Kids Health

Worried Your Child Is Underweight? Here’s What You Should Do


For my 6-year-old nephew, David, there’s nothing that ignites a full-fledged anxiety attack like mealtime. He goes pale; he hides; he launches into a mischievous act of rebellion so wild he’s sure to get himself expelled from the table. This kid hates to eat — and his former pediatrician’s constant talk of growth charts and calorie intake only magnified the problem. 

As parents, we are well-versed in the signs, symptoms, and side effects of obesity. But there’s little attention paid to the trouble served at the opposite end of the growth chart. So, what can you do when your little one struggles to gain weight? We brought in two registered dietitians who specialize in pediatric nutrition to be our guides.


When Weight Gain Matters

First, it’s crucial to understand when your child’s weight is actually an issue. “Oftentimes parents, or even healthcare providers, will express concerns about a child’s weight because it is on the low end of the growth chart (say the 3rd, 5th, or 10th percentile),” says Jessica Gust, MS, RDN. “Where their weight falls isn’t necessarily the issue.”

Instead, Gust advises parents and providers alike to pay attention to how a child’s growth trends over time. If your little one grows consistently, it’s likely he or she is gaining in a way that’s healthy and natural for them. According to Gust, a weight decrease — either a sharp or gradual decline — warrants a closer look. 

So, the pediatrician has labeled your child as underweight? What’s next? Follow this expert advice on coaxing your kid back to the table in a way that is resourceful, respectful, and encourages body confidence. 




Assess Mealtimes

When Gust works with a child struggling to gain weight, one of her first steps is to assess when and what this child is eating. If a child is filling up by grazing on snacks throughout the day, he or she will be less likely to take in the nutrient-dense stuff that really matters.


Strike a Balance

Sure, kids are going to eat what they want to eat — but to achieve healthy weight gain, they need protein and fats as part of their diets. Gust relies on foods like avocado, nut butters, full-fat yogurt, cheeses, and healthful oils such as coconut, olive, and avocado oils. 


Source: Well Plated


Offer Structure

If you have been at this mom game long enough you know this to be true — children thrive in a structured environment. According to Leah Hackney, RD, LD, CSP, the dinner table is no different. She encourages parents to embrace a concept called the “Division of Responsibility” — a phrase coined by Ellyn Satter that boils down to this: you provide healthy food choices, and your child decides what and how much to eat. “Setting a schedule around meal and snack times allows kids to develop hunger and fullness, which helps them self-regulate around food,” she explained. 


Encourage Autonomy

Within this structured mealtime, both Gust and Hackney advise that parents step back and allow children to lead the way, trusting that they understand their bodies and when they are hungry and full. To this, Gust adds a disclaimer: “I recommend that parents who have concerns about their child’s weight work with a pediatric dietitian that is well-trained in how to address these issues. Many providers have the best of intentions for helping families but may not know the way to help without creating harm.” 


Celebrate Bodies

Take the focus off your child’s physical appearance and the way clothes fit his or her body. In fact, don’t comment at all about how your child’s body looks. Instead, Hackney suggests celebrating all the amazing things bodies can do. She encourages parents to practice affirmations with their children, reciting statements such as “My body is strong and healthy” or “My body can do incredible things!” 


Get Kids in the Kitchen

According to Hackney, when our children have a hand in meal prep, they are more interested in food and more likely to try it. Explain your process, let them do some stirring, and share with them how you add ingredients like hummus, hemp seeds, or healthful oils to better suit your needs. 





Don’t Put the Pressure On

What mom hasn’t found herself begging her child to take just one more bite of dinner? “This method inevitably perpetuates selective eaters,” warned Hackney. Pressuring children to eat may find them losing touch with their hunger and fullness cues, and makes for a stressful mealtime all around, she added.

So, what can you do to coax your little one into eating? “Model the behavior you want to see,” Hackney said. “And don’t shame anyone who isn’t joining in.” 


Don’t Track Food

Some pediatricians may advise parents to count a child’s calories throughout the day. Keeping a food and calorie diary may seem like a smart way to ensure your kid’s on the right path, but Gust says this is a misnomer. “Any time food tracking starts, an obsession can develop and that puts added pressure on both parents and the child, which is not helpful,” she explained. Instead, focus on offering plenty of nutrient-rich foods, healthy fats, and proteins at mealtimes. 


Don’t Compare Bodies

Working through our children’s weight issues can be a slippery slope. On one hand, we want their bodies to be as well-nourished and healthy as can be. But on the other hand, we don’t want kids to get the message that there’s anything wrong with their bodies just as they are. “It’s important for kids to develop body confidence from a young age, and part of this is how parents talk to them about body size,” said Gust.

She encourages parents to drive home the message that our bodies are all unique and made to look differently — no matter where they fall on the growth chart. She adds, “I like to encourage parents to focus on healthful dietary changes without discussing weight or physical looks at all.”