High-Calorie Foods for Underweight Children

Healthy Strategies to Increase Weight Safely

It can feel overwhelming if you're told by your pediatrician that your child is underweight. It's important to remember that one or two plot points on a growth chart are not necessarily a sign that a child isn't growing at the rate that is right for them. And genetics should be considered as well. However, keeping an eye on a child's growth and having ongoing conversations with their pediatrician (and dietitian, if you have access to one) is important to recognize any potential undernutrition or an underlying medical condition.

If you and your pediatrician decide that it's important to increase or maximize your child's food intake, here are some helpful tips that can help make this possible while helping to reduce stress around eating and preserve a healthy relationship with food and eating for your child.

Causes of Low Weight in Children

Infants and children may struggle to gain weight for a variety of reasons: Difficulty latching as a newborn, sensory/texture disorders, not being offered foods, food insecurity, stress, excessive milk or juice intake, swallowing dysfunction, food allergies, medications that dull appetite... And the list can go on.

Some concerns around inadequate weight gain are related to feeding or eating issues that are transient and resolve on their own or with a little encouragement from parents and the help of a registered dietitian and/or pediatrician. However, there are times when a child's weight decreases or fails to increase and specific, immediate, and ongoing intervention is necessary. For example:

  • Type 1 diabetes can lead to severe weight loss if uncontrolled.
  • Congenital hypothyroidism is associated with poor growth.
  • ADHD medications are known to cause appetite suppression.
  • Cystic fibrosis can make it difficult to gain or sustain weight.
  • Celiac disease can cause low weight and short stature in kids.
  • Eating disorders, like anorexia nervosa and bulimia nervosa, are now being seen in children.
  • Children who live in households where people around them are dieting may take on the behaviors and food choices of the adults around them.

Depending on the underlying cause, you may need a specialist physician as well as a registered dietitian to help create an eating plan appropriate to the condition, or to provide tips on implementing an increase in dietary energy (i.e., calories). There is rarely a one-size-fits-all solution.

Treatment plans can look different depending on the child and the underlying cause. Many things factor in, including food accessibility, eating environment, consistency, and preferences.

Where to Start

Take a look at what your child eats and enjoys currently as well as their general schedule for eating. Consider the following:

  • Create a schedule. Is there an eating schedule your child can depend on? Maybe you offer three meals and three snacks each day so your child can not only practice eating skills but learn to listen to body cues for hunger and fullness.
  • Minimize distractions at meals and snacks. Try turning off the TV and not taking phone calls or using a tablet. This can help connect a child with hunger and fullness cues and also help with overall enjoyment.
  • Don't push food, or reward or punish eating behaviors. Keeping associations of morality away from how much food is eaten can help to maintain a healthy relationship with food for the child and everyone at the table.
  • Create a relaxed, pleasant eating opportunity. Eating with other people, so kids can see others trying new foods and partaking in the eating experience, can be really helpful in teaching kids to eat. Encouraging conversations that don't have anything to do with nutrition or weight, and that don't focus on how much or how little anyone is eating, but rather are pleasant and inclusive, are preferable.
  • Keep trying! It can take many (many!) exposures to foods to create a space in which a child is ready to try it. This may look like: First, allowing the food on their plate; then touching food with their fork, then smelling the food, then touching the food with a finger, then touching the food with the tongue. It can take 30 or more exposures to a food before a child accepts the food. Include new foods in meals, but be sure to provide things you already know your child loves as the bulk of the meal so the new food can be explored but not depended on for energy.
  • Involve your child. Sometimes getting kids into the kitchen to help makes them more excited to eat certain foods. In addition, asking a child what they enjoy and incorporating this into family meal planning can increase what they eat.

As a rule, avoid speaking about fad diets. Don't comment on the body size of yourself or others, categorize foods as "good" or "bad," or talk about eating in moral terms (i.e., someone being "good" or "bad" because they did or did not eat something).

If in doubt about any food on a weight-gain plan, speak with your pediatrician. This is especially true if your child has diabetes or digestive problems or is on chronic medications.

Weight Gain Strategies

Start with where your child is currently in terms of food, beverages, and overall eating schedule. Making sweeping changes all at once can feel overwhelming for everyone involved and can actually have the opposite effect you're looking for when it comes to a child eating.

  • Are there things you can add to the meals and snacks they are already eating and enjoying that can boost the energy in each?
  • Is there a way to adjust the current eating schedule to be more consistent? Would it help to include more snacks? What about fewer snacks, but very consistent meals?
  • Where are beverages fitting in? Are they filling a child up before meals and snacks? How can this be gently modified?
  • Is there stress around meals/snacks? How can this be gently reduced?

If you have trouble thinking of a plan for any of these, consider working with a specialized registered dietitian to help create a plan that feels good for the entire family.

Preparation and Eating Strategies

The goal is to get adequate energy into your child to create growth, but without making your child feel anxious about eating, contributing to diet culture, and/or vilifying or glorifying specific foods. It's also important that a child not feel overwhelmed with meals and snacks and that you have tools to help them with this.

One important tool is to use energy dense foods to add energy to meals without adding a lot of additional volume. Oils, nuts/seeds, and nut/seed butters can be a great way to do this. For instance:

  • Peanut butter and jelly sandwich: Add a layer of butter or oil to the bread before putting on the peanut butter and jelly.
  • Avocado toast: Add a layer of olive oil to the toast before spreading on the avocado.
  • Yogurt with cereal and berries: Blend almond butter or peanut butter into the yogurt before using it to make a parfait.
  • Fruit smoothie: Add avocado, powdered milk, or nut/seed butter

Use non-diet versions of products like mayonnaise, yogurt, cereals, etc. The diet versions will contain less energy.

The Most Energy-Rich Foods

When thinking of how to efficiently add energy to meals and snacks without changing too much of the integrity of the original food, it's important to have many ideas to choose from. This way you can work with your child to find meals and snacks they enjoy that get enough energy in.

The following foods can be helpful for increasing the total energy in meals because they are more concentrated sources of energy.

  • Avocado
  • Butter
  • Cheese
  • Cream cheese
  • Heavy cream
  • Vegetable oils
  • Nuts and seeds
  • Nut and seed butters
  • Dried fruit
  • Whole-milk yogurt

Meal and snack ideas:

  • Smoothie made with whole milk, banana, and peanut butter
  • Frozen waffle toasted with coconut oil and topped with almond butter, fruit, and maple syrup
  • Whole Greek yogurt topped with granola
  • Scrambled eggs made with half-and-half or cream
  • Trail mix with nuts and dried fruit
  • Pasta tossed in olive oil, then topped with breaded chicken and marinara sauce
  • Egg salad made with full fat mayonnaise on toast spread with olive oil
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