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Underweight Toddler
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cloudscudding wrote in parenting101
Our 15-month-old toddler is underweight (3rd percentile for weight, and tall--usually measures in at 90th percentile for height!), so we need to fatten him up. He is a somewhat picky eater--he refused to eat any solid food at all until he was a year old, and then he leapfrogged ahead to finger food. High calorie foods we've had success with: avocado pudding, cheesy bread, cake. We also mix extra heavy cream and/or pediasure in with his milk.

Does anybody have any other recommendations for toddler-friendly, high calorie foods?

ETA The doctor wants us to get him more calories. There is concern about a dropping weight percentile. Our calorie goal is normal, 1200 per day, but our baby does not eat a large quantity, so we need to make what he DOES eat more calorie-dense.

Are you trying to add calories because you want to or because the child's doctor wants you to? (I ask because my 4 and a half year old has always been in that range and we've never been encouraged to "fatten her up"-just to ensure she eats a healthy, well balanced diet, that she's offered adequate food and drink options, and that she meets milestones.)

same with my 3.5 year old.

The doctor wants us to. There is concern about a dropping weight percentile.

Can I ask, you do breastfeed? And if you do, is your son being measured on a breastfed baby's growth chart?

My son dropped percentiles also. From something like 60% at birth to 4% at two. But that's on the regular growth charts. On the breastfed ones, he's been hanging out at 40% since birth and never dropped or went up.

I did breastfeed. He weaned himself cold-turkey about a week and a half ago. Ouch! Not sure about the charts--I think it was a standard one being used.

This.

My son has never been higher than about the 10th percentile and is hovering around 3 percent right now, though he is of average height.

He is 22 months and just under 22lbs. Nobody has ever said anything about fattening him up.

This! My son has never been above the 5th to 10th percentile but has followed his curve. Our doctor was never worried. He is around 30lbs and is 4 years old.

Edited at 2012-11-11 05:01 pm (UTC)

Our baby has dropped off his curve (he was about 10th percentile, then between 10th and 5th), which is a primary reason for the concern.

I know the charts are different for boys and girls, but my 23 month old daughter hasn't even yet hit 20 lbs, so I also think the OP's son's percentile alone is not alarming.

We tried every fattening food in the book- veggies roasted with butter and olive oil, whole fat yogurt/dairy/cheeses, tons of avocado... I tried those pediasure shakes, though after reading the ingredients, I felt really uncomfortable giving her those. I even used to give her bottles of breastmilk with extra breastmilk fat mixed in. NOTHING helped her gain, she stayed tiny regardless, so I gave up the battle, and she's perfectly healthy.

OP- was/is your son Breastfed? It definitely can impact when their interest in solids actually picks up. My daughter has only started eating a significant amount in the past month or two. Before that, I told people she survived on breastmilk and thin air. Pediatricians are used to seeing a lot of above average sized formula fed babies, and some charts even skew toward formula feeding. It has made it harder for them to consider small babies 'normal' and there is often a lot of pressure for them to gain weight.

Our old ped was CONSTANTLY harping on me to get my daughter to gain, even telling me to 'slather' her food in butter and give her high fat foods like cupcakes! I was pretty appauled, and once we switched pediatricians, I didn't hear a single word about her being small, except when they said, "She's always been at the bottom of the chart. Why would we expect that to change?

You also didn't mention if the < 3rd percentile is normal on his growth curve. Has he always been low on the weight charts? Or, did he used to be high and is consistently dropping? If its the former, I would honestly not have any concern. Some kids have to be at the bottom (or below) the charts for them to be able to establish average. If he is consistently dropping percentiles (significantly), it might be worth questioning if he has behaviors of an oral aversion.

This, my 4 year old is 43" talls and 36lbs. His 10 month old brother is 30" tall and 28lbs. That's just how he is, tall and skinny.

Yeah, my son dropped percentiles at 9 months and has remained around the 5-3rd ever since then (he's 2 now). He's also short but meeting all developmental milestones. We feed him a wide variety of healthy foods, make sure he has full-fat everything, have tried most of the suggestions given here, breastfed until he was 2, but he's just a active, healthy, small kid. Sometimes he eats more than I do, I think all those calories are just being converted straight into running around energy.

Edited at 2012-11-11 09:45 pm (UTC)

Nut butters if he isn't allergic!

Though I second the above commenter's question. :)

Peanut butter can be a choking hazard...are others more dissolvable?

The doctor wants us to. There is concern about a dropping weight percentile. We have a target of 1200 calories per day.

