On this week’s pediatric nutrition podcast, Registered Dietitian Betsy Hjelmgren and Jen Karakosta discuss low weight for kids. Did you know a child can be thin and healthy, and totally fine; or can be thin and healthy, and malnourished? Do you know how to tell the difference? Join Jen and Betsy in this interesting interview with pediatrician Divya Gupta, MD, as they discuss and explore the difference between being thin and being underweight, and what to do if you are a concerned parent.
Jen and Betsy, along with fellow Feed to Succeed colleague Gia Diakakis, discuss disordered eating among children and teens of different ages. Join in to hear more about signs, symptoms and prevention.
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.
- 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.
- 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.
- 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.
- 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
- 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.