About the Child (Let's call her Elisabeth)
Elisabeth came across as shy and timid. Her hip bones seemed to protrude a little out of her jeans, her eyes seemed a little deeper set and her shoulder blades were visible through her shirt. She seemed content standing beside her mother.My Initial Thoughts
As soon as someone mentions "13-year-old underweight girl," a red flag is raised. Does she have an eating or body image disorder? Research indicates that girls as young as 11 are being diagnosed with Anorexia Nervosa, the third most common chronic illness for young women. As well, about one in four teenage girls may suffer from the symptoms of an eating disorder. I look for accompanying common physical symptoms such as yellowish palms, dry, pale, pasty skin and a bloated stomach. If this is the case, I make a point to (discreetly) discuss with the parent some of the general behavioural signs to look for such as baggy clothes, social withdrawal, excessive exercise, frequent weighing and obsessive dieting, to name a few. At this point, I forward them to a qualified professional.
Action Plan
After the initial 20 minute consultation with Elisabeth and her mom, it was clear that Elisabeth's daily behaviour patterns were of a "normal" 13-year-old girl. Once she became comfortable with me, she was pleasant, witty and talkative. We calculated her BMI to be on the lower end of the "underweight" category. We had to assume that she is a late bloomer with an extremely fast metabolism.The most effective way to approach the situation was to keep it simple by increasing her caloric intake and adding resistance-type training to her daily routine.
Exercise
I recommended training all major muscle groups five to seven times a week at a lower intensity. I started her off with one exercise per major muscle group, 15-30 repetitions per exercise and completing two sets in a circuit. Here's what I gave her:1. Chest Dumbbell Press: Lying on bench, press weights up and away from chest
2. Side Shoulder Raises: Standing with weights by sides, raise arms to sides to shoulder height
3. Standing Bicep Curls: Standing with arms straight and palms facing up, raise weights up to shoulders by bending at the elbows
4. Triceps Overhead Dumbbell Extension: Sitting with one arm straight overhead, slowly lower weight behind head by bending the elbow, exhale as you straighten arm to return to start position
5. Lunges: Standing with feet together, take a long stride forward until your knee is bent at 90 degrees, not allowing it to pass your toe, push back to the start position
6. Squats: Standing with feet shoulder width apart, lower your body as if sitting in a chair behind you until your knees are bent 90 degrees, exhale as you stand
7. Bent-Over Dumbbell Rows: Sitting off the edge of a chair leaning forward with your chest to your thighs and your arms hanging to the floor, exhale as you lift the weights up by bending the elbows and squeezing your shoulder blades together
8. Abdominal Crunches: Lying on a mat with knees bent, feet flat on floor, hands on thighs. Exhale as you crunch up and slide your hands over your knees
Nutrition
Gaining weight boils down to consuming more calories than you burn on a daily basis. In some cases, kids are prescribed drugs that increase their hunger; something I generally shy away from. As long as the child appears healthy and energetic, I believe you have to let them physically mature in their own time.Besides eating healthier, nutrient-dense foods more often throughout the day, I recommended Elisabeth see a registered dietitian. They will decide the appropriate amount and types of proteins, fats and carbohydrates for Elisabeth's diet.
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