home
RSS
March 7th, 2011
11:35 AM ET

How can I get my underweight toddler to eat?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Mondays, it's pediatrician Dr. Jennifer Shu.

Asked by Pruth, Wood-Ridge, New Jersey

I have a 3½-year-old daughter who weighs 26 pounds. She does not eat by herself and when I feed her, eats very little. She gets tired easily and remains very cranky. How can I encourage her to eat?

Expert answer

Thanks for your question, Pruth. A weight of 26 pounds is at the 3rd percentile for 3½-year-old girls, according to the CDC growth chart, meaning that the child weighs the same as or more than 3% of girls the same age.

This weight may or may not be normal for your child, depending on a number of factors including prenatal and birth history, genetics, ethnicity, diet, height, general health and development, and more.

Your pediatrician and/or a registered dietitian can advise you best regarding whether your daughter eats enough and if any specific treatment or studies should be performed for her tiredness and cranky behavior.

It can be helpful to rule out any medical conditions that could be causing problems with her growth, such as a hormonal imbalance, gastroesophageal reflux, food allergies or intolerances, weak oral muscles, stress, etc.

As far as encouraging children to eat, here are a few ideas to consider:

Keep in mind that it's a parent's job to offer healthy food, but it's a child's job to decide how much of it to eat.

Children who eat relatively small amounts can optimize their nutritional intake if nearly everything they eat is rich in nutrients. Whenever possible, choose milk or water as beverages, and offer fruits, vegetables, whole grains, dairy products, lean meats, nuts, legumes or other proteins as meals or snacks. Limit foods that are high in fat or added sugars.

Make sure your child does not fill up on drinks or snack foods such as cookies or crackers; doing so will leave little room for healthier foods.

It may be helpful to save any drinks for the end of a meal. You can also take the opportunity to serve traditional mealtime foods or breakfast cereals (which are often fortified with vitamins and minerals) during snack times if your child is hungry between meals.

Using a multivitamin supplement can be helpful to make sure children get the nutrients they need until their diet improves. Ask your doctor which vitamins are most important for your child.

Monitor your child's diet over the course of a week rather than focusing on what she eats during a single day or meal. This will allow for some day-to-day variability that is normal and to be expected in both adults and children.

Some children with slow weight gain may benefit from adding more calories to their food (such as cheese, butter, or olive oil). Using fortified nutritional beverages instead of milk may also help.

Keep mealtimes consistent and free of distractions. Eat together as a family whenever possible, since many children will eat better if other people around them are also eating. Encourage but do not force children to eat. It's best if you do not punish them if they do not eat much.

For children who do not wish to feed themselves, take turns - one bite from your spoon, and then one bite from her own spoon (or fingers). Try to make foods appealing and easy to pick up. For example, use small cookie cutters for sandwiches and serve a variety of different-colored fruits and vegetables that are cut into child-size bites.

Let your child pick out fun bowls and utensils so she'll be more likely to use them at mealtime.

Again, I hope you will talk to your pediatrician for more recommendations regarding your specific situation. I encourage our readers to share their tips for feeding children as well. Good luck!

Post by:
Filed under: Children's Health • Healthy Eating

soundoff (29 Responses)
  1. rh

    My oldest son was less than 5th percentile, but was always very fit and active. I would worry more about her toddler being tired all the time than her weight. And not self-feeding at that age is a sign of something. My middle son was diagnosed autistic, and one of the signs was that he would play with his toys all day and not ask for food or drink (he has outgrown most of the symptoms now, and is rather chunky :).

    March 7, 2011 at 12:13 | Report abuse | Reply
  2. ieat

    you know it's absolutely bs when people say it's the parent's job to offer and it's the child's job to eat. As a parent, you know something is not right. If the child doesn't have enough energy and is not eating enough food, it is very concerning. I would recommend the mom to find what type of food the child likes to eat and try to work around that. If the child likes pasta, make pasta with different sauce. If the child likes bread or carbs, make pancakes with pureed veggie and egg. If the child likes fruit, add it to yogurt, etc.
    If whatever you're doing in trying to feed isn't working, switch it up. GL.

    March 7, 2011 at 13:46 | Report abuse | Reply
    • T3chsupport

      lol, if we had done that, my kid would still be eating nothing but PB&J and chicken nuggets!

