Nutritional Supplement For Weight Gain

[dddave]

A friend left her 9 year old son in the care of her older sister and husband in Isan while she worked in Bangkok.

The husband died suddenly last week and my friend went home for the funeral rites.

It was the first time she had seen her son in 3 months and she was shocked at how thin and undernourished he looked. He is about 130 cm tall and weighed only 25Kg.

She will bring her son back to Bangkok to live with her as soon as possible but in the meantime, she would like to see him gain weight. He eats only small amounts and quickly feels full. I suspect his stomach has shrunken.

Are their appropriate nutritional supplements available in Bangkok that would help him gain some weight? I could send it to her by post.

Remembering some earlier threads here that discussed worms and other parasites makes me also wonder if they could be a factor here. I suggested she try to find out if worm tests are available locally.

[bkkjames]

I suggest you get him to a doctor/nutrionist first. Getting his appetite back will take time.

[Sheryl]

I wouldn't bother with a worm test, just presumptively treat him for worms (albendazole, sold over the counter, single dose. Package insert should adviser re dosage for a child that weight ).

But I would take the child to a doctor for a thorough check-up to see if there is anything else going on that may explain such a dramatic weight loss in so short a time.

As for supplements, they cost a lot and won't put the weight on any faster than good home prepared food would. Coconut-milk based curries and anything fried in oil, or oil added to rice soup (if he prefers that to rice) will help. Ice cream, cakes. Plenty of fattening food around. His stomach will indeed have shrunk so the other key is frequent feedings, try to have hinm eat something 6 times a day i.e. 3 meals and then 3 snacks. that will help.

An all round vitamin/mineral supplement is also probably wise for a while as if he lost that much weight some micro-nutrient deficiencies are likely.

There is more to this story, either an underlying medical condition or serious abuse/neglect of some type where he was staying. Homesickness for a parent will make a child eat less and lose some weight but not to that extent in just 3 months.

[AyG]

She needs to get the child to a doctor. Any doctor will be able to test a stool sample for worms. This would be better than simply taking an over-the-counter pill since some types of worm require a longer course of treatment.

High energy food is vital. No need to buy special supplements, though. Traditionally small children were fed lots of belly pork. This is still a good approach today. Children in the south were also made to eat fish liver. It tastes foul, and probably isn't going to be traditional in Isaan. Both these foods are high in fat and protein. Small quantities of traditional sweets (the kinds made from egg yolk and sugar) could also be added to the diet in the short term, until the child is eating better. Make sure the child doesn't fill his stomach with lots of rice or soup.

The Thai diet tends to be rather low in calcium, and a lack of calcium will stunt bone development. The child should be encouraged to drink full fat milk, rather than water, with meals. Yoghurt would also be good, as would canned fish, as long as he eats the bones. This could be served as yam plaa grapong, for example.

A multivitamin pill for a week or two would also be a good idea.

Since the stomach appears to have shrunk, it would suggest that the child has been eating too little food; a child with tapeworms would typically eat more, rather than less. This indicates the real possibility of abuse. The child (indeed any child) shouldn't be left in the care of the sister until it becomes clear what has happened.

[dddave]

Thanks for the complete and thoughtful reply's. Of course, a medical examination by a skilled practitioner would be the best option all around. Unfortunately, she is deep in the country where such medical resources are generally scarce and substandard. The death of the caregiver's spouse has made an already marginal family situation chaotic and unsurprisingly, lack of money is a central issue.

I will buy the worm pills and send them to her by post as there isn't a pharmacy within 30KM.

Thanks for all the food suggestions. Using locally available foods is certainly more sensible.

She knows it will be best to bring him to Bangkok and live with her however she has a 12 hr. a day job so issues of child care need to be addressed and that is not easy. She is also concerned that enrolling him in school in Bangkok will be very hard for him. The local school is very poor and teaches little. He will find himself far behind kids his own age academically in Bangkok and will be socially vulnerable as an Isan country boy as well. We all know how cruel kids can be to an outsider.

Not a good situation all around. Once again, thanks for the suggestions.

[AyG]

For the worm pills, please follow Sheryl's advice. Albendazole will treat both round and tape worms. Many of the products in the local pharmacies only treat round worms.

I'd add, don't worry too much about the possibility of worms. They take months, or even years, to have a serious impact upon a person's health. I'd be much, much more concerned about the possibility of child abuse.

I know it's a long shot, but is there a vet near the child? Most vets are able to screen animal faeces for worms. Perhaps a vet could be persuaded to have a look?

Vitamin tablets are expensive in Thailand, but if you can, please send a small bottle with the worm pills. It might help the child if he has been seriously malnourished over the past few months.

Enrolling him in a school in Bangkok may well be difficult and hard on the child, but how much harder will it be in the long term if he continues to receive a thoroughly mediocre education in Isaan? It will also keep him with his mother who clearly loves him and away from any potential abuser.

[dddave]

Again, thanks. What is a good, locally available multi-vitamin?

[AyG]

Centrum is available in most pharmacies, including those attached to the big supermarkets. There are various versions such as "Silver" and "Gold". Just go for the cheapest - it'll do the job.

I've also heard that Boots own brand vitamins are cheaper than Centrum.

In short, any multi-vitamin pill will be fine. This really is only to address any severe vitamin deficiency from the last few months of poor nutrition. All being well he'll be back on a normal, balanced diet in the next few weeks.

Do make sure the vitamin pill is taken with a meal, though, otherwise the vitamins won't be absorbed properly.

Good luck!