16 year old son

[Forestgarden]

Hi there, this is my first post about my son, apologies for the length! My 16 year old son has been below the 1st centile for bmi for several years. A few years ago (4?) he was seen by a paediatric consultant who concluded there was nothing physically wrong, he just needed to eat more. We've struggled on. His height has shot up, but his weight has not. He eats very little during the day. He does not eat breakfast but recently has managed a glass of oatmilk before school. In the last couple of weeks he has started to take a chicken sandwich to school because he doesn't like the ones in the shops. He doesn't always eat it though. After school he often won't eat until dinner. He's started waiting to eat until after the rest of the family have finished. He has a reasonable portion. Then, late evening 10/11pm and later he will snack (meat pie, ham roll, vegan yogurt). Dairy makes him constipated, so he mostly tries to avoid it. He seems to go between bouts of diarrhoea and constipation. He avoids onions and artificial sweeteners, but we haven't figured out what else affects him. These intolerances are presumably ibs symptoms. I think he was tested for coeliac, and was negative. His sleep routine is atrocious. At weekends he will game all night, going to bed at 4 or 5am, sleep all day, then be a zombie for half the week when he has to get up at 7am for school. We have now put some controls on his pc to shut it down at a more reasonable hour as he seems to not be able to do that himself. Obviously this has not gone down well. He's intelligent and we've talked about routine for sleep as well as eating regularly, and he understands, but can't seem to follow through. He says he never feels hungry. Body image: he's obviously more self aware now and has started going to the gym with friends, and has bought some protein powder mix. He obviously wants to increase his muscle, not least because he has a pigeon chest (pectus carinatum) which he wears a brace for at home (never out of the house). How do I get him into a proper sleeping and eating routine? I believe his lack of hunger is due to him not recognising the signals. What to do?? How do we sort this mess out?

[MountainHare1]

Hi there! Yes there are some similarities as to what you are describing about your son in possibly having IBS. As a parent of a 15 year old daughter, I can understand your concerns and worries about your son and wanting to help him get better sleep etc. However, you a dealing with a 'teenager'! One of the major contributions towards IBS flare ups is stress and anxiety and for a father trying to connect with my daughter is virtually impossible! So I do understand.

If it is IBS that your son has, in my humble opinion, and I am sorry to say this, he will probably have it for the rest of his life! However I do hope that there will be a cure one day but having had it for over 6 years, and know that my IBS is constantly changing everyday, it is difficult to manage and therefore difficult to prescribe the appropriate medication!

I think as he gets older and matures into an adult, he will have to accept that if he needs to get good quality sleep, exercise, spend time outdoors and eat healthy (food that his body is able to tolerate) he will be able to manage the IBS effectively. He also needs to manage his mental health and I would encourage you to ask him on a regular basis how he is feeling. Knowing what teenagers can be like (based living with my daughter) that they aren't always keen on talking! Over time I hope your son opens up!

Unfortunately IBS can be a difficult illness to manage but if he looks after himself well then he should be ok. He also needs some fun in his life, so if he enjoys playing on his computer and going to the gym with his mates then it can only be a good thing!

Your son's sleeping habits seem completely normal if my daughter is anything to go by. Personally I don't eat late at night as my stomach will not digest the food properly and will probably cause me to have diarrhoea. Having said that, if your son is up gaming until 4 or 5 in the morning, then may be his stomach is active enough to be able to digest is late night snacks!

Take care!x

[Forestgarden in reply to MountainHare1]

Thanks for getting back to me. We generally have a good relationship. He does talk to me, mostly! Today he started exam leave so I have drip fed small bits of food today and have managed to get him to eat about 700cals before tea tonight. But, if I hadn't taken him the food he wouldn't have come to get it himself. Yes, he'll gradually learn to make food choices that suit his body. I guess I just need to ease up a bit, but its difficult when he eats so few calories

[MyStar86]

I am not a parent so I can’t offer advice on that front unfortunately however there are shakes that you can get on prescription that are to aid weight gain and only a small quantity. I am on Vital 1.5kcal shakes x3 daily and each bottle is only 200ml and contains 300 calories. These are more expensive as I have had bowel surgeries and do not digest food the same however the gp can easily prescribe fortisip shakes I have tried these in the past and they do lots of different flavours with the same nutritional values 300 calories in a 200ml bottle and if that’s too much they even to a compact version which is 300 calories in a 125ml bottle. These shakes are good as they contain all the essential vitamins and minerals as well to help a growing child and anyone who is malnourished.

You can buy fortisip online or over the counter In some shops they are not cheap but you can even get them on eBay you could buy a few to see if you son likes them first before asking the gp. They are just little milk shakes plus they are high in protein so that might go down well with your son. There is also ensure that is another shake brand that the gp can prescribe which can also be brought online or over the counter. Have a Google of fortisip shakes and ensure shakes and see what you think.

Sorry I can’t help more I just know about malnutrition and weight loss so that’s why I thought I would suggest the shakes xx

[Forestgarden in reply to MyStar86]

Thanks for getting back to me. We have looked at various shakes before but many of them are dairy which is no good, but I'll take a look at these. I did make him a 'shake' this morning with oat milk, bone broth powder and vanilla which came to about 250cals, but will find out whether he liked it or not! This would ease my mind if he could manage one of these or similar before school

[MyStar86 in reply to Forestgarden]

The fortisip and vital shakes are both lactose free if that helps. I understand making your own but I was just thinking of an easy option that he could just grab and go if you had lots in the fridge as I do find them helpful. It’s worth looking into as they do cater for all dietary requirements. I hope he likes the shake that you have made for him and things start to improve x

[xjrs]

Has his GP run through all the required tests to eliminate other things and to give a formal IBS diagnosis? Required tests here include blood and stool sample tests:

nhs.uk/conditions/irritable...