      March 7, 2011 at 15:58 | Report abuse |
    • kirstyloo

      ieat – Based on the description, this could very easily have a medical problem, and your comments don't make identifying it of addressing it any better. As the parent of a toddler who has an eating problem, we've tried everything and then some to encourage our daughter to eat. I'm guessing that you can't imagine celebrating your child eating 3 blueberries (each cut into quaters so that she can swallow them...one at a time...2 minutes apart) while still knowing that they can't support her growth. We were lucky because our daughter would still drink almost enough calories to meet her needs, and she had plenty of energy. So far it has been 7 months of early intervention and numerous sessions...she's finally starting to be ABLE to eat food. Yes, she actually couldn't eat for a number of sensory reasons...and she was developmentally normal in other ways. For some families, it takes a decade or longer and externally given nutrition. Having a child who can eat well is something to be greatful for.

      March 7, 2011 at 16:47 | Report abuse |
  3. mj

    My 2 year old son will not eat very well no matter what. We have tried to give him Boost, Pedia Sure, Carnation Instant Breakfast, etc. to try to help. Nothing has worked. He had bad reflux as a baby and is working with an OT for eating, but that still has not gotten him to eat better. He will be getting a feeding tube in a few weeks.

    March 7, 2011 at 13:59 | Report abuse | Reply
    • e

      A feeding tube sounds so scary...I'm sorry he and you have to go through that! Best wishes for his speedy recovery.

      March 8, 2011 at 17:06 | Report abuse |
  4. Jim

    I have a 9 year old chubby grandchild who takes over an hour (if we let him) to eat any meal.

    March 7, 2011 at 14:07 | Report abuse | Reply
  5. Chantal

    In regards to not eating check for EE our son has it, only found out because he was refusing to eat had not gained a pound in over year in half

    March 7, 2011 at 14:21 | Report abuse | Reply
  6. Jess

    It's very typical for toddlers to be picky eaters or eat what perceive to be very little. However, at this stage of the development, they are not growing as much as they did the first year and don't need that many calories for their bodies. It's best to offer food that is nutritional and what they like and not force them to eat. They won't starve.

    March 7, 2011 at 14:50 | Report abuse | Reply
    • kirstyloo

      I'm sorry, but I disagree with making this a general statement. Parents should discuss this with their Peds because some toddlers are functionally starving. There is an important difference between a picky toddler...and one that can't eat. It can be really hard to find the line between the two.

      March 7, 2011 at 16:51 | Report abuse |
    • Shane

      Kids can most certainly starve themselves! You may not know it, but they may not be eating enough to support their system and that could cause serious organ failure. CHECK WITH YOUR DOCTOR if you feel something isn't right. And if you don't like the answers they give, talk with someone else. You are your child's only advocate.

      March 8, 2011 at 15:26 | Report abuse |
  7. kdw31

    There is some information that would have been nice to have from the parent. One thing is why is a 3.5 y/o not feeding themselves. Does she have a motor impairment that makes it so she can't feed herself or does she just refuse to do it. Is this child developing typically otherwise (no cognitive, social, or motor delays). Has she always been this small or has there been a drop in her growth percentile over time. How much liquids does the child drink (is she filling up on milk and juice and thus not eating and not getting her nutrients specifically enough iron). She definitely needs to see a doctor for the simple fact that the child is acting overly tired and cranky. A referral to an ST or OT may be needed if a feeding disorder is suspected.

    March 7, 2011 at 14:59 | Report abuse | Reply
  8. Katie

    I agree with most of the parents here – the child needs to be evaluated to see if motor skills or other development is delayed for some physical reason, and to see if there is some underlying medical condition. My nephew started losing weight because he turned down his food and they found out his tonsils were so large they were practically clogging his throat. He probably always had a mild sore throat but wasn't a complainer – he just didn't want to eat.

    OTH my older son was always at the very bottom of the percentile chart – even off the chart for a little while! – but was healthy and active. He didn't eat a lot, but nobody was worried about him. I kept waiting for him to enter that phase where he eats you out of house and home but he never did that, and he never was sickly or dreadfully underweight, so I didn't make an issue of it. My other son, however, definitely had a bottomless pit stage....

    March 7, 2011 at 15:14 | Report abuse | Reply
  9. Lou50

    best thing to do is change mothers, this one aint working out.

    March 7, 2011 at 15:14 | Report abuse | Reply
    • Orchids

      Blaming the parent(s) is wrong. You don't even know what they've tried or why the child isn't eating. It doesn't sound like she has a proper diagnosis yet, so how on earth can you say what's the blame?

