of story.

If your kid continues to be small or skinny, teachers will do it to.  "You need to eat more, blah blah blah."  

You get used to ignoring it.

Edited by BadCat, 19 June 2019 - 05:23 PM.

#22 lucky 2

Posted 19 June 2019 - 05:21 PM

View PostHolidayromp, on 19 June 2019 - 03:48 PM, said:

To be honest I would take that ‘advice’ with a grain of salt.

A good MHN is very hard to find and I have had many a WTF with them before ditching them altogether when my eldest was about sis months old.

As long as he is following a steady growth pattern who cares?!!

He doesnt need to be loaded up with all that crap.

If you have any concerns - see your gp.  I find some ‘advice’ from that lot can be quite dangerous.
In general sense I think it is unwise to run down the knowledge base and experience of a hp such as a chn, considering how important the role is, especially if done well.
I've had some shitty advice re infant feeding from a gp and chn so I know it's not all sunshine and lollipops.
Child nutrition isn't really something a gp would have much training in, they'd usually refer you back to the chn, or dietician if there were concerns.

Eta, butter is delicious

#23 .Jerry.

Posted 19 June 2019 - 05:25 PM

As PPs have said, if your child's growth is still on track, despite being little, I would be fine to just feed normally.

DD was premature and very tiny.  Under Paed's directions (also seeing Dietician), we added cream or butter to most of her meals, to boost her calorie intake for growth.

We did that for the first three years of her life.   She is regular sized now (if short).

#24 ~LemonMyrtle~

Posted 19 June 2019 - 05:29 PM

It’s pretty standard advice that I have heard before, for helping kids to gain weight. Butter is calorie dense and makes things taste nice. Nothing wrong with butter, humans have been eating it for centuries.

I even had a good quality baby food book that suggested adding a bit of butter to purée veg to make it a bit more of a complete food for a baby.

Edited by ~LemonMyrtle~, 19 June 2019 - 05:30 PM.

#25 ~J_WTF~

Posted 19 June 2019 - 05:37 PM

Geez now butter has zero nutritional value...

No food is safe on EB.

But seems to be pretty standard advice to add some calories to kids meals. I wouldn’t say it’s an odd suggestion!

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