Parents of kids who really don’t eat enough deserve better help than they often get. Still, most of the time when people say to me that their child is skinny and a very picky eater, the child does not need to eat more. When kids do need to catch up on weight growth, slower is better than faster. Even though we are eager to get them back on the curve, for long term health it’s generally best just to be moving in that direction.

Before focusing on trying to pack on the calories, be sure

1. They really are underweight (for their height)
2. It’s not for medical reasons that need to be addressed

 
Remember, the goal is to add calories, while still preparing them for long term healthy eating patterns — this means doing it without processed white flour or added sweeteners or fried foods.

Fats have the highest calories. Add fat (olive oil, peanut butter, avocado, cheese, butter, etc.) to healthy foods (veggies, whole grains, lean protein sources — you can gradually wean back the added fats later, just like switching from whole milk to 2% to 1% to nonfat).

Liquid calories are less likely to fill you up — smoothies and shakes and juices are great for this. I prefer using real food ingredients, not a chemistry set (like you might find in some manufactured versions). e.g. Whole fat dairy or soy. Add an oil. Add fruits. Maybe peanut butter. (note: getting rid of unnecessary calories in drinks is one of the best ways to help overweight kids. Liquid calories sneak in.)

When eating is restricted, I recommend a multivitamin, multi-mineral supplement, with DHA, as spackle to fill in any nutrient gaps.

Periactin, an allergy medicine, can be a potent appetite stimulant. It can be a godsend, helping kids with no appetite suddenly start eating 3 meals a day. For kids in the first 2 1/2 or 3 years of life – when long term flavor preferences are forming, and kids need multiple experiences with a wide variety of whole foods — I’d try the medicine sooner rather than later. These are precious months for food experiences, and should not be wasted.

Dr. Greene’s Answer:

Kids can benefit from dietary improvements at any age. Quality foods  make a difference when they are young, and their brains are growing most rapidly. It also makes a huge difference for teens, whose brains are restructuring for adult life.

For most kids, about 80% of adult height is gained before 6th grade is over, but the need for quality nutrition doesn’t stop there. About 20% of adult height and 50% of adult weight are gained during adolescence. Most boys undergo a dramatic increase in their lean body mass between the ages of 10 and 17. Because growth and change is so rapid during this period, the requirements for all nutrients increase.

You can use these guidelines to help make nutritious choices and create balanced meals for your kids. And remember that organic foods  may provide a nutrition bonus from healthy mineral content, higher antioxidant content, as well as lowering your child’s exposure to developmentally disruptive pesticides.

Girls from 4-8 years old Whole grains – 4 oz Vegetables – 1 cup Fruits – 1.5 cups Beans, nuts, eggs, or lean meats – 3 oz Milk, other dairy, or other source of calcium and protein – 2 cups

Boys from 4-8 years old Whole grains – 5 oz Vegetables – 1.5 cups Fruits – 1.5 cups Beans, nuts, eggs, or lean meats – 4 oz Milk, other dairy, or other source of calcium and protein – 2 cups

Girls from 9-13 years old Whole grains – 5 oz Vegetables – 2 cups Fruits – 1.5 cups Beans, nuts, eggs, or lean meats – 5 oz Milk, other dairy, or other source of calcium and protein – 3 cups

Boys from 9-13 years old Whole grains – 6 oz Vegetables – 2.5 cups Fruits – 1.5 cups Beans, nuts, eggs, or lean meats – 5 oz Milk, other dairy, or other source of calcium and protein – 3 cups

Girls from 14-18 years old Whole grains – 6oz Vegetables – 2.5 cups Fruits – 1.5 cups Beans, nuts, eggs, or lean meats – 5 oz Milk, other dairy, or other source of calcium and protein – 3 cups

Boys from 14-18 years old Whole grains – 7 oz Vegetables – 3 cups Fruits – 2 cups Beans, nuts, eggs, or lean meats – 6 oz Milk, other dairy, or other source of calcium and protein – 3 cups

Dr. Greene’s Recommendations are adapted from the 2006 American Academy of Pediatrics/American Heart Association guidelines.¹⁸

Read More From This Series:
Part 1 – Brain Food For Your Kids: How Do You Score?
Part 2 – From Backyard Gardens to Kindergartens
Part 3 – Brain Building
Part 4 – How is your food grown?
Part 5 – Antioxidants – Extra Credit
Part 6 – How Our Food Is Processed
Part 7 – Refined Sugars and Flours
Part 8 – School Fuel: Homework for Parents
Part 9 – How Much Does a Child Need Each Day?

There’s good news and bad news. Dramatically good and dramatically bad. Duke University announced on May 28, 2003 the results of their 5-year randomized study on body fat. Two kinds of body fat accumulate as we gain weight: subcutaneous fat (under the skin) and visceral body fat (in and around the organs). It’s the huge increase in visceral fat that is the scary part of the obesity epidemic, and the reason that we are now seeing the diseases of middle age in many children.

The Duke STRRIDE project (Studies of Targeted Risk Reduction Interventions through Defined Exercise) looked carefully at the effect of exercise on visceral fat. Before and after CT scans revealed striking results. Over an 8 month period, those in the study who did not exercise regularly increased their visceral fat by a frightening 8.6 percent (even though their weight only increased by about 1 percent). Those with moderate exercise kept their visceral fat stable. Those with lots of exercise enjoyed a powerful 8.1 percent decrease in their visceral fat within only 8 months!

In this study, vigorous exercise was the equivalent of jogging 17 miles per week on an exercise bike or treadmill which would take only about 30 minutes a day (with one day per week off)!.  People in the study were not allowed to change their diets. Getting active is worth the effort.

This study was conducted in adults, but obesity is also an epidemic among children. I would expect their young bodies to be responsive to the benefits of physical activity as well.

Ever-increasing screen time has led to the most sedentary generation of children in history – and the most obese. Making a habit of active play every day is more than just good fun, it is the foundation of health both now and for the rest of their lives.

Dr. Greene’s Answer:

Forcing specific foods on children usually backlashes on you. Even if you get kids to eat them, they will often not like them when they are older.

What we’ve recently done with our 4-year-old son who isn’t fond of veggies is to let him taste a wide variety of veggies and pick which ones he would like us to serve often. He will eat at least one serving of veggies every day, but he gets to pick which one he likes the most. I have four kids and they each have a different favorite vegetable.

I encourage families to grow a garden together and to involve their children in cooking what they grow. Children will often get excited to eat fruits and vegetables if they are involved in growing and preparing them.

You can also sneak veggies into breads and muffins and fruits into smoothies. You can find other delicious ways to cook fruits and vegetables in our recipe section.

Dr. Greene’s Answer:

In small amounts, neither diet or regular soda is very harmful. But of course, neither has great benefits.

I have no problems with sugar when it comes naturally with fiber such as with fresh fruits. When it comes to soda, you may not want your child to develop a taste for sugary sodas because the amount he consumes may not stay small. Sugar is loaded with calories and it puts stress on the body’s mechanisms for regulating energy levels.

As for artificial sweeteners, the best research on NutraSweet (aspartame) has not shown any conclusive problems. In the body, it breaks down into two amino acids that are naturally a part of the diet. However, the long term effects of drinking diet soda has yet to be determined. Interestingly, a recent study showed an association between diet soda consumption and an increased risk for heart disease and diabetes (Circulation Feb 12, 2008). Although this finding needs to be confirmed by more research, it’s something to think about.

Personally, I prefer water, milk, and flavored waters (i.e. water with pieces of fruit, vegetables or herbs for flavor).