Managing low weight and weight loss

Why is my child underweight?

Your child’s weight may be low or dropping due to a number of reasons, which can include:

• medications can reduce appetite
• your child may be burning off energy due to hyperactivity
• your child may have lost interest in food
• at meal times your child may become distracted. 

Your consultant or clinical nurse specialist will monitor weight, height and growth patterns. If there are concerns with your child weight a dietician can work with you to provide tailored advice for weight gain.

Why is it important that your child is a healthy weight?

Children need enough energy, protein and nutrients to grow. If your child’s weight is low or decreasing it can show that they are not receiving the correct nutrients. This can lead to deficiencies and faltering growth.

How can we increase weight?

The best way to increase calories is to offer 3 small meals and 3 snacks per day. Make every bite count by ensuring they are nutritious and energy dense. High energy, high protein foods are an easy way to increase your child’s intake without increasing portion sizes. 

Why high energy and high protein?

Energy will help to increase weight. High energy foods are usually those that contain a lot of fats and sugars. These help to put on weight. Protein allows growth and to help build muscle. Both of these nutrients are essential in increasing weight and promoting growth.

High protein foods

• dairy products
• meat 
• eggs
• beans
• nuts
• seeds
• peanut butter

High energy foods

• butter
• margarine
• cream
• full cream dairy products
• ice cream
• chocolate
• chocolate spread

By adding high energy and high protein food to meals you can increase the calories significantly, without increasing the volume of meals.  This is called food fortification.

Butter/margarine can be added to:
1 heaped teaspoon = extra 75 calories

• potatoes
• vegetables
• pancakes
• crumpets
• omelettes
• scrambled egg

Dried milk powder/evaporated milk can be added to:
1 heaped tablespoon = extra 50 calories

• milk
• all hot drinks
• custard
• soups
• porridge
• milk puddings
• milkshakes

Ice cream can be added to:
1 scoop = extra 115 calories

• fruit
• desserts
• lemonade
• milkshakes

Full fat yogurt can be added to:
130g of yogurt = 90 calories

• fruit
• cereals
• smoothies
• curry
• chilli

Custard can be added to:
130g of custard = 130 calories

• fruit
• sponge/cakes 
• fruit pies
• jelly

Full cream milk/double cream can be added to:
1 tablespoon of double cream = extra 135 calories

• porridge
• custard
• soup
• milk puddings
• drinks
• milkshake 

Cheese can be added to:
Small matchbox size = extra 125 calories

• potatoes
• vegetables
• scones
• crumpets
• bread/toast
• crackers
• soups
• pasta dishes
• pizza
• chips
• baked beans

Nuts and seeds
Whole nuts can be a choking hazard for under 5’s and those with swallowing difficulties.

• bread
• vegetables
• bread sticks
• yogurt
• ice cream
• pasta
• ice cream
• peanut butter
• chopped nuts

Dips
Sour cream/guacamole/cheese and chive

• vegetable sticks
• breadsticks
• crackers

Sample meal plan:

Breakfast

• Porridge (add cream, milk powder and jam)

Snack

• Biscuit (add a chocolate dip)

Lunch

• Ham sandwich (add butter and cheese)
• Yogurt (make sure it is full fat)
• Crisps (add dips)
• Fruit juice (swap for a milk shake)

Snack

• Rice pudding (top with nuts and add a drop of double cream)

Evening meal

• Lasagne (add cheese, cream and fry meat and vegetables in oil)
• Chips (deep fat fry)
• Salad (add salad dressing)

Supper

• toast (add butter, cheese and mayonnaise)

Fortifying this meal can increase calories by around 1,700 Kcals. 

This meal planner is an idea of what you could work towards. You need to add in changes slowly and get your child used to the high calorie and high protein foods. 

Snack ideas

• mixed nuts
• cracker and cheese with butter
• crisps with dips
• milk dessert
• breakfast cereal
• porridge
• toast with butter or chocolate spread
• cheese scone
• full cream yogurt
• rice pudding
• custard
• cheese on toast
• croissant

Nourishing drinks 

Nourishing drinks are a great way to increase calories. These drinks are milk based. Milk is high in protein, energy and nutrients. Full cream milk is preferable. In the back of this booklet there are some nourishing drinks recipes. 

Fortified milk: 2 – 4 heaped tablespoons of milk powder can be added to 1 pint of full cream milk.  You can use this milk and add this to custard, rice pudding, cereals, porridge, mashed potato or whenever you would normally use milk. 

