Very Slow Weight Gain: possible delayed gastric emptying?

Question: I have a three year old boy who weighs 27 pounds. He vomits a couple of times a week after eating, and we find undigested food he ate a couple of hours prior. I had taken him to a gastroenterologist a little over a year ago and she did an endoscopy and told me everything looks fine.

I have since then been supplementing with Carnation Instant Breakfast with whole milk, which he drinks a couple of times a day. I have noticed he does not eat "normal" amounts of food; but will throw up if he eats more than what is normal for him. He will also likely throw up if someone else is feeding him, but does okay when he feeds himself at his own pace.

I am wondering if he has delayed gastric emptying. His day care sitter wants him to eat like the other children and gain weight and is worried something is wrong with him because he does not. I am trying to boost his calories by adding butter, cheese, mayo whenever and wherever I can. He has not lost weight, but his weight gain is extremely slow. He is developmentally on track and is otherwise a healthy, active boy. What should I be doing?

Answer: It sounds like you are doing the best you can and it's great you are giving him Carnation Instant Breakfast a few times a day. From what you are describing I agree it sounds like delayed gastric emptying. To get a definitive diagnosis consider getting a delayed gastric emptying study.

While it's good that your doctor did an upper endoscopy, that rules out things like reflux and ulcers and would not diagnose gastroparesis (delayed gastric emptying). The endoscopy looks for problems with similar symptoms to delayed gastric emptying however cannot diagnose DGE.

It sounds like you are doing a good job adding calories to foods, for more suggestions check out calorie boosting article: http://www.feeding-underweight-children.com/calorieboosters.html and high calorie foods: http://www.feeding-underweight-children.com/highcaloriefoods.html.

If he's doing well on Carnation and you feel comfortable, that's great, but you may want to try an even higher calorie supplement that has ~375 calories per serving. You can look at a review of them here: http://www.feeding-underweight-children.com/highcaloriesupplements.html. Just keep in mind that if he gets full quickly he may not be able to drink the full 8 ounce serving, in which case if he will take the full serving of CIB you should stick with that since it will give him the fluid as well.

I understand why your child's babysitter is concerned, but she should not force him to eat more than he's comfortable with.

My recommendation would be to get a second opinion from a gastroenterologist and possibly request a delayed emptying study. Here's an article on information to take to your GI appointment: http://www.feeding-underweight-children.com/gastroenterologist.html.

If you need more help, please feel free to contact me or make an appointment. I hope this information helps you, and that you find the answers you are looking for by going to another GI and requesting a delayed emptying study.