How To Increase Calories In Your Underweight Child’s Diet

increasingcalories

We are frequently asked this question by both parents and care providers: How do I help an underweight child gain weight with foods that are higher in calories?

As a pediatric dietitian and a parent of a child who is underweight, I have faced similar challenges working through this situation with my son. Some of the more notable obstacles I encountered were related to finding higher calorie foods that my son would actually eat, and practical, inexpensive choices. And when I found good options, I realized that I needed a strategy to keep my son’s high calorie foods separate from the other family members who were not underweight.

For example, I knew how to make the highest calorie cookies, but if my son did not eat them I had to figure out what to do with the rest of the batch (my other family members did not need the high calorie cookies). They would just get thrown away, which I hated doing.

It was also important to me to find options that did not have a large upfront cost and came in reasonably-sized packages so that I did not feel bad about wasting food from the failed product or experiment. The following are some ideas of different foods that can be used to help improve your child’s weight gain. The list is quite extensive so we created a PDF that you can download below.

Aside from the foods listed on the PDF, you can also incorporate supplements in your child’s diet to increase calories, such as Pediasure, Boost Kids Essentials, or Organic Pediasmart. If your child has a milk allergy, Soy Bright Beginnings and Organic Pediasmart Soy are also available.

I recommend starting with one or two of these supplements per day as the overuse can cause your child to lose interest in eating. I gave my son a pediatric supplement while we worked on increasing his daily calories and eating a wider variety of foods. He had about four ounces of it at snack time because he got more calories from the supplement than from the few crackers or pieces of fruit he would eat.

After reviewing the high calorie food list, here are some additional tips to help you increase your child’s calories:

Make food for the child that needs extra calories without giving it to the whole family. Some ideas to accomplish this are adding extra oil and butter to one serving of pasta, using extra nut butter on your child’s bread, serving whole milk to your underweight child with meals, and adding extra cream and maple syrup to oatmeal.

Purchase small packages and individual servings.  This will help you avoid food waste while you’re experimenting with different types of foods.

Young children have smaller tummies and therefore are not able to eat a large volume of food. In this case you will want to choose foods on this list that will have the most calories in a small volume. For example hummus is 25 calories per tablespoon, but cream cheese is 50 calories per tablespoon and peanut butter is 100 calories per tablespoon. Therefore if your child eats only small amounts and you’re looking for a good dip to have with celery, serve it with cream cheese or peanut butter.

Balancing a healthy diet with high calories foods. Many families feel like their child is not eating healthy when calories are increased. There are ways to make the diet balanced by using the foods listed on the high calorie foods PDF. For example, if your family is having grilled chicken for dinner you can offer a high calorie side item with it, such as sweet potato fries and steamed broccoli and melt butter on the portion for the child who needs the extra calories.

If your child has never been diagnosed as being underweight but you are concerned, discuss it with your pediatrician. He or she can review the growth history and determine if there is reason for concern. If it is recommended that your child needs to eats more calories, consider a referral to a registered dietitian.

Amy Reed, MS, RD, CSP, LD

About the Author: Amy Reed, MS, RD, CSP, LD

Amy Reed, MS, RD, CSP, LD, has worked as a registered dietitian at Cincinnati Children’s for 15 years. She lives in Cincinnati with her husband and 2 boys, ages 7 and 5. In her spare time she likes to cook, exercise, and spend time with her family.

Write a comment

Your data will be safe! Your e-mail address will not be published. Also other data will not be shared with third person. Required fields marked as *

