Today’s paediatricians are far
busier counselling overweight children. But underweight children — often fussy
eaters who have little interest in food — can be just as frustrating and
Parents think they know the
solution: more food. But that’s often not necessary and can set the stage for
unhealthy habits. Some children simply have a genetic tendency toward thinness.
Others may appear scrawny until their weight gain catches up with a sudden
increase in height. “There could be medical reasons, but sometimes it’s also
behavioural,” said Dr. Keith-Thomas Ayoob, a professor of paediatrics at the
Albert Einstein College of Medicine in New York. “Kids can realise that they
get a lot of… attention from parents when they don’t eat.”
Identifying there’s a problem
Technically, a child more than two
years old is underweight if his or her body mass index (a measure of height and
weight that can be calculated online at cdc.gov/healthy weight/assessing/bmi/
or at the doctor’s office) falls below the fifth percentile. If you’re
concerned, ask your doctor to evaluate your child and his or her diet. In the
meantime, here are some ways to help an underweight child pack on the pounds.
What parents can do
Look at your child’s fist. That’s
about the size of his stomach. Parents can overestimate how much it can hold. A
good measure is one tablespoon of food per age of child, said psychologist
Michelle Mastin, programme director of the intensive feeding programme at Helen
DeVos Children’s Hospital in Grand Rapids, Michigan. So if a two-year-old is offered
three different foods per meal, he should eat a total of about six tablespoons.
Some fussy eaters dislike feeling full. Try more frequent feedings. Stay
flexible but consistent. If your child likes eating dry cereal and having milk
in a glass afterward, so be it, said Dr. Ayoob. It ends up in his stomach
anyway. But get your kids on a regular schedule for meals and snacks “to train
their appetites,” he said. Limit the time for meals and snacks, and don’t allow
grazing between scheduled feedings.
Go high-calorie, high quality.
Giving a thin child food every time he asks is “a recipe for manipulation,”
said the doctor.
Don’t give something just because
it’s high calorie. “Instead, focus on high-calorie foods (fats) that bring some
nutrition along for the ride,” he said. “Add nuts and trail mix to frozen
yogurt. Give an OK to the chocolate milk. Hit the peanut butter jar, but spread
it on whole-grain breads and crackers.”
Other good fats include olive oil,
avocado and cheese. Sneak in liquid calories. Overweight children should avoid
liquid calories, which are less likely to fill them up. But for underweight
kids, smoothies, shakes and juices are great ways to pack on a few pounds, said
paediatrician Alan Greene, author of Feeding Baby Green.
“The goal is to add calories while
still preparing for long-term healthy eating patterns,” he said. “That means
doing it without processed white flour or added sweeteners or fried foods.”
Rule out medical issues
If a child gags, coughs or vomits
around certain foods, or hasn’t developed chewing skills and will eat only
purees, parents should consider an evaluation by an intensive feeding team,
said Ms Mastin. Other red flags: If your child can’t eat at friends’ homes or
restaurants, or if a parent has to make separate, different meals for the
Be the change. In addition to
modelling healthful eating habits, Dr. Ayoob asked parents to examine how they
eat. Is the environment stressful? “No child wants to eat under these
circumstances, although parents may have become so accustomed that they can’t
see the stress around meals,” he said.