Quick Answer: If your child is not gaining weight as expected, the goal is not simply to give them more food. The first step is to determine whether your child is experiencing faltering weight and why. Once a healthcare provider has identified a need for additional calories, increasing the calorie density of foods, adding appropriate nutritional supplements, and establishing a structured eating routine can help support healthy growth.
There are several ways to increase a child’s calorie intake, but it is important to begin with the bigger picture. A child who is small or who eats less than other children does not necessarily have a growth problem. What matters is the child’s individual growth pattern and whether their weight gain is meeting their nutritional and developmental needs.
What does underweight mean?
Parents often use the word “underweight” to describe a child who appears thin, eats very little, or does not seem to be gaining weight. Clinicians, however, look at a child’s growth over time.
In 2026, the American Academy of Pediatrics (AAP) and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), published a clinical practice guideline that uses the term faltering weight instead of “failure to thrive.”
Faltering weight means that a child’s weight gain does not meet expected growth standards. It can sometimes be associated with undernutrition or malnutrition. Importantly, these conditions do not develop into severe malnutrition overnight. Early recognition and appropriate nutrition intervention can help children get back on a healthy growth trajectory.
What are the signs of faltering weight?
Possible signs that warrant a conversation with your child’s healthcare provider include:
- Weight loss or slow weight gain.
- Little or no increase in height or length over time.
- Persistent decreases in food or fluid intake.
- Difficulty eating because of gastrointestinal symptoms or other medical concerns.
- Feeding difficulties or significant food refusal.
- Decreased activity or less interest in play.
How can I help my child gain weight?
One of the simplest ways to increase calories is to choose foods that provide more calories in a relatively small amount of food. This can be especially helpful for young children who have smaller stomachs. If your child’s healthcare provider determines that additional calories are appropriate, there are several strategies that may help:
1. Offer higher-calorie foods without giving them to the whole family
The goal is not to replace a balanced diet with foods that only add calories, but to improve the calories that are being provided:
- Add extra oil or butter to one serving of pasta.
- Add nut or seed butter on your child’s bread.
- Serve whole milk with your child’s meals.
- Add extra cream and maple syrup on their oatmeal.
2. Choose high-calorie foods when your child eats small portions
If your child can only eat a small amount at a time, the calorie density of the food matters. For example, consider three possible dips for apple slices or raw vegetables:
- Hummus: approximately 25 calories per tablespoon.
- Cream cheese: approximately 50 calories per tablespoon.
- Peanut butter: approximately 100 calories per tablespoon.
When volume is limited, choosing a more calorie-dense food can provide more energy without requiring your child to eat a larger portion. See the chart at the bottom of this blog post for suggestions.
HELPFUL TIP: Purchase small packages and individual servings. This will help you avoid food waste while you’re experimenting with different types of foods.
3. Follow a structured meal and snack schedule
It may seem logical to let an underweight child eat whenever they want. However, constant grazing can sometimes make it harder for a child to eat enough at meals.
The “Division of Responsibility” approach to feeding gives parents responsibility for deciding:
- What food is offered.
- When food is offered.
- Where food is offered.
The child’s responsibility is to decide whether to eat and how much to eat from what is offered. A typical structure for young children may include three meals and two to three snacks each day, depending on the child’s age and individual needs. Avoiding frequent snacking immediately before meals can also help a child arrive at meals with an appetite. In general, a child should have enough time between eating occasions to become hungry again.
4. Consider nutritional supplements when recommended
Some children with faltering weight benefit from an oral nutritional supplement in addition to food. Examples include:
- PediaSure®.
- Boost® Kid Essentials™.
- Kate Farms® Pediatric Beverages.
- Orgain® Kids.
- Carnation Breakfast Essentials® (This is for adults but can be used in kids if discussed with health care provider).
In my practice, I may recommend using a nutritional supplement as one tool for increasing calorie intake while we work on improving nutrition from food. These products provide approximately 200 calories or more per 8-ounce serving, although the exact amount varies by product and formulation. Too much supplemental nutrition can sometimes decrease a child’s appetite for meals, so the appropriate amount and timing should be individualized.
Important to know: Some nutritional supplements may be covered through programs such as WIC or, in certain circumstances, insurance.
5. Infants need a different approach
For infants younger than 12 months corrected age who are experiencing faltering weight, increasing calories should be done with guidance from the child’s healthcare provider and, when appropriate, a pediatric dietitian, lactation consultant or speech therapist. There are ways to increase calories in:
- A baby who drinks human milk.
- A baby who drinks formula.
- Babies six months or older who are ready to eat solid foods
Parents should not add or increase calories of human milk or formula without working with a healthcare provider or registered dietitian.
