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My 2 year-old seems to have lost her appetite in the last 3 to 4 weeks: she eats very little at meal times (couple of mouthfuls) and definitely much less than she used to. She does not seem to be ill, sleeps well at night and nap times, has plenty of energy to run around and is generally happy. The only changes I have noticed is that she seems a little more clingy and moody than she used to. She has lost some weight (over 10% of her body mass - she was in the 25% in the curves, and has always been there, and so is now in the 10%).

I expect it is normal that appetite and weight somewhat fluctuate so would like to know at what point one should worry about this and seek medical advice (e.g. signs to look for, a % weight loss that gets too significant, a prolonged period of time, etc.)?

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5 Answers

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I like Torben's list, but I don't think that having a child who is low on the growth curve is a reason to be overly concerned about weight loss unless your child has all ready been diagnosed as being underweight by his/her pediatrician or with failure to thrive. The reality, though, is that children in the lower percentiles follow the same growth patterns as children in the upper percentiles. I doubt anyone would bat an eye if a 26 pound 2-year-old lost two pounds. While it might seem alarming that your child has gone from the 25th percentile to the 10th percentile, a quick check for growth charts shows that the difference between those percentiles is, like, 2 pounds. What I'm saying is, it doesn't take much for a kid to fluctuate between percentiles at this age, and my daughter has floated between the 5th and 10th percentiles her whole life.

There does come a point in a child's development when their eating habits change because they are not growing/changing as rapidly as they previously were. I have found in my own kids and in my friends' kids that this usually occurs right about the time they turn two (some earlier, some later).

My daughter just turned 2 and could probably be awarded the crown for world's pickiest eater. She'll go a couple of weeks and pick around throughout the day with her food, then she'll suddenly gear up and start eating more. This usually coincides with a small growth spurt. After the growth spurt is over, she goes back to her usual routine of picky, less-than-stellar eating.

Frequently, I've seen that toddlers at this age lose some of their baby fat and grow taller. If she's grown taller, then there shouldn't really be need for concern. Her body is getting adequate nutrients to continue growing, it's just that the resources are being allocated differently (ie. growing in height rather than girth). Additionally, your child is more active than he/she has ever been, and, therefore, burning more calories as a result. You would think this would make your child hungrier and make them want to eat more, but it generally doesn't.

If she has not gotten taller, this should probably be cause for concern. There are plenty of illnesses and diseases whose early indications are so few or minor that it's not until the patient becomes seriously ill that they even go to the doctor. When it comes to weight loss like that, diabetes comes to mind as one example.

As for her crankiness, strangely enough being cranky or clingy is one of the signs of a growth spurt. So, perhaps she's just growing. Or maybe she's teething. Or maybe she's bored. Who knows? Kids get cranky/clingy for lots of reasons. If you don't believe she's ill, then the clingy list could go on and on.

She will probably pick her eating up again on her own. One night you'll sit down to dinner and she'll clean her plate and ask for more.

This next part is purely opinion, kindly remember I'm not a doctor--never have been; never claimed to be: I would give it maybe two to three more weeks (depending on your tolerance level) and see if she's improved any. Despite my daughter's eating issues, she's never gone more than a couple of weeks of being exceptionally picky. Anything more than that and you're starting to get to the 2-month threshold and that, personally, seems too long. I have been known to weigh my daughter frequently so there's no shame in standing her on the bathroom scale if it will give you some hard data to take with you to the doctor.

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+1 for taking into accounts natural peaks (and lows) in children's growth and behaviours and looking out for overall growth (heigth and not just weight). The timeframe (2-3 weeks) you mention is I think the one that is comfortable for me. Incidently her appetite has picked up again and she's put the weight back on, and overall her loss of appetite lasted I'd say 3 weeks. –  Aqua lullaby Aug 7 '12 at 1:02
    
We have a number of small kids in my family (my daughter plus my two nieces), so if there are any two parents in the world who have struggled with weight concerns, it's my sister-in-law and me. But I'm glad your daughter has gotten back into her normal groove again and that you can breathe a sigh of relief! –  Meg Coates Aug 7 '12 at 1:22
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As a parent of a child the same age if I were in your situation I'd take her to the doctor now. A 10% weight loss in a child plus a loss of appetite for more than a couple of days is something you should address right away.