Comments

  1. Wolfgang Ludwig March 29, 11:18
    Hello from Germany, Transplantat-Kids is german federation which had its focus on transplanted children. In our yearly we offer outdoor education and age appropriated workshop s about compliance, nutrition and stress management. We publish once a year a magazine about transplanted child's. In the past years we have learned that liver and lung transplanted child's are very often underweighted. So your article maybe helpful for some parents. Can we use this article for our journal and you as the author? Thanks for a short notice. Regards Wolfgang
    • Rachel Camper
      Rachel Camper March 31, 08:50
      Hi Wolfgang, Yes, of course! So long as you credit our dietitian, Amy Reed, you may use our information.
      • Wolfgang Ludwig April 01, 11:10
        Hi Rachel, Thank you. The link to our actual journal (only in German) http://www.transplant-kids.de/journal/2013/flipviewerxpress.html regards Wolfgang
  2. Adina April 04, 10:25
    How do you classify 'underweight' is it merely being in a low percentile or when growth is plummeting down the percentiles?
    • Amy Reed, MS, RD, CSP, LD
      Amy Reed, MS, RD, CSP, LD Author April 08, 08:19
      Hi Adina, We have a couple of ways to classify a child as underweight: Ages 0-2 years- if weight for age is less than the 5th percentile or weight for length is less than the 5th percentile on the World Health Organization's growth chart. Ages 2-20- if weight for age is less than the 5th percentile or Body Mass Index (BMI) is less than the 5th percentile on the Centers for Disease Control growth chart. There are also may be concern if a child has an unintentional weight loss that causes him to drop percentiles on a growth chart or fall off his own growth curve. For example, if a child goes from the 50th percentile of weight for age to the 10th percentile of weight for age in 2 months (and they were not trying to loose weight) that may be reason for concern. The child’s height to growth also needs to be monitored. Since there can be several factors that can lead to a child being underweight, it is always good to discuss any concerns with your pediatrician and have him or her review the growth chart with you.
  3. Laura Mettee September 20, 09:45
    Hi, Looking for a list of recipes for breakfast, lunch and dinner for my two underweight, failure to thrive, former feeding tube fed kiddos who are 6yrs old in 1st grade. Especially helpful would be lunch box ideas and dinner ideas. They are on ADHD meds during school which mean that lunch is tricky because the meds make them not so hungry and every bite and sip count. We are stuck in a rut and need some variety to shake things up. Any suggestions or links would be greatly appreciated. Thanks!
    • Amy Reed, MS, RD, CSP, LD
      Amy Reed, MS, RD, CSP, LD Author November 14, 08:34
      Hi Laura, Here are some suggestions for all three meals: Breakfast: If you are not already I would wait to give your kids their ADHD meds until after they have had their breakfast. For breakfast I would suggest providing them with foods that are the quickest and easiest to eat. If they like to drink things then you may want to try a smoothie or a supplement like carnation instant breakfast added to whole milk. Some kids like to eat bars for breakfast so you may be able to utilize Zbars, or another kind of granola bar that would have more than 120 calories in it. An egg and cheese sandwich or burrito might also be a good option depending up on their preferences. If they like fruit you could do a banana or apple with nut butter. Lunch: Since this is the meal when they are not as hungry I would try to pack things that are quick for them to eat but have a lot of calories. Examples would be meat and cheese roll-ups, puddings, high calorie yogurts, peanut butter and jelly, and if you find a smoothie they like you could even pack that in their lunch. Dinner: If you are trying to only make one meal for the entire family I would suggest looking at their preferences and making sure you have at least 2 items that are preferred on the table. If the main dish you are having is not preferred then I would make sure you are serving higher calorie sides that they will prefer. No matter what meal they are eating if weigh gain is a concern I would suggest making sure that you are not giving them anything that is low fat or fat free.
  4. Keri December 09, 18:49
    Thanks for the list. I checked it and we are already feeding our daughter most of the foods listed here, so I feel a bit relieved that we are already on the right track. I bought some pastured butter (Kerrygold) to add to her veggies and cream to add to her oatmeal.
  5. […] Mar 27, 2014 … After reviewing the high calorie food list, here are some additional tips … Make food for the child that needs extra calories without giving it to the … [more] […]
  6. gaias May 30, 13:58
    I would like to retract my comment. The child was weighed on a non calibrated scale. She is thin but not in danger. We are going to learn good nutrition habits that will follow them as a habit so they make good choices. And set up an appointment if needed and follow the nutrition advise provided.
  7. ReviewKid July 24, 07:34
    Well, there are many other good supplements for gaining weights for children, you just need to search on Amazon and go with the product that has good positive reviews and high ratings.....
  8. Pallavi September 06, 10:26
    I have tried so many things post 5 month completion of baby ,but nothing was working out…. As I hail from India , here one cartoon character “Chhota Bheem” & another one which is famous across the world "wheels on the bus" is extremely famous & kids can easily develop connect with this….while watching this cartoon my baby take the feed very easily & comfortably & :-) really he dont take a single pie if I pause this cartoon on youtube. My husband made a Youtube video of baby's feeding during watching it & posted there (he was considering this trick as a help for feeding) , kindly spare time & have a look on this this as this has become an obcession for my baby https://www.youtube.com/watch?v=RlW6h3TpUHI My question is , how can I develop the habbit of taking feed regularly while he not watching the cartoon ? I have already visited many doctors but baby is not keen to take the feed. Kindly help & pls suggest what to do...........
    • Amy Reed, MS, RD, CSP, LD
      Amy Reed, MS, RD, CSP, LD Author September 09, 15:50
