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| |    Feeding the Underweight Toddler by Mary Silva, M.S., R.D. reviewed by Robert Needlman, M.D., F.A.A.P. Children come in different shapes and sizes as well as temperaments. In many instances, parents find themselves unnecessarily worried about their toddler's reduced interest in eating and minimal weight gain. And because many toddlers slim down at this stage in life, it can be difficult to recognize when your child is not gaining an adequate amount of weight. For this reason, children's weights and heights are plotted on growth charts as part of their routine medical visits. If weight gain slows a little relative to what's expected during the toddler years, there isn't always reason for concern. However, slow weight gain is something that should be followed by your child's practitioner over time; if it persists and is unexplained, it probably warrants further evaluation. Arguably, few things worry parents more than hearing that their toddler is underweight. The usual reaction is either to assume the worst possible cause (is there something terribly wrong?) or to blame themselves for failing to take better care of their child. In fact, neither is usually the case. When a toddler is found to have slower than expected weight gain for his age, his parents are typically advised to take some initial measures, such as watching the child's beverage intake and assessing the type of food that he does eat. Sometimes simply being aware that a child isn't putting on enough pounds helps parents adjust his diet. But more often than not, it requires a close examination of the toddler's diet and eating environment to pinpoint where the problems lie. If your toddler is underweight, consider trying the following techniques--in addition to consulting with your child's healthcare provider--as an initial step toward figuring out why and improving the situation. Keep a record It's extremely helpful to keep a journal for several days listing when, what, how much, and where your child eats and drinks. You may be surprised to discover a pattern to your toddler's eating habits. Note frequency of meals, snacks Generally, toddlers need to eat four to six times a day to get in all the food their growing bodies require, although keep in mind that typical serving sizes are probably smaller than you may imagine. Another thing to consider: If your child is snacking or drinking 10 to 12 times a day, he may not actually feel hungry enough to eat adequately at each feeding. So while it might appear that he's putting away plenty in his stomach, that's not necessarily the case. When does he eat less? Examine the information you've recorded in your journal to see if there's a particular time of day when your child eats well or poorly. Then think about why this might be so. For instance, if your child eats best at breakfast, it may be because he didn't have anything to eat or drink throughout the night or because he is well rested. Also, it's not uncommon for children who are fed close to their naptime or bedtime to feel too tired to eat much of their meals. Beverages can be filling Don't be surprised if your toddler picks at his plate after sipping juice or milk all day; after all, his small stomach has only so much room. The same thing can happen when a child drinks something shortly before mealtime. It's true: Treats can spoil the appetite A food journal also provides the perfect opportunity to assess the type of foods your child eats. Clearly, the child who frequently eats high-fat or sugary snacks won't be hungry at mealtime. But it may surprise you to know that low-calorie fruit can have the same result. Crisp vs. soft Like adults, children have preferences when it comes to the texture of foods. Some people prefer foods that are crunchy, while others like creamy or chewy items. Look over your records for foods that your child wolfed down or ignored, and then consider their respective textures. Try to offer your toddler all sorts of snacks or meals, but if weight gain is the ultimate goal, present more foods of the texture he prefers. Be aware of distractions Consider the environment in which your child eats. Many toddlers are sensitive to distractions like television or noisy siblings, and too much action will interfere with your child's ability to focus on the task of eating at hand. It's also important that your child sit in a chair that allows easy access to the plate or bowl, as it helps to establish good coordination and facilitates a rhythm of eating. Kneeling or standing on a chair is not a good idea, since most toddlers lack the stability it takes to eat this way. Likewise, sitting on the floor eating from a bowl on the floor should be avoided. You may want to give some thought to the overall atmosphere at mealtimes. If your toddler often tries to establish his independence when eating, and you or your partner feels the need to direct the meal, the result can be a battle of the wills. Wise parents will allow their child some latitude by letting the little one feed himself, but will exert some control by cutting the food into bite-sized pieces or by otherwise overseeing the mealtime process. Finally, don't forget to communicate a positive message to your toddler. Parents who say encouraging words like "good job" when a child eats a small amount will likely see a more positive outcome than parents who say, "You're being bad."
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