That's not far off from what a "normal" child of the same age would be recommended to eat. It doesn't really sound like you need to take extraordinary measures. Just feed him a well balanced diet, avoiding "lowfat" or "nonfat" food options. Whole milk yogurt, whole milk cheese, meats, fruits, vegetables, whole grains, potatoes, etc. etc. I think your primary concern is just making food available to him so he can eat whenever he pleases and not making a big fuss of sitting him down for designated meal times.

this is just purely from my experiences, but my son had all kinds of problems with choking and coughing, he even had a swallow study, and he still does to some extent, but for some reason never had a problem with any nut butters in terms of choking, but we always put it on bread maybe that is why.

If you are worried about it needing to be dissolved you can add peanut or other nut butters to a smoothie, http://ohdeardrea.blogspot.com/2010/10/protein-chocolate-cashew-shake.html this one is vegan, but something like that, and you could add things for calories like the pediasure, cream, whole milk, ice cream, all sorts of things.

Thank you! That's a useful suggestion.

You could try out peanut cookies, I'm sure there are recipes with peanut butter, too.

My 14 month old eats creamy peanut butter, just make sure to offer it in small quantities at a time and give him milk right afterwards. This is one of my sons favorite snacks; peanut butter and milk.

I would avoid adding sweet foods (like cake) just for the calories and focus on healthy, high-fat, high-calorie foods instead.

You could add coconut oil or flaxseed oil to his foods - soups, smoothies, yogurt, etc. Bacon, egg yolks added to soups, using coconut oil or butter for cooking, etc.

I hope that helps.

My daughter has always been super tall and skinny. She's usually in the 95ish percent for height, and about the 5th percent for weight. When she was about 2, the doctor recommended we try and get higher fat/calorie foods into her. His advice was to give her breakfast drinks, things like Carnation instant Breakfast/Ovaltine that kind of stuff, twice a day. Keep her diet as balanced as we could for a 2 year old and leave it at that. His thought was as long we know she's getting two solid servings of a fairly high fat/calorie/vitamins a day, then skinny is just skinny. As long as she wasn't loosing weight in real lbs (not just height vs weight precents) then he wasn't worried.

Here in Canada we have a yogurt brand, Greek Gods, that is organic, 10% fat, and has the extra protein of a Greek yogurt. My toddler loves it plain (tastes not unlike sour cream), or I make different flavoured dips (onion powder +garlic powder+dried dill+pepper for "ranch") for her veggies. I'd look for something similar in your home area. I've also kept my daughter on full-fat milk instead of switching to 2% like you're supposed to after age 2.

Also, avocado if your child likes it. Mine doesn't :(

(Deleted comment)
Cottage cheese was a hit for my son. Also, cream cheese (and other cheeses). Eggs with cheese on them.

I don't think pizza has been metioned?

Use coconut oil, olive oil and when appropriate bacon fat (great for fried eggs!). Full fat dairy as much as you can find it. I wouldn't worry too much, my 4 yr old is about 44 in tall and weighs about 33lbs but there are some days that he can pack it away like a football player.

Our kids are the same size and age.


Greek full fat yogurt, cottage cheese, peanutbutter,, sushi (with cream cheese and avocado) guacamole, hummus are staples in her diet.

Yep too all of this, although mine isn't much of an avocado or hummus fan ( more for me!). Add in the occasional Nutella and honey sandwich and our kids pretty much eat the same.

Home made mac n cheese, make the sauce from scratch, both my daughters adore this. Put ranch dressing on his veggies, cheesy broccoli soup, bacon, sausage eggs etc for breakfast. We also did oatmeal and added honey for sweetening, Whole yogurt, cottage cheese, apple butter sandwiches, bologna and cheese sandwiches. These are all things we've done for my daughter (currently 21 months) who dropped from the 49th percentile to the 11th percentile between one well baby check and the next. Also make sure he's getting at least 24 ounces of whole milk a day (my doctors advice to us mainly because Lily would rather drink water). Keep a couple pieces of string cheese or some other high calorie snack with you when you go out and offer small amounts every two hours or so.

She's back to the 25 percentile on weight so it worked. Hope this has some useful stuff for you.

Honestly, I would do a second opinion as one option. If he's never been above 10th percentile in weight for his age, and he's recently gotten longer, could this just be a normal fluctuation? My son's growth pattern his whole life has been to gain pounds, then stagnate on weight and just get taller, so he's never stayed on a single weight growth curve for more than a month or two. Did your ped talk about coming back in two weeks or so for another check, just to make sure this wasn't a fluke due to low water or being earlier in the day than a previous check (less food in the tummy just because he's only had breakfast)?

