If there are any concerns with a child's poor weight gain or faltering growth, it is recommended to speak to their health visitor or GP, who may give advice and/or refer to a dietitian. As all children are different and reasons for poor weight gain vary, it is very important that the child is assessed by a healthcare professional. Individual advice can then be given, taking the child's weight, height and feeding history into account. If a child's weight is maintained but their height increases, their BMI will reduce to a lower centile.

Children in the underweight range, or with faltering growth, are eating/drinking less energy than their body needs. To help children become a healthier weight, families are usually advised to increase the child's energy (calorie) intake. It's important for children to continue to be active, and children who don't have enough energy may struggle with this.

Food fortification

One of the main strategies used to improve weight gain in children is food fortification. This involves adding calories (energy), protein and/or fats to foods without dramatically increasing the portion size of the meal or snack. This can also be called making the food more energy dense.

Foods which can added to meals or snacks to make them more energy dense include:

  • Full fat milk and dried milk powder
  • Cheese, yoghurt and cream
  • Margarine, oil and butter
  • Meat, fish and other protein sources
  • Nuts and nut butters
  • Avocado
  • Sauces e.g. mayonnaise, ketchup, pesto, sour cream, guacamole
  • Sugar, honey and jam

Where possible, try to aim to keep the diet balanced. It can be tempting to increase high sugar and/or ultra-processed foods in the diet. Small amounts of these foods can be included, but it is recommended they are added to balanced meals/snacks, rather than given by themselves e.g. adding chocolate spread to a slice of toast with banana, rather than a just giving a chocolate bar.

It is helpful to offer children 3 meals and 2-3 small snacks per day (making them energy dense where possible). Desserts and nourishing drinks are also an easy way to increase calories. Remember to take into consideration any allergies and choking risks.

Avoid force feeding your child. Children should be praised when eating well, but avoid negative comments or behaviours if your child chooses not to eat.

Some children may also need a nutritional supplement to boost their weight gain. This may be advised by their GP or dietitian.

Babies under 1 year

Whilst your baby is breastfeeding or given formula milk, your healthcare professional may suggest increasing the volumes or frequency of feeding, top up feeds, increasing the concentration of formula and/or using a high energy formula.

Whilst your baby is weaning (from 6 months) you may be advised to increase both milk and solid foods.