Treating Underweight Children at Any Age Questions and Answers for Helping Children Gain Weight

Despite the well-known obesity epidemic in our country, approximately 5 percent of children struggle with the opposite issue and are underweight. Because body fat is critical to healthy growth and brain development, we work with underweight children from infants to young adults to achieve the healthy growth they need in order to thrive.

Following are some questions and answers on treatment for underweight children.

  1. How do we determine when a child is underweight?

According to the CDC, children with BMI values below the 5th percentile of the sex-specific BMI-for-age growth charts are categorized as underweight. This means that each child’s weight is compared to his or her height. At Feed to Succeed, we assess a child’s overall growth pattern and also consider the size of a child’s parents. A child who is thin or slight is not necessarily underweight.

  1. What causes children to be underweight?

The cause for being underweight varies for every child. Some children we see have been recently diagnosed with a food allergy or celiac disease, which is the obvious reason for not gaining weight properly. Babies can be underweight because of reflux or because they were preemies. And older children can be underweight because they are picky eaters and don’t eat a wide range of food or because they have an eating disorder.

  1. How do we treat underweight children?

Because the source of being underweight varies for each child, our treatment is highly personalized. During our first visit at Feed to Succeed, we assess the child’s current weight and height and compare that to their growth over time and their heredity. We look at a food record for a typical day to see how many calories, protein and fats the child is consuming. We also look for anything we consider a possible risk factor to determine the source of the problem. Sometimes, we know a child is underweight because of celiac, for example, or sometimes we don’t know the cause. We especially look for changes in growth patterns that occur at a critical period of time.

Next, we come up with a highly customized treatment plan. Sometimes a child needs more protein, and other times a child needs more calories. Sometimes, it’s both. Once a plan is in place, we tend to see children with more severe issues every week and children with more moderate issues once a month. For some young children, we will follow them for up to three years, and for older children, we will see them up to 3-4 times and then encourage them to follow up with their pediatricians. There are some children with severe underweight issues, and we will work with them throughout their childhood.

  1. What are some foods that help children gain weight?

While weight gain shakes are the first to come to most people’s minds, our first line of treatment for underweight children is to focus on nutrient dense foods. Protein shakes tend to have a lot of sugar and highly processed ingredients. We instead prefer healthy sources of calories such as:

  • whole milk yogurt
  • avocados
  • high fat meat
  • healthy oils (like coconut oil)
  • nuts and nut butters
  • granola or trail mix

We also discourage foods that are highly processed—containing empty calories–because these foods can make a child feel full without providing any health benefit. The diet for each patient we see is highly customized.

Regardless of the reason for being underweight, some conscientious changes in diet can usually help children get back on track for years of healthy growth.

Patriotic Pops Healthy Treat for July Fourth

Move over Bomb Pops, these red, white & blue Patriotic Pops are just as fun and a whole lot healthier.

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Red Layer:
1 cup fresh or frozen strawberries
1/2 cup orange juice
1T honey or maple syrup

White Layer:
1 overripe banana
1/4 cup plain yogurt
1/4 cup milk

Blue Layer:
1/3 cup frozen or fresh blueberries
1/4 cup orange juice
1T honey or maple syrup


Mix the three different layers in a blender, one at a time. Store the white and blue mixtures in the fridge. Pour the red layer into popsicle molds and freeze for at least 30 minutes.

Add the white layer and freeze again (don’t let this layer harden too much because you’ll need to stick the popsicle stick inside of it).

Add the blue layer and the lid and freeze for at least an hour.

On the Run Summer Snacks By Betsy Hjelmgren

With a whirlwind of outdoor activities, day trips and late bedtimes in the summer, healthy eating often takes a backseat to convenience. That’s why we’ve come up with some healthy, easy and delicious snacks to stand up to even the hardest temptations.

Below are five on-the-go snack and meal ideas in order of how long they take to prepare. We started with the easiest (1 minute) and worked our way toward the most ambitious (5+ minutes).

