Dear Dietitian

Thank you for seeing my daughters in clinic this morning. I appreciate the time you took to read their notes before seeing us, and I appreciated your ability to talk directly to each child, not just to me.

That said, I would like to tell you how upset I now feel after our appointment.

You took Mog's weight and were happy that she has put on weight. I am too, it's good news. However, I wanted you to look at Mog's weight in relation to her height. She has grown a lot recently, and as a result is very skinny. You did not do this, and would not look at her ribs, focusing instead on your chart, which put her nicely on the 25th centile. I know that she's on the 25th centile for weight; she has been for a very long time. However, she is five, and wears clothing for children age seven - she's very long. Surely then, to be in proportion, she ought to weigh rather more than she does?

I realise you are new to my girls, and that there has been a vacancy in your post for several months. But there were specific concerns raised back in the autumn, and I was hoping to deal with those today. You did not have that information to hand, so now we will have to wait again.

Next, Little Fish. Little Fish is overweight. Thank you for calling it "well covered"; I did appreciate it. I know that she is overweight. I'm not sure how to put a toddler on a diet, not when she already has an extremely healthy diet, that's why we wanted to see you. You said that she must not have cows milk any more, but that she should instead have a special medical formula. One which is higher in calories than cows milk. How will that help? I told you what Little Fish eats on a typical day; half a weetabix with a tablespoon of fruit puree for breakfast, a tablespoon of pureed savoury - made up proportionally of a little meat, a little potato or rice, and a lot of vegetables - and another tablespoon of apple puree or a mashed banana, sometimes a yoghurt for lunch. And the same again for dinner, with the addition of a small piece of chocolate. More stewed fruit as a snack, if she needed it.

You appeared to be listening. But then told me that she needs to eat lots of vegetables (she does, I've just told you this), lots of fruit (again, I have just told you this), and that she should "fill up" on fruit. She doesn't ever feel full - she has limited sensation in her stomach. I told you this too.

I feel strongly that you did not hear what I was saying. You looked at me. I am overweight. I know this. I am overweight because I eat too much (why I eat too much, well that's a different issue and a much longer post). It does not render me incompetent in the kitchen. I am well aware of how to give children healthy nourishing meals. I fed Goldy for years, and despite being immobile, and having eating as one of the greatest pleasures in life, she was not in any way overweight. I know how to cook for children. I know what children need to eat in order to sustain life, in order to put weight on, and in order to maintain healthy lifestyles. I also know what foods to avoid. Little Fish has never had any kind of junk food - she can't; it doesn't puree. She doesn't eat biscuits or cakes or popcorn or crisps or chips or deep fried anything- she can't.

What I needed was advice on how to feed her a diet which gave her everything she needed without causing her to put on more weight. If I cut her food down further I am worried that she will not be getting sufficient fruit and vegetables. If I cut out the meat and dairy, cut out the potato and just leave the fruit and vegetables, that's not balanced either, is it?

I didn't need a basic lecture on healthy living. I am well aware of that. I needed some specific suggestions for how to help Little Fish. I know that she receives all her liquids via a tube. But that is simply a method of delivery. Her cousin the same age drinks her cows milk. Why are you insisting that Little Fish has a jar of artificial paediatric formula instead? One which is higher calorie than the milk you are so worried about in the first place? I know she is less active than her cousin, she receives proportionally less food than her cousin to compensate. Her cousin has two weetabix in the morning, Little Fish has half of one. That continues throughout the day.

I would appreciate it if you could get back to me with some advice tailored to Little Fish's needs, rather than targetted at my own weight issues.
Many thanks,
Tia