If he has been formally diagnosed with IBS, have you tried any probiotics on him (for example well studied ones such as Alflorex or Symprove)? If not, maybe try that in the first instance.

If that doesn't help, you could ask for a GP referral to a dietitian to go through the FODMAP elimination and reintroduction diet with him. That may help him to realise that there are certain foods that he can rely on not to upset him. It may be only a small amount that he needs to eliminate, making him less afraid of other foods. This will make him feel more in control of the situation. The dietitian may help him to work on his eating fears, in tandem, an online self referral for psychological support in regards to his eating may be helpful.

[Forestgarden in reply to xjrs]

Thanks for getting back to me. No he hasn't been formally diagnosed. I'll talk to him about going back to the gp, but he wasn't keen a few days ago. We have tried a simple elimination diet, and artificial sweeteners definitely cause problems. I think he has a fairly good idea what can be a problem, its just he ignores it sometimes. We have tried probiotic capsules before, but I'll look into getting the ones you suggested. He does have the alpro probiotic vegan yogurts. I'm a big fan of probiotics and bone broth! He did see a dietician briefly a few years ago, but unfortunately we weren't too impressed.

[Bowels1]

My son also has this routineStays up until 4 am,I can gear the birds singing when he decides to retire to bed.

He does eat during the day sometimes his normals meals sometimes smaller meals.

Then like your son he snacks throughout the early hours.

I think this is due to the fact like another member suggested below they get hungry or peckish as they are up later than we all are.

There. Is also something called the not sure if I have spelt in right circadian rhythm where teens sleep till mid morning or afternoon.

It will right itself eventually.

However my son too has IBS

I do feel when he does eat a bit better during the day he does try to go to sleep a bit earlier as food can make you sleepy like we all do nod off after a meal sometimes.

That said when he is going through a gassy. Constipated time he tends to stay up later .

He does tend to eat a bit better and sleep if only a bit better when his bowels are a bit ok.

He does eat his meals with us and if he is having a flare up then he will push his food around his plate as he says he feels the need to go to the toilet and any many I B S suffers get this I can imagine it must feel uncomfortable to eat you meals when you know your stomach feels like you need to have a bowel movement.

Keep you son hydrated.

Lots of small snacks healthy ones.

We keep califigs in so he can take this when he has not been.

As also keep a diary of food intake and symptoms

Hope this helps Just saying my son is the same you are not on your own any worries though please always get checked at the doctors

[Forestgarden in reply to Bowels1]

Thanks for getting back to me, sounds very familiar! We have just put some software on his pc to limit his late nights (He's not impressed!), however he has slept better and been less moody. I think when he's constipated it stops him eating, so when he deliberately eats something that he knows is going to cause problems, it worries me because it drastically reduces his calorie intake. He's on exam leave at the moment so I have a couple of weeks to work on his diet with him. Hopefully we can make some progress.

[Bowels1 in reply to Forestgarden]

My son is over 6"3 tall and very slim.I find small snacks and then smaller meals and I tend to do big dinners and this may put them off eating when they feel uncomfortable.

I did put a block on my internet line so the it does stop at midnight however he has a phone and then somehow uses his date on the or bypasses it somehow.

We just have to make sure they get small high calorific snacks and meals.

Not to put pressure on them to eat as this can make them feel worse and just hope we can help them manage this.

No late nights

Meals if we can at the right times.

High calorific meals and snacks

Drink water and regular times

Not sitting to long on the toilet and if they cant go they need to come of then go back otherwise this can cause piles through straining.

I found what helps son is he leans back on the toilet if he finds it hard to pass a motion.

Hope all these little bits of advice helps

Good luck

[Forestgarden in reply to Bowels1]

he has a phone and then somehow uses his date on the or bypasses it somehowLol, yes my son is definitely more tech savvy than me and will find a way around it!

can cause piles through straining.

Yes, I'll mention that to him. Hadn't thought about that. He can spend hours in there!

Seems like we're in very similar situations. I'll try to concentrate on getting a more regular routine and hopefully that will help.

[Bowels1 in reply to Forestgarden]

Good luck and yes in the toilet then off if he cannot go its always best to go back in otherwise he will be stuck in a cycle of just sitting in there Dont forget to lean back when on the toilet.

Good luck

[Superzob]

I think MountainHare1 got it in one - teenage metabolism is probably unpredictable because of the "phase" he is going through.

When I went to uni over 50 years ago, I was 54kg - I was lucky enough to be in a hall of residence for 3 years and, after eating 3 cooked meals everyday, left uni after 3 years weighing 60kg! I am now 73 and still 20kg underweight for my height, but my low weight has not affected me (I have other unrelated conditions). In fact, recent research on the so-called "superslim" 3% of the population suggests that they actually eat 14% less than the average (which I certainly don't realise as I eat 4 meals a day), rather counter-intuitively exercise less, and have a higher than average metabolic rate - none of this is harmful.

What you do need to watch out for is your son losing weight - that could be a problem, particularly at an active age. But if his weight is stable, then I doubt that is a problem.