If you have an underweight child (or a child who takes medication that affects her appetite), here are six tips to help you!
About a year ago, I was told by our pediatrician that my son was borderline underweight. He’d been battling stomachaches, and there were many nights when he didn’t feel well enough to eat dinner. While everyone around me seemed to be going on and on about the vast quantities of food their kids were inhaling, I was asking my child if he’d eaten at all–and clearing away barely-touched plates.
We were worried. As parents, we all have an instinctive drive to feed and sustain our kids. When something gets in the way of that–whether it’s picky eating or an illness–it’s hard not to stress.
A few doctor’s visits, a trip to a specialist, some lifestyle changes, and many months later, I’m happy to report that his stomach pain is mostly a thing of the past. But that year taught me a lot about the day-to-day practicalities and challenges of feeding a child who needs to gain weight but doesn’t have much of an appetite. I’ve heard from some of you that you have a child who is underweight and/or takes medicine that affects appetite and weight. So I wanted to share some lessons I’ve learned about feeding an underweight child:
1. Quality matters. It would be easy to throw a bunch of calories at the problem in the form of cookies and potato chips. But I’m a dietitian, so I can’t help but focus on the quality of those calories too. As children are growing and developing, they need nutrients like iron and calcium–and just as important, they’re forming ideas and habits around food and eating that can stretch into adulthood. So during the year of stomachaches, I kept serving healthy meals and made sure most snacks were calorie-dense but also nutrient-dense, which meant things like nuts, dried fruit, and cheese sticks. That being said, I also didn’t worry about daily dessert (I still don’t) or the liberal use of real butter (still don’t).
2. Presentation Presentation Presentation. I firmly believe that when it comes to kids and food, presentation is key. But this is especially true for kids who have small appetites. I tried to make those healthy, nutrient-rich foods look especially appetizing, whether it was putting yogurt and berries in a fancy glass or pulling together an after-school Snack Platter. These were small and easy things for me to do but made a difference for him.
3. Full fat dairy for the win! Switching from low-fat to full-fat dairy products like milk and yogurt is a great way to snag a lot of nutrients and extra calories (read about why full-fat milk shouldn’t be feared: Is Whole Milk Healthier?). I buy full-fat cheese and pick up tubs of full-fat yogurt and individual cups for lunch boxes. (Though low-fat and non-fat yogurts still dominate shelves, more companies are making full-fat versions too. My kids like full-fat cups made by Dannon, Stonyfield, and Annie’s.) I also buy a half-gallon of whole chocolate milk every week, and we have a one-glass-a-day-max guideline.
4. Serve favorite dinners in small portions. You know I’m all about making just one meal for the whole family (read The Dinnertime Rule That Will Change Your Life). But when my son’s appetite was down, I did make sure to regularly serve meals I knew he especially enjoyed–and tried not to show my disappointment if he didn’t want to eat that evening (some of his favorites are this Whole Wheat Chicken Pot Pie and this Whole Wheat Spaghetti Carbonara). But this is key: I either had him serve himself or gave him very small portions (with seconds and thirds readily available). I learned this from my rotation through a nursing home while in school to become a dietitian: Large portions are overwhelming and unappealing to someone with a small appetite, but small portions may actually encourage that person to eat more. That was also my approach when packing his lunch (read How Much Should You Pack In Your Child’s Lunch Box?).
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5. Compromise is good. In my ideal world, my son would be craving quinoa salads and butternut squash soup. In the real world, he’s a regular kid who likes chicken wings and soda. Thankfully there is a middle ground with foods we both feel good about (like whole wheat spaghetti and meatballs, guacamole and chips, and Caesar salad), and there’s wiggle room too (like the beef jerky he loves).
6. Pressure is bad. Nagging kids about food is never a good idea. It was tempting to grill my son about what he’d eaten that day or sigh with dismay when he barely ate his packed lunch. But I tried to have the same relaxed, accepting attitude I recommend all parents strive for at the table (full disclosure: I didn’t always succeed!). I also tried to have faith that things would get better. And luckily they did!
Do you have any experience feeding an underweight child–if so, what works/worked best for you?