  1. Grab and Go. Of all the ready-made snacks, some are certainly better than others (and nearly all of them are better than ice cream every day at the pool snack bar!). To keep kids full longer, consider adding these few pre-packaged but minimally (or not at all) processed snacks. Individually portioned hummus, guacamole or nut butters as dips can serve as a mini meal. Bars, like Larabars, and fruit are easy and great options.
  2. Trail Mix. Good, old-fashioned trail mix is easy to make at home. Throw in any cereal, pretzel, dried fruit, chocolate chips, seeds and nuts in a big zip lock. Turn it into an activity and put out some choices the night before and let your kids make their own custom snack mix to hit the road with. This has a bit more sugar, but when you stack it against other snacks, it still packs on the fruit, protein and whole grain servings.
  3. Whole-Wheat Pita Pizza. Pita pizza wraps take all of four steps: open fridge, take out toppings and pita (or wraps), assemble, press in a hot sandwich maker or toss it in a microwave. REPEAT!
  4. Fruit and Yogurt. Freeze your yogurt in advance to give yourself a couple hours of defrosting time before eating it on the road. Pack fruit in containers, or you can even layer them on skewer sticks and wrap in aluminum.
  5. Whole Wheat Pancakes with Nut or Seed Butter. Spread nut butter or maple syrup between two pancakes for fun sandwiches on the road. Try our banana pancakes or make your own. Kodiak Flapjacks, available at Target and other groceries is an even easier version that’s whole wheat, with minimal ingredients.


Healthy eating, much like your summer, is a journey and adventure. Try your best, have patience and mostly importantly have fun!



7 Reasons the New Nutrition Labels Are Better Gia M.Diakakis MS, RD, LDN, CNSC

After more than 20 years (1993!), the Food and Drug Administration (FDA) has finally made changes and updated the nutrition facts label that we rely on so often when choosing our foods. When I initially heard the news, I was worried the label would become more difficult to read and use, but I have been delightfully proven wrong. It seems the changes the FDA has made help to highlight some of the most important items on the label.

New food lable

  1. Servings: The new label brings attention to the serving size and number of servings per container. The serving size, when evaluating a food item, is paramount to understanding the item itself. A consumer can pick up a box of cereal, read “calories 90,” and easily assume it is a low cal. If the consumer fails to look at the “serving size 1/3 cup” and eats 1.5 cups of the cereal, their “low calorie” cereal catapults from 90 calories to 405 calories (a 450% misinterpretation of the calories!). In addition to bringing attention to the serving size and number of servings per container, they have also adjusted the serving size (only in items they felt were relevant) to reflect the serving size consumers are now consuming. For example, that cereal box we just discussed, would have “1.5 cup” listed as a serving and not “1/3 cup.” Time will tell if consumers will see the serving size as a suggested serving or if this modification will lead to healthier choices.Serving size
  2. Calories: The font of the calories per serving will be increase to help draw consumers’ attention to the area.
  3. Daily Values: The “% Daily Values” have been updated to reflect “newer scientific evidence from the Institute of Medicine and other reports such as the 2015 Dietary Guidelines Advisory Committee Report”1. This just means the amount recommended for daily consumption has changes for some of the items, and the label has been adjust to reflect this.
  4. Added Sugars: This may be the change I am most excited for. We have always instructed our patients to look at the “total carbohydrates” line of the nutrition facts label, and this will not change. The new “added sugars” line will help consumers steer away (hopefully!) from food items that have a large amount of added sugars (versus naturally occurring sugars). Including the word “added” may draw attention to how far the product has deviated from its natural state (ex: dried fruit) or how unnatural and processed the item itself is (ex: Oreo cookies).
  5. Vitamin D & Potassium: Goodbye vitamin A & vitamin C and hello vitamin D & Potassium. Since vitamin A and C are no longer inadequate in the American diet, they have been removed and replaced with two nutrients our diets have been shown insufficient in our diets (Vitamin D & Potassium). Manufacturers have the option to continue to include Vitamin A and Vitamin C on the label, but it is no longer mandatory.
  6. Micronutrients: In addition to adding Vitamin D & Potassium, the label will also include the actually amount of the four mandatory micronutrients on the label (Vitamin D, Calcium, Iron, Potassium). This is super helpful, especially since a child has a different requirement for calcium than adults.
  7. Footnote: Daily values at the bottom of the label has been updated. The old label stated, “Percent Daily Values are based on a 2,000 calorie diet. Your daily value may be higher or lower depending on your calorie needs.” The new label reads, “The % Daily Value (DV) tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.”

I’d be remiss if I didn’t mention a Graham & Roberto study evaluating the impact of the FDA label changes. They assessed visual tracking on the old nutrition facts label versus the new nutrition facts label. Their main findings were the following:

  1. Fewer individuals looked at the % Daily Values with the new label
  2. The increase in font size and bolding of the serving sizes (on the new label) and number of servings per item did not draw more attention to this area
  3. The “added sugars” line (on the new label) increased attention to the area

They also noticed that with both labels, the most attention was paid to the top of the label and the further down the label the information (ex: vitamin D), the less attention it received. This type of information is what helps to reconstruct these labels to provide the most impact with consumers.