Make every bite count: how to increase calories for underweight children

Although the United States is in the midst of an obesity epidemic, some children are underweight. Your child’s pediatrician charts your child’s height and weight in order to determine whether he is growing appropriately. Just as obesity has many causes, kids can be underweight for many reasons. Regardless of whether the cause of your child’s poor weight gain is medical or behavioral, the bottom line is that underweight kids use more calories than they take in.

Here are ways to increase calories. Remember, you cannot force children to eat if they are not hungry. For example, you can’t just demand that your child eat more noodles. Instead of trying to stuff more food into your child, increase the caloric umph behind a meal.  Make every bite count:  

  • Mix baby cereal with formula, not juice or water.
  • After weaning formula, give whole milk until two years, longer if child is still underweight.
  • Add Carnation Instant Breakfast or Ovaltine to milk.  
  • Add Smart Balance, butter, or olive oil to cooked vegetables, pasta, rice, and hot cereal.
  • Dip fruit into whole milk yogurt
  • Dip vegetables into cheese sauce or ranch dressing
  • Offer avocado and banana over less caloric fruits such as grapes (which contain only one calorie per grape).
  • Cream cheese is full of calories and flavor: smear some on raw veggies, whole wheat crackers, or add some to a jelly sandwich
  • Peanut butter and other nut-butters are great ways to add calories as well as protein to crackers, sandwiches, and cereal.
  • If your child is old enough to eat nuts without choking (as least 3 years), a snack of nuts provides more calories and nutrition than goldfish crackers or graham crackers.
  • For your older child feed hardy “home style foods.” Give mac ‘n cheese instead of pasta with a splash of tomato sauce or serve meatloaf with gravy instead of chicken breast
  • Try granola mixed into yogurt or as a bar.
  • Give milkshakes in place of milk (no raw eggs!)
  • Choose a muffin over a piece of toast at breakfast.

Some causes of poor weight gain are medical. Have your child’s doctor exclude medical reasons of poor weight gain with a thorough history and physical exam before you assume poor weight gain is from low caloric intake. Sometimes, your child’s physician may need to check blood work or other studies to help figure out why he is not gaining weight appropriately. 

Some common behavioral causes include drinking too much prior to eating, picky eating, or parents failing to offer enough calories. Sometimes tweens and teens develop a pathologic fear or anxiety about gaining weight and deliberately decrease their food consumption. These kids have eating disorders and need immediate medical attention. 

A common scenario we often see is the underweight toddler whose parents describe as a “picky eater.” Meal times are stressful for the entire family.  Mom has a stomach ache going into dinner knowing the battle that will ensue. Her child refuses everything on the table. Mom then offers bribes or other meal alternatives. Dad then gets into the fray by making a game out of eating, and when the child does not eat, in frustration he yells at the child.  Grandma then appears with a big cookie because “well, he needs to eat SOMETHING.” All the adults end up arguing with each other about the best way to get their toddler to eat. If you recognize your family in this example,  please see our post on how to help picky eaters for ways to break out of this cycle.

Just as obese children need to see their doctors to check for complications relating to their increased weight, underweight children require weight checks to make sure that they gain enough weight to prevent poor height growth and malnutrition.

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

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1 Comment

  • Reply Marissa March 30, 2012 at 1:58 am

    Will these suggestions work for an eight month old baby?

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