My son actually lost a pound between his 3rd and 4th year well-child visits. However, he'd gotten quite a bit taller, and my ped wasn't concerned. Now at almost 4y6m, he's started gaining pounds again (3 pounds since his 4y visit).

All of this. Dropping from 10th to 3rd is not a huge drop and can easily be explained by tons of things.

My skinny boy child struggles to stay on the chart as well - here are some of the things we feed him:

Meatloaf made with 85/15 ground meat
Slim fast as a drink, lately I've been using cans, but if you use the powder you can add extra, and use whole fat milk to make it.
Real butter on his veggies
Full fat ranch to dip (but really, try out a few different dressings - my daughter likes the poisonous orange "French" dressing and that stuff is a calorie bomb and a half)
Slim jims
Crackers with spread - cream cheese, peanut butter, whatever he'll consume at that moment.
Anything that he'll accept butter and/or cheese on - grits, mashed potatoes, toast
Smoothies with the calorieriffic add ons (the counter worker can tell you which pack the most punch)
Meal replacement bars or energy bars (but check for stimulants on the energy bars - I only made that mistake once.)

Careful about adding too much sugar - if he doesn't already have a sweet tooth, you don't want to give him one.

Good luck!

The breastfeeding question is good, if your child was breast fed, make sure they are taking that under consideration. My son measures small(10th percentile), but when compared to the WHO breast fed chart, he's ok, even though he wasn't ever EBF. To compare, my 14 month old to me has always seemed thin, at 14 months he wears size 18months for length but is really a 9-12 month waist. I take his cues as well, (BLW) so he didn't really start eating a significant amount of solids until he was 1. He's a healthy, normal, active and hitting all milestones early. What I suggest is offering him whole fat of milk, yogurt, & cheese. Do not fill him with fatty foods that contain lots of sugar just to increase his calories. Processed/boxed food is usually high in calorie, but won't offer him a lot of nutritional value. Make sure the fats come from healthy fats, like avocado, almond/peanut butter, olive oil and lean meats. My kid LOVES pasta, though I don't recommend anyone to feed their child pasta every day, we include it in his diet about 3-4x's a week. The key to having your child eat often, is to have a meal plan in mind. This is what I do on a normal weekend when I can monitor his food intake:
Breakfast: Multigrain pancakes (mix with whole milk & coconut oil instead of water & canola) with blueberries and a tiny bit of whipped butter served w/a glass of milk.
Snack: Diced cheese stick with whole grain crackers
Lunch: Open-faced sandwich= whole wheat bread (w/out edges), ham, cheese, diced lettuce, avocado and cucumbers
Snack: Peanut butter w/a glass of milk.
Dinner: Homemade chicken noodle soup with diced chicken breast, pasta, zucchini, brown rice, carrots and cauliflower

That's what I normally feed him when I am home. He hardly ever finishes anything (snacks and breakfast are usually 85% eaten and lunch and dinner are more of a 50% eaten). We still offer him formula in between meals and he still breast feeds on demand. My husband works from home and with help from my dad they usually take the easy route and make oatmeal, or pbj sandwiches, scrambled eggs etc. I try to cook ahead of time to leave them stuff ready, like homemade version of popular foods like mac n cheese and spaghetti o's that are popular hand foods or easy to use a fork with.
Also, take a weekend to make healthy muffins; I like zuchinni/apple muffins and pumpkin spice muffins. My kid will snack on these between meals and are good to have to toss in a diaper bag. It's not easy, I work full time and my husband and dad aren't creative or healthy food conscious eaters, so it does take time and preparation, but I promise, it's not impossible.

Advice we got from a dietician to fatten up our teeny tiny (not even on the WHO charts) 28-month-old:

Focus on fats:
Olive oil or butter on veggies
Butter every carb (bread, waffle, pancake, whatever)
Butter both sides of the grilled cheese
Butter the PB&J
Add canola oil to yogurt (whole fat, of course)
Add canola to all condiments (ketchup, mustard, etc)
Make eggs with whole milk, butter and cheese
Add powdered milk to milk
Just generally add butter or oil wherever you can

Our case is kinda extreme (she didn't hit 20 pounds until 27 months, which was after a month on this high-fat diet), so take which tips make sense for you. At one point we were doing all of this, but I stopped mixing canola into the ketchup, cause it was annoying.

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