So often in the media we hear about the obesity epidemic and how too many children are overweight or obese. But what about those on the flip side of the coin? The ones that may not eat much, may be very selective with their food choice, may have an aversion to food, or may have other underlying medical concerns that it is hard for them to keep weight on?
Being underweight is not the same as being thin or slender. Some children have a naturally slight build and maintain it with a well-balanced diet and physical activity.
The child’s weight can cause great worry to the parents.
THIN OR UNDERWEIGHT? CHECK THE GROWTH CHART
Children show us they are thriving through their normal growth and development as demonstrated on the Growth Chart. Your public health nurses or paediatrician plots your child’s weight and length/height routinely at well-visits and check-ups.
There are 4 nutrition indices to define nutritional status of children as measure through anthropometric measurements – body weight and height.
- weight-for-age (risk for underweight)
- height-for-age (risk for stunting)
- body mass index (BMI)-for-age (risk for overweight)
- weight-for-height (risk for wasting)
Percentiles (from 3 to 97) represent the normal window of growth we can expect for children.
The 50th percentile shows the average. This is where most children are.
It means that below 50th percentile is lower than the average, but still normal. Above 50th percentile is above the average, but still normal too!
Here’s what the percentile values on a growth chart do mean:⠀
A 2 year old boy who places on the 48th percentile on the weight-for-age growth chart means that 52% of all the boys (same age) out there weigh more than him and 48% weigh less than him.⠀
OR
Even if your child is at the 8th percentile for his weight, meaning that 92% of kids his age weigh more than he does, if he has always been at the 8th percentile, then he is likely growing normally. It would be concerning and it might mean there was a problem with his growth if he had previously been at the 50th or 75th percentile and had now fallen down to the 8th percentile
What you should actually look at is how they progress over time on the growth chart and whether or not they’re staying on THEIR particular curve. Children who are growing normally will track their growth predictably on their own personal growth curve. Whether 48th percentile or 8th percentile, it doesn’t mean that his particular weight is good, bad, right or wrong. There is no “goal” to reach here. It just shows that body come in all shapes and forms. Some children are meant to be more petite or smaller, some are meant to be more largely built or much taller. Just look at their parents and family history as a good indicator! Genetics will win!
If time passes and you notice they’ve dropped from the 48th to the 15th percentile, that’s more of a concern! Same thing goes when it’s a big jump from the 60th percentile to the 85th percentile. That’s more of what we would call “falling off the growth curve”. It could be, of course, due to over/under-eating, malabsorption issues or some other underlying medical issue or it could be something as simple as a growth spurt.⠀
The key message here is that there’s no right or wrong percentile for your toddler! Every child has their own established growth curve. Where another child has nothing to do with where your child should be. Having a chubby or a skinny toddler does not mean they are healthy or not healthy. And trying to actively change their natural curve does a lot more harm than good.⠀
Last, the growth chart is a good indicator of your child’s overall nutritional status. If your child appears to be maintaining a usual and predictable pattern on the curve, you can rest assured that your child is getting adequate calories for normal growth.
It is not just about extra calories.
START WITH HEALTHY MEALTIMES
Sometimes, parents use ineffective strategies to get their child to gain weight and grow, including negative feeding practices, in an attempt to feed them high calorie foods to boost their weight.
First, building a healthy food relationship (not just calories) is more important.
Understand the Feeding Relationship
A parent’s role is to choose what foods to offer, when, and where. Parents should provide healthy foods and offer regular meals and snacks.
A child’s role is to decide how much to eat and whether or not to eat at each meal.
Zero Pressure
Sometimes your child may refuse meals or snacks. Don’t beg, bribe or threaten your child to eat certain kinds or amounts of food.
Pressuring a child to eat can make them eat less.
Away from Distraction
Families should enjoy healthy eating together. Your child shouldn’t be singled out from the rest of the family. Everybody eats at the table together. Your child will focus on eating with fewer distractions. Turn off the TV, computer, IPad, and put toys aside around feeding time.
Stick to Mealtime Schedule
Regular meals and snacks will help your child eat enough food to grow well and be healthy. Offer food every 2-3 hours at planned times.
Offer 3 meals and 2-3 snacks each day.
Watch Empty Calories
Limit foods like sugary drinks, candies, potato chips and donuts. These foods don’t help children grow well.