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I agree about the doctor's visit. Weight loss in a child that is already low on the chart needs to be checked more carefully than if the child started out in the 95th percentile. –  Torben Gundtofte-Bruun Jul 30 '12 at 11:04
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Thank you for your answer, but to me this is more like an opinion (which I fully respect :)) about what you would do in your own context. The "couple of days" timeframe you mention seems very short - from what I have read and heard it is quite common for toddlers to have periods of time when they just eat less (I have another child who has huge fluctuations in appetite yet is very healthy). For the 10% loss, my taking (see my comment to Torben's answer) is that it needs to be checked over time (so a one-off weighing is not sufficient). –  Aqua lullaby Jul 31 '12 at 3:51
    
@Aqua, it's not the weight loss, it's the whole package. If my child lost appetite and was clingy for more than 2-3 days, and lost weight I'd worry. And so you are, or you would not have posted on this site. –  GdD Aug 1 '12 at 8:11
    
Yes, i was worried, but not after 2 days; i guess i was trying to say in my comment on your answer is that it shows that parents may respond differently to this situation depending on their own circumstances, their child and their way on handling things. So you worry after 2 days, when I wouln't :) –  Aqua lullaby Aug 1 '12 at 10:33
    
@Aqualullaby - Short answer - if you're worried, talk to your child's doctor. It's better to talk to them and it turn out to be nothing/normal, than to ignore it and have it be something serious. –  Shauna Aug 1 '12 at 14:21
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When to worry about weight loss:

  • When the child is already low in the weight chart.
  • When the child shows signs of sickness.
  • When the child is not feeling well.
  • When the child is apathetic.

Feel free to add more here! Just click the edit link.

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+1 - I like your answer although I would welcome some qualifyers around the criteria listed (e.g. more than one applying, symptoms for a period of time, etc.). Also if a child is sick, it can be expected that (s)he will be losing some weight, but regain it quite quickly. Incidently, I weighed my daughter today and she has regained 1 kilo (not sure how :)), so I am taking as a lesson learnt that weight loss should be checked over a period of time (just not sure how long). –  Aqua lullaby Jul 31 '12 at 3:44
    
Another comment is that I am not sure I understand about the first criterium "When the child is already low in the weight chart". If a child is for example at 95th and drops to 50th, I would say it would be more worrying than one who is at 10th dropping to 5th. Wouldn't it be better to say "if child crosses x curves" or if child loses more than x% body weight? –  Aqua lullaby Jul 31 '12 at 3:47
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@Aqualullaby - "Crossing x curve" doesn't really work either. What if they dance on a threshold naturally? 10% bodyweight is generally considered significant, regardless of starting or ending size (for example, in adults a 10% decrease in bodyweight is linked to significant improvement in heart health; it doesn't matter if the person was 175 or 350 pounds before the weight loss). –  Shauna Aug 1 '12 at 14:19
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As long as your child is on the normal range of the BMI percentile, you have nothing to worry about. If there is only slight changes in the BMI curve, it may be due to your child's activities, which is normal because she is growing up. But you should regularly monitor your child's BMI using a baby calculator, so you can be sure that there is no any drastic changes in the weight, so she won't be at risk of being underweight. If you think there is a radical change, better to check with your pediatrician, so she can be given proper medical attention.

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Children and babies change all the time.

For example, at about 3 weeks old, a baby will breast feed almost constantly. then at about 5 weeks, they'll sleep for 18-20 hrs a day and eat almost nothing.

Opinion: If there's a significant over a period of several days, see your Dr. However, I think if that were to be the case, then you'd see other more prevalent symptoms of something greater long before that.

Cycles. Growth spurts and plateaus. That's what you're seeing. It's all good. Enjoy the respite.

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