CHOOSING HIGHER CALORIE FOODS AND PROTEIN BOOSTERS
| Food | Calories / Protein per serving | Uses |
| Oils (canola, safflower, olive, or coconut) | 40 calories/teaspoon 0 protein | Use in salad dressings, toss with pasta or cooked vegetables, and use in baked goods. |
| Butter (can use either dairy or soy butter) | 35 calories/teaspoon 0 protein | Spread on toast or bread, melt onto vegetables and pasta, and use in various baking recipes. |
| Nuts (calories per ounce) |
| Use in baked goods, sprinkle on yogurt and cereal, trail mix, salads, and stir fry. Whole nuts can be a choking hazard to children less than 3 years of age. |
| Nut and Seed butter (peanut, almond, cashew, and sunflower seed) | Per tablespoon: 100 calories 3-4 grams protein | Use as a dip for fruits or vegetables, spread on crackers or toast, stir into hot cereals. Some brands of sunflower seed butter are nut free. |
| Eggs | 80 calories per egg 6 grams protein | Use as breakfast food, add to baked goods, and when hard boiled can be eaten as a snack. |
| Hummus or other bean dip | Per tablespoon: 25 calories 1-2 grams | Use as dip for vegetables or a sandwich spread |
| Cheese | Calories per ounce
| Use as toppings for sandwiches and soups, melt into casseroles, sprinkle on vegetables, or as a snack. |
| Heavy Whipping Cream | 45 calories/tablespoon 0 grams protein | Use as some of the liquid in hot cereal, add to milkshakes, smoothies, and other beverages. Use in casseroles, potatoes, rice, or noodles. |
| Whole Milk Yogurt | At least 140 calories/cup 6 grams of protein | Use as a snack, dip with fruit, or mixed into a smoothie. |
| Cream Cheese | 50 calories/tablespoon 1 gram of protein | Spread on bagels or toast or use in dips and sauces. |
| Sour Cream (Do not use reduced fat or fat free) | 25 calorie per tablespoon 0 gram protein | Top on potatoes, use in dips, and mix into casseroles or soups. |
| Sweet Potato |
| Use in soups, casseroles, and baked goods. |
| Peas | Per 1/2 cup:
| Mix with rice, pasta, soups, and casseroles. |
| Avocado | 240 calories/fruit 4 grams of protein | Slice on sandwiches and salads, mash as a dip for chips and vegetables, and add to smoothies. |
| Banana | 1 medium sized fruit 105 calories per banana 1 gram of protein | Eat as a snack, mash to put in baked goods, blend into a smoothie or milkshake, and use as a topping for cold or hot cereal. |
| Flax seed | 1 tablespoon 45 calories 2 grams of protein | Add to salads, soups, baked goods, yogurt |
| Dried Fruits | Calories per ounce
| Use in a trail mix, mix with yogurt, top a salad, add to cereal, or as a snack |
| Pure Maple Syrup | 50 calories per tablespoon | Use to top pancakes or waffles, use to flavor hot cereal, yogurt, or smoothie |
| Honey | 65 calories per tablespoon 0 grams | Use to sweeten milkshakes or smoothies, mix into hot cereal, and use as a dip for chicken. Do not give to children less than 1 year of age. |
| Canned Coconut Milk | 25 calories per tablespoon | Add to sauces, smoothies/shakes, and soups. Do not use the light or fat free versions. |
| Wheat Germ | 25 calories per tablespoon 2 grams protein |
Additional Options
| Food | Calories / Protein per serving | Uses |
| Ice Cream | 130-250 calories per 1/2 cup 2-4 grams protein | Milkshakes, topping for pancakes, waffles, or as a snack |
| Instant breakfast (1 packet) | 130 calories 5 grams protein | Mix with 8 oz. of whole milk Add to hot chocolate, pudding, milkshakes |
| Sweetened condensed milk | Per tablespoon 60 calories, 1.5 grams protein | Add to pudding, milkshakes, pies |
| Salad dressing | Per tablespoon 80-100 calories | Add to salad, raw or cooked vegetables as a dip |
| Mayonnaise | Per teaspoon 45 calories | Use on sandwiches, in cold salads or as a dip |
| Jelly/jam | Per tablespoon 55 calories | Spread on toast, biscuits, muffins Use as an ice cream topping or in a milkshake. |
| Milk Powder, made from whole milk | Per tablespoon 40 calories 2 grams of protein | Add to milk, yogurt, pudding, mashed potatoes, etc. |
THE BOTTOM LINE
If you are concerned about your child’s weight or growth, talk with your pediatrician. They can review their growth history and determine whether additional evaluation or nutrition support is needed. If it is recommended that your child needs to eat more calories, consider a referral to a registered dietitian.
In the Cincinnati area, your child can be seen by a registered dietitian at Cincinnati Children’s Outpatient Nutrition Clinic. If your family is outside of Greater Cincinnati, visit the Find an Expert feature from the Academy of Nutrition and Dietetics to find a pediatric dietitian in your area.
This is a great article on adding calories when needed! an often unexpected side effect is the potential increase in cavities ! Each bottle of Pediasure for example contains 18 grams of sugar, that’s 4 ½ teaspoons of sugar in only 8 oz., which is exactly the same sugar content as in sweet tea. Gaining calories in children who are struggling with growth is always the most important aspect but parents should understand that regular oral hygiene (maybe even brushing 3x /day) as well as increased visits to the dentist are key in preventing cavities!
Use high-calorie, nutrient-rich foods: avocado, nut butter (age-appropriate), and full-fat dairy for healthy growth.