Top tips for meal times

• Make everything your child eats and drinks as nourishing as possible
• Don’t let your child fill up on fluids before meal times
• Take advantage of the times your child feels hungry – usually this is evening when medication can be wearing off.
• Keep ready to eat snacks available for your child to help themselves to at snack time. You could make a snack plate for them whilst they are playing. 
• Make a timetable of meal times so your child knows when they are eating next.
• Keep a food chart so your child can tick off when they have had their meal or snack. This will help busy house hold keep track of meals and snacks.
• Make meal times relaxing and try not to cause anxiety around meals. 
• Some children find it difficult concentrate at meal times. Remove distractions away from the dinner table. 
• Praise your child for eating. Don’t punish them for not eating as this can cause negative associations with food. 
• Offer two separate courses. One main meal and one dessert. 

At school

• If your child finds it difficult to eat at school as they are not hungry then provide them with a nourishing drink. 
• Go through school meal menu options on a weekly basis so they know what to expect. 
• Ask your child’s school to provide an early pass for lunch so they have more time to eat their lunch.

Make food interesting

• Take your children shopping to look at foods.
• Include your children in preparing the food. 
• Think about how you display food – make it look interesting.
• Don’t give large portions which can over face your child.
• Let children serve themselves and put food on their plate.
• Have theme nights to make food more fun. For example American Breakfasts or Mexican nights.

Recipes

Porridge

540kcals and 9.8g protein
Serves 1

Ingredients

• 2 heaped table spoons of skimmed milk powder
• 1 table spoon of double cream30g rolled oats
• 150mls whole milks

Method

1. Mix ingredients in a sauce pan
2. Stir over medium heat for approximately 5 – 7 minutes
3. Add extra milk to alter texture

Serve with honey, dried fruit or nuts.

Omelette

536Kcals and 31.5g Protein.
Serves 1

Ingredients

• 2 eggs
• Tablespoon of double cream
• 1 table spoon of butter
• 120g of grated cheese
• 50g chopped ham
• 1 tomato chopped. 
• Pepper to season

Method

1. Beat the eggs until mixed.
2. Beat in cream and pepper
3. Melt butter in a large frying pan over a medium heat
4. Pour eggs into pan
5. When set, but still soft, spread the tomatoes, cheese and ham over the top.
6. Pop under the grill to cook the top of the omelette.
7. Fold in half and serve.

Pancakes

Serves 2

Ingredients

• 100g plain wholemeal flour
• 2 teaspoon baking powder
• 2 teaspoons of sugar
• 300mls of fortified milk
• 1 egg
• 3 table spoons of butter – melted. 
• Oil

Method

1. In a large pan sift together the flour, baking powder and sugar.
2. Make a well in the centre and pour in the milk, egg and melted butter. 
3. Add 1 tablespoon of oil to the frying pan and heat over a medium heat.
4. Pour or add a scoop of the batter into the pan, using approximately ¼ cup for each pancake. 
5. Brown on both sides and serve hot. 

Serving suggestion: Fruit with honey, double cream and fruit, ice cream and fruit or chocolate spread.

Scrambled egg

Serves 1

Ingredients

• 2 eggs
• 1 table spoon of double cream
• 1 table spoon of butter
• 125g of grated cheese
• Pepper

Method

1. Whisk together the eggs and ream in a bowl.
2. Melt butter in a pan.
3. Add the egg to the frying pan and cook over a medium heat.
4. Stir the mixture. 
5. Sprinkle over grated cheese. 
6. Continue to stir and cook the egg.

Serving suggestion: Add buttered toast to serve and fried Bacon.

French toast

Serves 1

Ingredients

• 1 egg
• 1 table spoon of double cream
• 2 slices of thick toast.
• 1 table spoon of butter

Method

1. Whisk together eggs and cream. 
2. Pour into a large bowl and soak bread on both sides.
3. Heat the butter in a frying pan. 
4. Fry the coated bread until golden brown over a medium heat. Cooked for 2 minutes on each side.
5. Repeat for the second slice of bread.

Milkshakes

Serves 1

Ingredients

• 200mls of whole milk
• 2 tablespoons of skimmed milk powder.
• Milkshake flavouring. 
• Squirty or whipped cream.

Method

1. Whisk the milk, milk powder and flavouring together.
2. Pour into a cup and top with cream. 

Serving suggestion: add ice cream or chocolate flakes

Fruit smoothie

Serves 1

Ingredients

• 200mls of whole milk
• 2 tablespoons of skimmed milk powder.
• Fruit – banana or strawberries work well. 
• 100ml of full cream yogurt.

Method

1. Blend together the milk, milk powder, yogurt and fruit.
2. Pour into a cup and serve.