      March 8, 2011 at 10:59 | Report abuse |
  10. Julie

    Could be a milk allergy. I just discovered my twin girls have one. Now that we are off of milk, they are eating alot more. The milk was causing constipation and so they were not as hungry. I disagree with doctors when they say toddlers are supposed to eat like birds. My girls run all day long so how could they not need food (energy). I think there's a reason if kids aren't eating. And if kids are hungry then they are going to be cranky.

    March 7, 2011 at 15:29 | Report abuse | Reply
    • Rahayu

      I too was from a family where we had no lxiurues and mum always used to put dinner on the table with no choices etc. I have two children both being boys. My eldest is a very good eater and I always used to use our food for his meals. From an early age he used to eat and enjoy a variety of varied foods and when on holiday in France or Spain used to try and eat everything in the restaurants the same as use from a very early age (around 4). My second son is the problem eater. He used to until just before his second birthday eat our meals the next mashed or precessed and then heated up. It was when he had a bad cold one day is simply refused his dinner. From then on he has never eaten meat or vegetables as a meal. He did for many years only eat peanut butter sandwiches and yogurts. He will now eat pizza and chips, together with crisps and chocolate, but his diet is very limited. He is now 17 and nothing has changed over the last few years. I still cannot understand to this day why this happened especially as my first son is an extremely good eater. He does though surprise me sometimes and will ask to try something new!

      March 4, 2012 at 05:33 | Report abuse |
  11. WR

    My youngest will be 3yrs old tomorrow. She weighs 22lb and has been off the growth chart since she turned a year old. I let her doctor test her for way too many things unfortunately. All those crazy and sometimes invasive test showed that nothing they know of is wrong with her. I should have went with my gut which was tell me nothing she is perfectly fine. Some people are just meant to be little and she is one of them. If your LO is not even trying to feed herself you should probably get her evaluated. The not feeding herself and being lethargic would set off alarms for me to take my LO to a doctor. GL to you!

    March 7, 2011 at 15:50 | Report abuse | Reply
  12. KR

    My 1 year old daughter is about 15 lbs (born 3 weeks early and was 5 lbs at birth), she is very active and seems very normal. Her pediatrician is concerned about her weight and wanted to do several tests to rule out potential issues. The doctor asked us to give my daughter pediasure once a day for a month and if there is no decent weight gain, she would want to start the tests. Some of friends say that a child in their 1st year birthday should weigh about 3 times the birth weight, if this is true my daughter should ok (given that she is very active as well). Wish me good luck.

    March 7, 2011 at 16:08 | Report abuse | Reply
  13. rob

    you can't. that's what kids do. I guess you could give them candy bars...but seriously, you can;t force food on your kids. Just keep them at the table and have them visually see the family eating. And, eventually, they'll eat. that's all.....

    March 7, 2011 at 16:40 | Report abuse | Reply
  14. CMC

    Unless there is an actual medical issue, kids will eventually eat. If a kid has the ability to put sweets in their mouth, chew and swallow it, then they have the ability to do the same with nutritious food. Make all options well rounded and nutritious and only have sweets as an occasional reward after eating real food. And if your child is truly underweight, get one of those old school homemade popsickle gadgets and freeze some Boost or Ensure in the form of a popsickle. If they think it's ice cream, maybe they'll eat it without hesitation.

    March 7, 2011 at 17:01 | Report abuse | Reply
  15. aubrie

    My son only weighed 5 pounds at birth. He was always slight and tiny. He looked like a little wood sprite. I worried about him, but when I had blood work done, the doctor said he would give anything to have even half of the children he sees be as healthy as he was. His weight did not reflect on his health. I made my own baby food, I always used fresh fruit and veggies and he ate a lot of fish and chicken. He even liked liver.... (go figure) But he ate very small amounts. At age 14 he hit a growth spurt and caught up to his peers. He's still healthy as a young man, and not overweight. Sometimes I think we try to feed children to much. Thus why we see an overall obesity epidemic among children now. Leave them alone if they eat very little. It's not how much you feed them, but WHAT you feed them.

