Underweight younger children

If you’re concerned that your child is underweight or not growing normally, see your GP. Low weight can occur for a number of reasons.

The GP will weigh and measure your child and talk to you about what your child is eating. If there is a possible problem with your child’s diet, your GP can provide nutritional advice that will help bring your child up to a healthy weight.

Paediatric dietitian Jacqui Lowden, from the Manchester Children’s Hospital, says that a healthy diet will see most underweight children achieve a healthy weight.

What your child needs

All children need the energy (calories) and nutrients that come from a varied and balanced diet.

“Remember, children have smaller stomachs," says Jacqui. "They may not get all the energy they need from three meals a day, and may need to eat some small, healthy snacks to boost their energy intake. They need to eat smaller amounts more frequently. Three meals a day with a morning, afternoon and bedtime snack is typical.”

If your child is underweight, it might be tempting to give them high-calorie but unhealthy foods, such as sweets, chocolate, cakes, fizzy drinks and fatty fried foods. But a healthy, balanced diet is the key to your child's healthy weight gain.

A healthy, balanced diet for a young child means:

• meals that contain starchy carbohydrates, such as pasta, rice and potatoes
• lean protein, such as lean meat, fish, pulses, beans and eggs
• three portions of calcium a day – a small glass of milk or a matchbox-sized lump of cheese is one portion, and calcium can also be found in broccoli, cabbage, soya beans and okra, as well as white and brown bread, which is fortified with calcium
• five portions of fruit and vegetables a day
• diluted juice or water instead of fizzy drinks
• chocolate, sweets and cake only occasionally (it’s best to give them at the end of a meal, to help avoid tooth decay)

A child’s diet

It’s important to remember, says Jacqui, that a healthy diet for a young child is not the same as that for an adult. Many of the "healthier alternatives" that adults are advised to eat aren't suitable for toddlers and very young children.

Young children need the concentrated energy provided by fat in their diet. But give them healthy, energy-dense foods such as oily fish, milk, yoghurt and cheese. Limit unhealthy, saturated fats such as those contained in burgers, sausages, pies, biscuits, crisps and cake.

“Up to two years old, all children should drink whole [full-fat] milk,” says Jacqui. “If your child is underweight, you can continue to give them full-fat milk beyond this.”

Children can have whole cow's milk as a drink after one year, and semi-skimmed cow's milk can be introduced after two years. However, if your child is underweight, it may be important to continue giving your child whole milk after two years.

Young children shouldn’t follow a high-fibre diet. Wholegrain foods such as wholemeal pasta, bread and brown rice may fill up your child too quickly, which means they won't get all the calories they need. Introduce wholegrain foods gradually, so that by the time children are five they are used to a healthy adult diet.

Make sure your child is not filling up on fluids. “We see some children who are drinking too much fluid and not eating enough, which means they don’t consume enough calories and important nutrients,” says Jacqui.

Increasing your child's calorie intake

There are a few steps you can take to increase your child’s calorie intake while still providing a healthy diet.

• Bulk up mashed potato by putting milk or cheese in it.
• Put grated cheese on beans on toast.
• Make milk puddings for a great, balanced pudding.
• Make soups with milk instead of water.
• Use other energy-dense foods such as bananas and avocado in meals or as snacks between meals.

A healthy attitude to food

Children can learn their attitude to food from the adults around them.

The best way to set up your child for a lifetime of healthy eating is to let them see you eating a healthy diet and having a healthy attitude to food.

Make mealtime family time. Sit around a table and enjoy the food you’re eating. It should be a fun and happy part of the day. Don’t associate food with reward or love as your child will learn to turn to food for comfort instead of when they are hungry.

Introduce a wide variety of foods and tastes early. If your child is a fussy eater, introduce new foods gradually and in small portions. Offer lots of praise when they eat a new food and ignore negative responses to the food. Be patient – some children need new foods to be offered many times before they will eat them.

Don’t insist that a child eats everything on their plate or criticise them when they don’t eat as much as you want. This turns mealtimes into a negative experience for the child.

Vitamins for children

All children aged between one and five can benefit from vitamin A, C and D drops. These may be particularly important for underweight children.

You can ask your health visitor where to get vitamin drops, or speak to your pharmacist or GP for more advice.

Keep your child active

Even if your child is underweight, it's important that they are physically active.

Physical activity helps them develop strong, healthy bones and muscles. It’s a crucial part of the way they learn about themselves and the world. And, best of all, it’s great fun.

If your child is underweight, the amount of physical activity they should do may be different from most children. Your GP, practice nurse or school health visitor can advise on this.

Monitor your child's progress

If you provide a healthy diet using these guidelines, and with advice from your GP, you should see your child’s weight and growth improve.

Make sure you go back to your GP to check that your child's weight gain is happening the way it should.