      Hi Pallavi, In this situation we would likely offer a couple of different suggestions. 1) Consider setting up a different environment for feeding, such as a high chair or booster seat. Make this a routine and slowly phase out the use of the video. Try playing a small part of the video and then turn it off to take another bite, eventually phasing it out as much as possible or all together. 2) Trying a child size spoon for comfort. 3) Considering an appointment with an occupational or speech therapist who specializes in feeding.
  9. Jill Beiger January 15, 10:03
    Hello Amy, Your PDF list is the most helpful I've found by far. My 13 month old has always hovered around 5-8%, and is now 3% d/t no weight gain in 5 weeks. He is diagnosed laryngomalacia, mild reflux and mild dysphagia. The dysphagia has improved with feeding therapy. I'm hoping to connect with a dietician in my area that can assist me further with meal planning. I had an appointment with a nutritionist at a feeding clinic at my local children's hospital, but they weren't very helpful. And recommendations you can make for a dietician in the Buffalo, NY area? Thanks so much!
    • Amy Reed, MS, RD, CSP, LD
      Amy Reed, MS, RD, CSP, LD Author January 19, 15:07
      Hi Jill, So glad you've found the PDF helpful! Unfortunately I am not familiar with any dietitians in the Buffalo area. If you haven't already, I might suggest speaking to your primary care doctor for a potential referral or contacting your local dietetic association for help. You might find www.eatright.org helpful as well.
  10. Greg January 30, 17:52
    Thanks for the insightful article. just returned from the Mayo clinic to determine if there's any underlying reason for our daughters low weight. There isn't. Might you know of any good calorie counter apps out there?
    • Amy Reed, MS, RD, CSP, LD
      Amy Reed, MS, RD, CSP, LD Author February 01, 15:55
      Hi Greg, Choosemyplate.gov has something similar on their website. Here's the link to their "super tracker." https://www.supertracker.usda.gov/ Hope this helps!
  11. Saba February 08, 19:18
    Hello Amy. I totally related to everything i read here. Mom to a preemie always been under 10 percentile. I know the caloric values of many foods by heart ;) small portions that pack a punch..totally agree nut butters are our friends. Very interested in the high calorie cookies. Can you share a recipe please.
  12. liz February 23, 10:06
    Hi amy, I have a 4 year old boy and he has had severe constipation problems since birth, so my question is how can I help him gain weight when dealing with the costipation? He loved peanut butter and bananas along with other foods, but then I found out that was no help... constipation again... I'm just running out of ideas....
    • Amy Reed, MS, RD, CSP, LD
      Amy Reed, MS, RD, CSP, LD Author February 29, 11:57
      Hi Liz, Before tackling the nutrition part of this question, I think it would be important to understand if you've spoken to your child's pediatrician about his constipation issues. Sometimes kids are so constipated that they won't eat.
  13. […] How To Increase Calories In Your Underweight Child’s Diet … – We are frequently asked this question by both parents and care providers: How do I help an underweight child gain weight with foods that are higher in calories? […]
  14. […] How To Increase Calories In Your Underweight Child’s Diet … – We are frequently asked this question by both parents and care providers: How do I help an underweight child gain weight with foods that are higher in calories? […]
    • Brenda November 22, 00:35
      Good Evening, I was wondering where I may receive more education on g-tube underweight kids, breastfed underweight children and underweight children. I am an experienced RD in wt management with focus on obese and overweight children. Needing information to increase my knowledge in underweight children. Thank you
      • Amy Reed, MS, RD, CSP, LD
        Amy Reed, MS, RD, CSP, LD Author December 01, 10:32
        Hi Brenda, If you're in the Cincinnati area, you could contact our nutrition department about potentially shadowing our staff (513)636-4211. If you're not in the area, I would have to imagine that your local children's hospital would be willing to do the same. The American Academy of Nutrition and Dietetics also has a mentor program and would be able to provide you with resources. Hope this helps!
  15. Brenda November 22, 00:33
    Good evening, As a dietitian I have worked with overweight and obese children, where would you recommend obtaining more knowledge to better help my patients who are underweight and g-tube fed? This is an area my education did not prepare me for. Appreciate it greatly Brenda
  16. Cyn December 01, 08:06
    I would love to have the recipe for the high calorie cookies to tuck into my son's lunchbox. As you described, I have 1 child who needs to gain weight and the rest of the family doesn't need extra calories. Thanks!
    • Amy Reed, MS, RD, CSP, LD
      Amy Reed, MS, RD, CSP, LD Author December 01, 10:14
      Hi Cyn, I do not have a particular cookie recipe, but I think something like a pumpkin oatmeal cookie recipe would be good or a peanut butter oatmeal. You could add extra dried fruits, nuts, or chocolate chips for extra calories. Sometimes families have even added a scoop or 2 of Carnation Instant Breakfast to boost calories.
      • MRINAL KANTI MRIDHA January 13, 03:48
        Madam my new born baby is now 33 days of birth, his birth weight was 1800gm, now it just gain 2000gm after 33 days. There is not sufficient breast milk from her mother to fed. Can we opt for formula milk
        • Amy Reed, MS, RD, CSP, LD
          Amy Reed, MS, RD, CSP, LD Author January 17, 07:00
          Hi MRINAL, This is a great question, but is probably best to check in with your health care provider to evaluate both you and the baby to help determine the cause of the low weight and best next steps, which could include a referral to a lactation consultant.
  17. Cynthia March 16, 15:11
    Hello Amy. My baby has been very underweight her whole life, now 0%ile. She just turned 1 year old but the pediatrician recommended keeping her on formula (for toddlers) rather than transitioning to whole cows milk. Where I live the cows milk has 3.8% fat so the calories are the same or slightly more than the formula. Is it safe to just add a little toddler formula to whole milk instead of only toddler formula? She loves whole milk and it would be much less costly to do this. I don't want to cause renal overload or electrolyte imbalances. Thank you.
    • Amy Reed, MS, RD, CSP, LD
      Amy Reed, MS, RD, CSP, LD Author March 22, 07:02
      Thanks for reaching out, Cynthia! It would be difficult for me to make a recommendation without knowing your child’s particular situation. I would encourage you to ask your pediatrician for a referral to a pediatric dietitian. If you are in the Cincinnati area you could be referred to our nutrition clinic.