    March 7, 2011 at 17:38 | Report abuse | Reply
  16. EP

    My 6 year old is a picky eater and there are days when she barely touches her meals, and thus gets very little in the way of snacks. She is moderately active and even though she has always been in the 5th percentile, is growing along the curve. My husband has a very high metabolism and eats a great deal of food through out the day. His whole family has his high metabolism. He can not understand why she won't eat, and constantly worries about it. He even tries to force her to eat, and punishes her when she doesn't (I do my best to stop his behavior). He and his family are constantly expressing concern that she is too thin, and blame every single physical problem on her eating. When she tripped at recess last fall and broke her ankle, the "discussions" about her "problems" tripled. They refuse to admit that she might just be a clumsy girl. We've talked to her doctor about it but still they refuse to listen, even with the doctor's lack of concern. They are convinced that her "poor eating habits" are hurting her health, even though the professionals are not agreeing with them. Medical professionals should always be consulted, but sometimes we as parents have to see that we are reading too much into our kids behaviors. Obviously, this is not always the case, but just as many parents can be blind to the problems, some parents can see problems where none exist.

    March 7, 2011 at 19:04 | Report abuse | Reply
  17. Emmaleah

    I'm surprised a Dr hasn't intervened at this point—I have cared for kids who were in the lower percentiles and all had intervention plans. Many are on the autism spectrum.

    The symptoms do not sound like a child who is just a picky eater. I would absolutely raise a stink with the Drs. In addition to being a nanny & pre-school teacher, I worked for some time as a cook for a very good daycare facility. Picky eaters who are also healthy do not show signs of other issues like exhaustion, inability to self-feed, and irritability; they are normal kids who don't eat a variety of foods or who may eat comparatively little. This is such a red flag.

    March 7, 2011 at 20:53 | Report abuse | Reply
  18. Heart defect awareness

    My daughter was similar. just before turning six a new ped heart a heart murmer, and it turned out she has a large asd (hole in her heart). i had taken her to the dr. Many times for fatigue. bTw an echo is needed as well as an ekg. she eats a little more now, after surgery. Go to a cardiologist, do not depend on the g.p.

    March 8, 2011 at 12:25 | Report abuse | Reply
  19. Laura Gomez

    I agree with taking her to the doctor to check at least for basic things like anemia which cause fatigue and irritability or food intolerances/allergies. If there really is nothing wrong medically there are soooo many things you can try. Making smoothies with nutrient dense foods like Spirulina and healthy fats like flax seed oil to boost calories. A health food book of super foods could give you lots of ideas and suggestions of foods to avoid for a little while like milk, soy and wheat that could be upsetting her stomach and putting her off eating. A kids food cookbook could give you ideas of how to sneak good stuff in and make it all look appetizing to a child.
    The articles suggestion of only drinking milk and water are good and at the end of the meal. I used to fill up on milk as a kid and refuse my food.
    Also growing your own food and/or letting her help in the preparation, and eating together can really help if it is a mental /emotional block of some kind. If that isn't possible, then let her choose some foods at the grocery store or push her own little cart, so that she feels excited about food.
    My son will not eat unless someone else is eating with him. If I am eating as well, he eats at least 2 x's as much food, usually b/c he wants what I have.
    Otherwise, sneak in good calories to her favorite foods if you can or keep trying new things until you find one that works.
    Good luck, I know it causes a lot of anxiety.

    March 28, 2011 at 22:03 | Report abuse | Reply
  20. jyo

    I have the same problem at home. My 33 month old is a poor eate. She loves candies but hates anything that is less appealing. She was of average weight from birth to 6 month. I breastfed her till 14 months and she is healthy as far as milestones, intelligence(above average) is concerned. She is also very active and jumps around a lot. I find it very difficult to feed her especially as I am pregnant now and its becoming very stressful for me and I end up showing it to her and she rejects even more. I used to be a good cook and now aside from being a once faculty now a stay at home mom I seem to have lost it raising a chubby kid. My kid is also shorter than her age kids whereas I am pretty tall. I just get a little scared if she will maintain her intelligence if she eats so less.

    March 30, 2011 at 20:43 | Report abuse | Reply
  21. Dee

    I am a mom who have under weight child my son is two and half years old he only weight 18.4lb am very concernd. He is being tested for genetic disease and I have been to all kinds of doctor. He has a hurt murmor which his cardiology thinks no surgery required, he has hypothyroidism which is under contorol, but his has no interest in food. I am really depressed because he is not eating I just do not know what to do. Can any one give advise what else to do at this point I really do not know.

    December 31, 2011 at 02:56 | Report abuse | Reply
  22. Maria Garcia

    Hello, I thought this was a great article. Apreciate you posting.

    http://www.poweropen.org

    June 14, 2014 at 21:39 | Report abuse | Reply

Post a comment


 

CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service. Comments are not pre-screened before they post. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.

Advertisement
About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.