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Poor Weight Gain in Children...Use a Scheduled Intake Approach for Foods and Liquids

Posted Jul 15 2008 12:00am
I get a lot of questions from parents about poor weight gain in infants and children. Many times I am told that a child "eats all the time" yet he does not gain weight. Grazing is a pattern of nibbling on food throughout the day. But when you gather those little bites together through the day, there really isn't that much food. Grazing continually shuts down a more vigorous appetite. That is why when we as adults try to lose weight, we are told to eat frequent meals.

Grazing patterns often occur for many reasons. Children with sensory issues may hate the smells and appearance of many foods. So the child tries to get away from the table as fast as possible. Children with swallowing problems avoid eating because they do not feel safe at the table. Some children with reflux do not like to eat large portions of food or do not like to eat in the morning. The time asleep and reclined can lead to more reflux and make a child unwilling to eat until mid-day. Some children with reflux also prefer to drink vs eat. Avoiding the table and meals often leads to a child trying to get out of eating and leave the table.

As parents, we worry about our children, so we start offering food all the time or chasing kids around with food as they play. (My mom is sooooo guilty of this!) A child's appetite is a delicate balance. Eating scheduled meals and snacks, three meals, two to three snacks, is a real key to improving weight gain. Meals cannot be too long, twenty to thirty minutes maximum and snacks 10-15 minutes long. A sample meal schedule may be 7 am breakfast, 9:30 snack, 11:30 lunch, nap time, 2:30 snack, 5:30 dinner and a before bed snack. Scheduled meals and snacks often leads to greatly improved sleep patterns and better behavior. Parents are always amazed when they return to clinic and tell us about all the positive changes just from following a schedule.

Do not let your child drink caloric drinks between meals and snacks. Limit juice to 4 ounces a day and milk for a toddler to 16-24 ounces. Drinking milk and juice frequently between meals dampens appetite. Offer these liquids with meals and snacks. Water in small amounts between meals and snacks can be offered. Toddler eating patterns change and growth slows down the second year of life. A toddler's goal in life is to play and eating just gets in the way. Keep portions appropriate. Rule of thumb is a tablespoon of food per year of age. So for example, a two year old would eat 2 T of fruit, 2 T of meat and 2 T of vegetables. Don't overwhelm a child with huge Supersize American portions. The key is trying to have your child appropriately hungry and if this happens kids usually eat more at each meal and snack than they ever would nibbling. Work on helping your child learn to eat at the table or high chair for all meals and snacks. This isn't easy, but it is part of setting yourself up for success.

There are also other physical reasons for poor weight gain and these need to be explored by a pediatric dietitian or physician such as a pediatric gastroenterologist. Some children need calorie boosters added to foods and/or a supplement such as Carnation Instant Breakfast added to milk (I use vanilla) or Pediasure. Don't just think the child will grow out of it, some may but others may not. Good nutrition is an absolute key to a healthy life. It is very important to address it, the sooner the better.
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