Thinness, like chubbiness, is often in the eye of the beholder. And, as with chubbiness, when the beholder is parent, the perspective is often a little skewed. So rather than believing your eyes, check with the doctor to see if your toddler is really abnormally thin from a clinical perspective. If the doctor is satisfied with your toddler’s growth and general health, put your concerns aside, and begin to accept and appreciate your toddler’s shape as is.
If your toddler is indeed underweight, it will be important for you to work together with the doctor to figure out why. To determine just what your toddler is eating and whether either the quantity or quality of food being consumed (or both) is at the root of the problem, you may be asked to keep a very detailed food and drink diary for a week or two a diary that lists not just what your toddler eats, but when and in what circumstances. (Keeping track of a toddler’s intake won’t b easy, of course, considering how much of each meal generally ends up on face, clothing, high chair, floor and elsewhere, and never makes it to the mouth.) Many factors, some of which are likely to be uncovered when a diary is evaluated, can contribute to a toddler being underweight. Happily, most can be easily remedied:
- Excessive fluid intake. Many young children fill up on fluids (milk, juice, soft drinks, and/or water), leaving no room for solids. So judiciously limit liquids.
- Easy distractibility. The child who is distracted during mealtime by toys, siblings, or television may leave the table before eating enough. So decrease distraction.
- Lack of assertiveness. Some toddlers never complain when they’re hungry; since they never ask for food, their parents may forget to feed them often enough. For these children, it’s especially important to provide regular meals and snacks at approximately the same time each day.
- Uncomfortable seating. The child who isn’t comfortable at the table is child who isn’t going to stay at the table long enough to eat a full meal.
- Unpleasant eating conditions. Mealtime stress can affect the appetites of children as well as adults. So serve up an atmosphere conductive to eating.
- Hurried mealtimes. Many young children are poky eaters. Give the opportunity, they eat a hearty meal. When rushed, they may leave the table before they’re done, and go away hungry.
- Poor food choice. Sometimes a child is offered foods that don’t adequately fuel growth and weight gain: foods that are too in fat; low in calories (artificially-sweetened ‘diet food, for example); low in nutrition (junk foods, overly processed and refined foods). In planning meals for your underweight toddler, focus on food that are calorie and nutrient dense and that will help meet the Toddler Diet Daily Dozen requirements.
- Self-feeding problems. Some young toddlers are not yet ready for exclusive self-feeding; when the feeding is left to them, they may not eat enough. Others are eager to self-feed and, when denied the chance, won’t eat much at all.
- Continued breastfeeding. Breast milk itself is not nutritionally adequate for children past for the first year, and a toddler who is still nursing may not be getting an adequate intake of other fluids and of solid foods. So limit this liquid.
- Ill-timed snacks. Snacking just before meals is sure to dull a child’s appetite. Do hold the line on snacks.
- Ill-timed meals. Toddlers who wait too long for a meal often lose their appetites altogether. So feed when hunger strikes.
- Untimed meals. Many toddlers need regularity to thrive. So try to serve your toddler’s meals and snacks at roughly the same time each day.
- Inadequate eating at day care. Some times, day nursery workers or childminders are not able to see to it that each of their charge finishes a whole meal. An inattentive (or nutritionally unaware) baby-sitter or nanny may also fail to feed your child adequate – or may be serving wrong – foods. If you suspect your toddler is not eating well enough in another’s care, take steps to remedy the situation. Include the caregiver in any attempt to change your toddler’s diet.
- Increased activity. The toddler years are a time of greatly increased activity (and, in the case of some toddlers, of what seems like perpetual motion).
- Illness. A wide range of physical ailments can contribute to underweight, including frequent ear or other infections, asthma or allergies, digestive problems, a metabolic disorder, an iron or an zinc deficiency. Certain medications, including some antibiotics can also dampen a child’s appetite. Discuss these possibilities with doctor.
- Stress. Stress of all kinds – parental pressure to eat, family problems (such as illness or job loss), family changes (divorce, separation, a new baby, a move), a new or unhappy child-care or school situation, an overly busy schedule – can interfere with a toddler’s appetite, try to eliminate or modify that causes, and use stress reduction techniques to relax your toddler.