Regaining weight is particularly important for a growing child, and can be particularly difficult because of the dual needs occurring at the same time – the need to regain weight and the need to grow. It is somewhat like chasing a moving target. Fats are needed for neurological development, proteins are needed for muscle growth, and carbohydrates are needed for energy, among other things. Therefore, although total calories are important, it is equally important to achieve the total number of calories with balanced quantities of carbohydrates, fats and proteins. 

The suggestions below are intended to help you determine the amounts of carbohydrates, fats and proteins your child needs in a day, and translate these figures into general amounts to prepare and serve at mealtimes so you do not need to be a slave to a scale, nor even use one.  

1.  Know what your goal is to start with. For your child’s age, weight, sex, height and activity level, find out what the total daily requirement for calories and carbohydrates, fats, and proteins actually is. 

The quantities listed in the table below represent the daily Recommended Dietary Allowances (RDA) for light activity recommended by the National Research Council (National Academy of Sciences, Recommended Dietary Allowances, 1980, 9^th edition).  

Table 1.
Recommended Dietary Allowances for Children

Type of Food	Children 1-3 years	Children 4-6 years	Children 7-10 years	Girls 11-18 years	Boys 11-22 years
Carbohydrates	165 g	240 g	330 g	345 g	390 g
Protein	23 g	30 g	34 g	46 g	56 g
Fats	38 g	58 g	80 g	80 g	90 g

Persons recovering from injuries, surgery, and major illness may have markedly increased caloric requirements. Persons trying to gain weight will also need to consume more calories than the daily requirement. In some cases protein requirements may be increased according to the recommendations of your doctor.

As a rule of thumb, it is a good idea to increase the requirements by the percent of total weight your child needs to gain. For example if a child is 10 percent underweight, increase the requirement in each category by at least 10 percent. This is important because the values provided above are intended to maintain weight, not increase weight. Thus in order to gain weight, a child would have to eat correspondingly more. For this reason, it is important to view these values as minimum values. Never restrict the total quantities your child eats. If he or she wants to eat more, even twice as much, let them. This could easily be needed during a healing process or a growth spurt.

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. 

Protein:                 4 ounces  
Carbohydrates:      (dry, as flour, cereal or seeds): 1 pound --or--  (fresh, as vegetables, eg potatoes,                             fresh corn): 5 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.

Table 2. Quantities Needed
to Achieve the RDA for Children

Type of Food	Children 1-3 years	Children 4-6 years	Children 7-10 years	Girls 11-18 years	Boys 11-22 years
Complex Carbohydrates	As fresh vegetable, eat about 2½ pounds per day. -or-As dry flour or seed, at least ½ pound per day.	As fresh vegetable, eat about 3¾ pounds per day.  –or--As dry flour or seed, at least b pound per day.	As fresh vegetable, eat about 5½ pounds per day. –or--As dry flour or seed, at least 1 pound per day.	As fresh vegetable, eat about 5½ pounds per day. –or--As dry flour or seed, at least 1 pound per day.	As fresh vegetable, eat about 5½ pounds per day. –or--As dry flour or seed, at least 1½ pound per day.
Green Leafy and Other vegetables	Eat as much as desired, generally ½-1 pound per day, but do not count as a calorie source. Be sure to leave room for the complex carbohydrates.	Eat as much as desired, generally 1-1½ pounds per day, but do not count as a calorie source. Be sure to leave room for the complex carbohydrates.	Eat as much as desired, generally 1-2 pounds per day, but do not count as a calorie source. Be sure to leave room for the complex carbohydrates.	Eat as much as desired, generally 1-2 pounds per day, but do not count as a calorie source. Be sure to leave room for the complex carbohydrates.	Eat as much as desired, generally 1-2 pounds per day, but do not count as a calorie source. Be sure to leave room for the complex carbohydrates.
Meats	Eat approximately 2½ ounces per day total.	Eat approximately 3½ ounces per day total.	Eat approximately 4 ounces per day total.	Eat approximately 5 ounces per day total.	Eat approximately 5 ounces per day total.
Nuts and 0ils	Oil: use approximately 2 Tablespoons/day Nuts: Use in moderation, reduce amount of oil slightly if you use nuts.	Oil: use approximately 3½Tablespoons/day Nuts: Use in moderation, reduce amount of oil slightly if you use nuts.	Oil: use approximately 5 Tablespoons/day Nuts: Use in moderation, reduce amount of oil slightly if you use nuts.	Oil: use approximately 5 Tablespoons/day Nuts: Use in moderation, reduce amount of oil slightly if you use nuts.	Oil: use approximately 6 Tablespoons/day Nuts: Use in moderation, reduce amount of oil slightly if you use nuts.
Fruits	Eat as desired, but do not use in place of foods and quantities listed above.	Eat as desired, but do not use in place of foods and quantities listed above.	Eat as desired, but do not use in place of foods and quantities listed above.	Eat as desired, but do not use in place of foods and quantities listed above.	Eat as desired, but do not use in place of foods and quantities listed above.

For carbohydrates, total carbohydrate quantities can be achieved 1) with all dry forms, just remember these are the amounts before cooking, or 2) with all fresh vegetables such as potatoes and fresh corn, or 3) with combinations of dry and fresh forms, such as ¾ from flour and ¼ from fresh vegetables. Although the quantities for fresh carbohydrates seem high, vegetables such as potatoes are about 80-85% water, and this makes the quantities seem higher.

Many vegetables, such as green leafy vegetables, green beans, summer squashes, melons and so forth are very low in calories. These should be eaten more for their value in vitamins and minerals than calories.

Persons struggling to gain weight should not include foods that are relatively low in calories in their carbohydrate daily totals, and should make sure that the complex carbohydrates have priority when they eat. In other words, make sure a child does not fill up on low calorie foods and then not have room for all of the more important higher calorie foods.

Table 2 gives you the amount to try for, and provides information to help you determine whether a child’s current diet contains enough calories or whether the total amounts need to be increased.

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 Foods^TM, 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 Foods^TM 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! 

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.