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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!

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Filed under: Children's Health • Healthy Eating

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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.