2. Learn the amounts of food to be eaten each day. Learn the amounts of food that have to be eaten each day in order for your child to obtain a sufficient caloric intake from balanced quantities of carbohydrates, fats, and proteins. This can be easier to accomplish that one might think. If one assumes (and this is in general true) that most protein will come from meat, milk and cheeses, that most carbohydrates will come from grains - wheat, corn, oats, barley, rye, rice, and that most fats will come from nuts and oil, then, the amount that needs to be consumed during a one day period can be written as total numbers of pounds, tablespoons and the like to prepare and eat each day.
   
   Table 2 has translated the numbers of grams of carbohydrates, fats and proteins in Table 1 into general quantities of major food categories that should be eaten one way or another by the end of the day. Using this approach, for example, to determine the amounts that, on average, a 10-year-old child would need to consume by the end of the day in various forms in his or her meals and snacks, the amounts are:
   
   - Protein: 4 ounces
   - C arbohydrates: (dry, as flour, cereal or seeds): 1 pound --or--
   (fresh, as vegetables, eg potatoes, fresh corn): 5-12; pounds,
   - fats: 5 tablespoons

Now you know why it can be so easy to lose weight in certain circumstances. Since these amounts are amounts to maintain weight, the quantities should be even higher in order to gain weight.

3. Keep the quantities of carbohydrates, fats and proteins in balance. Table 2 also presents the quantities that make it possible to achieve balance among carbohydrates, fats and proteins; this will help to achieve optimal nourishment. Balanced quantities of carbohydrates, fats and proteins and the total number of calories eaten are equally important. The term ‘balance’ used here refers to the optimal quantities of carbohydrates, fats and proteins to achieve optimal nutrition. According to the NRC (1980) a nutritionally balanced diet is high in complex carbohydrates, moderate in protein and moderate to low in fats.

Although vitamins and minerals are talked about a lot, persons who are underweight are generally not eating enough of the MACRO nutrients - carbohydrates, fats and proteins and are accidentally starving.

4. Intervene when you need to. There is a commonly accepted belief that, if left to his or her own devices, a child will eventually eat what he or she needs without coercion, power struggles and the associated psychological trauma that is supposed to surely accompany parent intervention at meal times. This may be true under circumstances that solely relate to a willful child, but this belief is not true when the reasons for being underweight are directly or even indirectly health related. In these circumstances, children who are underweight and left to their own devices, generally remain that way.
   
   It is not harmful to intervene and help an underweight child eat enough. It is very important to help a child struggling with maintaining weight, who really needs to gain weight, find ways to eat enough.
   
5. It helps to actually gather and set aside the food to eat in a day. Do you remember when your child was an infant? If your child was bottle-fed, do you remember preparing a 24-hour supply of formula, setting it in the refrigerator, and heating up a bottle as needed during the day? If not, you kept a supply ready, in cans, pre-prepared bottles, etc.
   
   This was for convenience, certainly, but one extra advantage was that it was possible to keep a visual check on the amounts the baby was actually eating. You would know immediately when the baby was eating more, or less. Remember when he or she suddenly began eating less, and you would ask, is he/she sick? Remember when he/she suddenly seemed to eat twice as much, and you would ask, is he/she sick? is this a growth spurt?
   
   When a child is underweight, it helps to apply this concept, often used inadvertently with infants, to older children. One approach that works well is to set out the total amount of foods for a day, the evening before so you can see it. (Be sure to keep all foods properly refrigerated, however). Then starting with a hearty breakfast, depending on how much your child eats, you can get an idea about the number of meals that you will need during the day. Will the normal three plus snack be enough? Or will one or more extra meals need to be included?
   
   Nothing is more important that eating enough, finding a way to get a child to eat enough is often where the real difficulty lies. The suggestions below will help to find ways to achieve the goal of eating enough.
   
6. Change the types of food your child eats. Avoid foods with high water content such as soups and stews. These are actually better for losing weight. With high water content foods, it is high amounts of water that are primarily eaten, and a child will feel full long before he or she has eaten enough.
   