Set Mealtime Boundaries
Set some table rules at meal times such as “everyone stays at the table until dad/mum’s finished”, even if your child doesn’t want to eat what you’ve served. Because they are sitting with food in front of them, they may end up picking at it! This is useful if your child wants to rush off and play rather than eat. But don’t force or nag them to eat. You’re just asking them to stay at the table. You don’t want to turn meal times into a battle.
Avoid Filling Up on Fluids
Drinking too many fluids like milk and juice may make a child less hungry for meals and snacks.
Serve no more than 2-3 cups of milk each day. Limit fruit juice to 0-1/2 cup each day.
Read Label
Limit foods and drinks labelled “light”, “low fat”, “fat-free”, “low calorie” or “sugar-free”.
Watch Your Languages
Watch your language and conversation around body size and shapes. If you talk about people being fat, on a diet, over-eating, or you are watching your own weight by counting calories or you obsess over food labels and your own body shape, then a child picks up on this quickly. Children mirror a parent’s pattern and chatter. Catch yourself out and avoid this kind of chatter, especially if your child has suddenly started eating less and is starting to lose weight, they may have started dieting because of this unhealthy conversation.
FOODS TO GAIN WEIGHT
Every Bite Count
Every bite of food and every gulp of liquid can make a contribution to your child’s ability to gain weight and grow. Offer foods high in calories and rich in nutrients at every meal and snack.
Make some simple switches to double up their energy intake without making them eat more.
Parents with an underweight child are usually struggling with knowing which foods to feed their child to help them gain weight.
If your child is thin or underweight and you are worried about whether he or she is getting enough nutrition, here are some ideas to help calm your fears and feed your child:
- Vegetables and Fruit
- Cooked vegetables with cheese sauce or grated cheese
- Fruit with yogurt or peanut butter
- Avocado as a spread, in smoothie, or as a dip (guacamole)
- Potatoes, sweet potatoes, squash (butternut squash or spaghetti squash), or turnips mashed with milk and butter (or non-hydrogenated margarine)
- Dried fruit (apple, prunes, apricots, raisins, cranberries) added to baked goods
- Grain Products
- Bread, crackers, muffins with cheese, cream cheese, hummus, nut butter
- French toast, pancakes, waffles made with eggs, oil, milk. Serve with syrup, fruit, yogurt on top
- Hot or cold cereal with milk, nuts and fruit
- Granola or muesli with yogurt and fruit (recipe here and here)
- Wheat germ added to baked goods
- Meat (fried in oil) with vegetables and rice
- Milk and Alternatives
- Choose whole or full fat milk. Offer as a drink or use it in place of milk in recipes
- Cream soup or sauce made with whole milk
- All types of cheese. Sliced or grated onto foods
- Yogurt as a dip, mixed with fruit, or added to smoothie
- Fortified soy beverages can be use as a drink or in recipes
- Plant-based milk are often lower in calories and protein. Not recommended !!
- Meat and Alternatives
- Meat with gravy or other sauces (curry or sweet and sour sauce)
- Scrambled egg with cheese
- Egg salad sandwich
- Omelette with cheese, ham, tomato, peppers
- Quiches
- Hummus with crackers or pita bread
- Fish cake (recipe: Easy Salmon Cake)
- Nut butter spread on bread, or added to smoothie or muffins
- Tofu
- Nuts or seeds offered as snacks or add to baked goods, granola, or muesli
I’ve also got another free FOODS TO GAIN WEIGHT guide you can use for your children to get you started so you can start feeling better about every bite your child takes.
ACTIVE LIFE
Give your child more time to be active. Being active can make children hungrier for meals and snacks. Limit screen time, like watching TV and using other electronics. Read this post to learn how to increase physical activity level of your child.
BOTTOM LINE
If you’re a parent struggling to put weight on your child, remember that at the end of the day, you want a healthy, happy and confident child. So, yes while it is important for your child to eat, do not make it a battle or power struggle. If you’re concerned about their growth, be sure to talk to your doctor, dietitian, or public health nurses.
Are you worried about your thin child? Are you thinking that you might want some one-on-one nutrition counselling, either for you, or your baby or child? Check out my one-on-one nutrition counselling services here.