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Children's Health

How to increase appetite underweight toddler

01/31/2008

Question:

My son is 19 months and is considered underweight. How do we help him get interested in eating his food. I have tried, variety, making it fun looking, and interesting. Let him coose between two items. Basically, I have followed every advice from doctors, books, other parents. He doesn`t even want to put it in his mouth, for us to even know if he likes it. Even if he eats, it is not a good amount. He has had tests which have come out normal. His other developmental milestones are fine. His intake of milk has also reduced. I would appreciate any help. Any time I get away from him, I am reading up books, trying out new food, reading articles, talking to parents. Should I be so worried? Thanks.

Answer:

Any good parent who is told their child is underweight is likely to worry over it. You are up against a really tough period in early childhood where many normal developmental factors challenge both you and your child! There is the normal toddler drive to be independent and declare their independence by saying "no" even when they mean "yes", by not wanting to do what you want them to do because they are not you and they are experimenting with who they are and what they like and want. There is a normal drop in appetite to match the slower rate of growth in the toddler years compared to the first year of life. As if that is not enough, toddlers also suffer from neophobia or the fear of anything new. This is actually protective for the active explorers that are our toddlers. However, it also means they don't want to try anything new.

So, I suggest not engaging in any battles of will over food and not expressing worry or frustration over your son's eating behaviors when he can see and hear you. A toddler is likely to find our reactions very entertaining and to try and cause us to entertain them over and over again.

Your son does need better calorie intake and nutritional drinks such as Ross's Ensure and similar products from Mead Johnson or the Bright Beginnings company will provide needed extra calories, vitamins, and minerals. They come in lots of different flavors and can be frozen into ice cream-like bars or scoops and blenderized with fruit. Check the calorie content on the can or box and choose the ones with the most calories. These companies also produce nutrition bars for toddlers. I would also not worry at all about limiting his fat intake. Gram for gram, fat provides 9 calories for every 4 calories in carbohydrates and protein. So if he likes mashed potatoes, load in the butter or soft margarine, put a bit of butter or soft margarine on his cooked veggies, and let him drink whole milk. He may discover that guacamole is delicious on crackers as are full fat dairy dips with his veggies. Make him milk shakes with ice cream and whole milk. Chuck in some fruit too. He might enjoy putting food coloring in just for fun.

Keep up the good work with offering healthful foods and limited choices. Whatever he refuses, just serve it again when you normally would. Eventually what is new becomes something familiar and eventually acceptable. 

I hope these ideas are helpful.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University