   Eat fewer low calorie vegetables in favor of more calorie dense foods when there is not enough room for both. The most dense forms of foods are the best; these include breads, nut butters, the nut butter substitutes from Special FoodsTM, crackers, and cookies.
   
   A dense wafer topped with a generous portion of an imitation nut butter is very high in calories, complex carbohydrates and fat; a few of these can provide more calories than a whole bowl of soup.
   
   Make every bite count, and include the maximum number of calories possible in each bite.
   
7. Drinking enough water is also very important, but try to drink a little less at meal times and drink a lot more between meals. In particular, avoid the temptation to wash down each bite with water, this fills up a child too quickly. Although dense foods are preferred, these should not be unduly dry, since dryness makes food seem to stick to the throat and needs to be washed down with lots of water. Special FoodsTM white sweet potato bread is an example of a dense bread that is not dry.
   
8. Eat more frequently. The stomach empties every two hours, so if you are having trouble getting your child to eat enough at meal times, increase the number of meals (complete meals, not just snacks) to as many as you need, up to as often as every two hours.
   
9. Encourage your child to chew his or her food thoroughly. Calorie intake can be increased by more thorough digestion. Especially for carbohydrates, critical digestion begins in the mouth. If the food is swallowed quickly, this vital step can be missed. Tell a child to chew each bite until it tastes sweet. All carbohydrates become sweet when the digestive enzymes convert them to the more simple sugars. The sweet taste lets you know that the food is well mixed with the necessary digestive juices and that chewing has been long enough. It is very hard to chew a large mouthful of food, so encourage your child to keep the bites to a manageable size.
   
10. Don't settle for less. A parent's attitude and resolve can make the difference for a child. Apply plenty of patience and plenty of time when necessary.

When I experienced severe weight loss problems with my child, I spent the hours it often took, sometimes as many as eight hours per day, to help my child eat enough, and he managed to maintain his weight during his critical growth periods. I know this was a critical factor in his recovery.

Sweet potatoes can play an important role in the struggle for calories, digestibility and nutritional balance. This role becomes vital in cases in which intolerances cause the inability to effectively digest the gluten in certain grains. For those who are gluten intolerant, sweet potatoes can be a complete substitute for grains, providing the total carbohydrate need of the body most effectively.

Sweet potato breads, muffins, crackers, cookies and nut butters are particularly appropriate for promoting weight gain. The best of all is the white sweet potato nut butter. Made of only whole white sweet potato flour and oil, the white sweet potato flour is moistened by oil instead of water, producing a nut butter substitute that is high in complex carbohydrates and soluble fiber as well as fats. This makes it an easily digestible, highly nutritional and highly caloric food. Spread on a dense piece of bread or on dense crackers, and with added jams, the result is the maximum number of calories possible per bite, and some super great taste!

The sweet potato nut butters and other imitation nut butters from Special FoodsTM were specifically designed to provide the highest calorie content possible per bite while also providing nutritional balance.

In summary, one of the most important steps to helping your child gain weight involves learning just how much food really needs to be eaten, and then setting up strategies to help your child eat those amounts. Make each bite count, packing as many calories in each bite as possible, and encourage your child to chew thoroughly so that the maximum number of calories and other benefits can be obtained from each bite. Spend the time you have to, to help your child eat enough, especially if your child finds this difficult.

Finally, once your child is eating enough to gain weight, and has adjusted to the added quantities, remember to vary the foods. Many parents are able to get a child to start eating enough by offering large quantities of favorite foods. This approach will only work for a relatively short term, because most children tire relatively quickly of even their most favorite foods when these are offered frequently. Then where do you go? In terms of taste it’s downhill from there. A better approach is to offer a variety of tastes and forms of foods as soon as the child has begun to adjust to eating the higher quantities of foods.

©Karen Slimak, 1997, all rights reserved.