Toddlers and Weight Gain

Last week I posted about a child put in foster care because the parents refused to follow medical advice to fatten him up with junk food. When experts also failed to increase his weight, the authorities admitted that the parents weren’t the problem and the family was reunited.

Over the years I’ve encountered many toddlers who did not eat or gain as much as they were supposed to. Before getting concerned, ask the following questions:

  1. Is the child really underweight? As Ingathered learned, older growth charts are based on bottle-fed babies. Breastfed babies are expected to gain 2.5 times their birth weight by a year, not triple like some charts indicate. Children at the 5th percentile are generally not underweight, just small compared to all healthy children their age.
  2. How much is the toddler really eating? Toddlers have small stomachs. Breastmilk and formula are high in calories and may not leave room for much more. Growth slows down in the second year so a toddler may eat less than a younger baby. And parents who record what a child consumes throughout the day are often surprised by how much is eaten. Toddlers are known for having irregular appetites.
  3. What do the parents look like? Babies follow two distinct growth patterns. For the first six months or so, they follow the growth curve of their birth weight.  So babies born large continue to measure at a high percentile. Between 6 and 12 months, babies switch to a curve closer to that of their parents. Sometimes a drastic drop in percentile can be a normal leveling-out to match a genetic growth pattern. I learned this when my daughter dropped from the 90th percentile for height to below the lowest line on the chart, holding that position for many years. I remember being very short as a child as well.
  4. Is the baby happy, healthy and developing normally? Look at the whole picture, not just numbers. An active and good-natured baby is a strong indicator for overall health.
  5. Is the child gaining slowly, or is he failing to thrive (FTT)? It’s important to know the difference.  Slow gainers stay on a curve, while FTT babies gain erratically or lose. Slow gainers have good skin and muscle tone, are active and alert, and meet developmental milestones. A good doctor can tell the difference.
  6. Are scales accurate? Always use the same scale from one weighing to the next, as differences can be significant.

A word about breastfeeding toddlers: I don’t believe in delaying  solids much past six months, but a small number of breastfeeding babies are not interested and do well on breastmilk alone for a year or more.  If the child is happy, healthy, and gaining weight, there is no reason for concern. In fact, starting solids too early can lead to poor weight gain.

Dr. Jack Newman tells of a child who ate only jello and breastmilk. The mother was told to wean so the child would eat more solids. After weaning the child refused everything but jello. Breastmilk is high in calories and has antibodies to fight illness. Weaning will not help a toddler gain weight.

I believe we have to trust our children, and our instincts. A healthy child will eat as much as he or she needs. A child who doesn’t is sending some kind of message.  I have known many children who did not eat as much as their parents or health providers thought they should. They outgrew it.

Sometimes, even after the issues above are resolved, there is still concern. Reasons for poor appetite, rejection of solids and low weight gain include allergies, reflux, celiac, abuse, sensory issues, anemia, and illnesses such as cancer or cystic fibrosis.

An excellent and humorous resource is Dr. Carlos Gonzalez’ book, My Child Won’t Eat.

If you enjoyed this post you might also like:

Four-Part Series on Feeding Babies Frugally (at CookingManager.Com)

Dr. Jack Newman in Israel


  1. One thing I will say is that I’ve seen 3 cases of FTT in the past few years. In all three, the parents are very good about offering healthy nutritional choices and the children were well-loved. I believe there may be some underlying medical conditions that cause it that doctors don’t know how to look for yet as one of the children was allergic to a number of foods and another had had serious reflux issues.

    I think this is another place where parents aren’t told the truth – the truth is that if the parents are offering healthy food regularly throughout the day and the child isn’t growing well, then what’s going on is probably NOT THE PARENTS’ FAULT. (which isn’t the same as saying that the parents can’t be part of the solution – they absolutely need to be -) I think there needs to be a big movement to stop assigning blame, especially to parents.

  2. Even if a kid is really underweight, the food choices and offerings may not be the cause of the problem. I have a kid who is extremely active and impulsive and can’t sit long for meals. Pair that with an appetite that’s below average, and the kid might really not be taking in enough calories. Offering small meals and nutritious snacks frequently might help with this. This kid often told me he was hungry right before bedtime, and I’d refuse to give him the snack because it was time to go to bed. When I realized he was not gaining weight, I made an effort to be patient and feed him (healthily) whenever he had an appetite.

  3. Nice post. My babies all fit the patter you describe: big good weight gainers until ~6 months and then going down to skinny. I was given hell by tipat halav with my first three. Then we moved and the new nurse just said – well look at you – that is why he isn’t gaining.
    There are some children (toddlers) who have a sensitivity disorder – they are hiper sensitive to stimuli, which may make them finiky eaters.

  4. Also the nurse at Tipat Chalav told me to feed my 18-month old girl more fat containing food since her weight was on the lowest line, BUT also her height was on the lowest line and proportionally she’s average. She’s still nursing a lot and not eating solids too much, but she does gain slowly.
    Why to feed her fat? Just for her to gain weight?! I might end up having a fat toddler!
    Anyway, she got her grandmother’s genes probably who was very tiny (about 1.30 m) and my husband isn’t tall either (1.64 m).
    I’m not worried.

  5. Leah, babies and toddlers need enough fat for brain development. But if she’s proportionate and still nursing a lot, that’s not really a problem for you.

  6. I had the problem of a doctor telling me to breastfeed less with my now 13 year old when he was 9 months old (and perfectly healthy). The short end of this story is I switched doctors. The longer story is I had one more bad experience with someone in the medical profession (although two doctors helped me out, so it taught me to be even pickier about the doctors I choose – and not to take everything a doctor says as the “truth”).

    “Dr. Jack Newman tells of a child who ate only jello and breastmilk. The mother was told to wean so the child would eat more solids. After weaning the child refused everything but jello.” – good story

  7. I had lots of friends who were borderline neurotic about their kids finicky eating, begging them to eat and worrying needlessly (I can say that now, more than a decade later.) I totally believed in, “they’ll eat when they’re hungry”. (Of course I’m talking about kids who are active, thriving, happy kids). My middle child was always on the “skinny” side as an infant/toddler, but I also felt she was proportionate for height and developing nicely. So when my doctor told me to add butter to her pasta when she was about two years old, I ignored the advice. (I know she was getting enough fat in her diet, Abbi).

    Another angle: as a speech therapist I see plenty of feeding issues that are “behavioral” in nature. I’m not blaming mom–they are often caused by illness in the first months of life, leading to an aversion to food. These are hard-core issues, and parents shold seek help by professionals. Going it alone, and stressing over every meal will just increase anxiety for everyone.

  8. I don’t really get this fear of fat for small children. Unless one has borderline obese children, I don’t see the point of not putting butter in their pasta or giving them lowfat milk. I understand why you wouldn’t want them eating deep fried foods for three meals a day, as that’s simply sickening and a bad habit. (and actually, I tried giving my kids full fat milk and it made them sick, since they love milk and drink a lot of it). As long as the child is getting enough exercise and not overloading on unhealthy snacks, I think it’s strange to limit fat because you’re afraid they’ll get fat.

  9. Sheesh. I leave you all alone for a little while and look what happens. 🙂
    Abbi, I don’t think anyone is afraid of fat. But we are afraid of too much fat, and with good reason considering today’s obesity rates. If a child is happy, healthy and growing there is no need to feed him fatty foods *in addition* to the fat he already eats as part of his normal diet. I’m pretty sure that’s what Leah meant.
    Trilcat: I think parents are blamed when there is no obvious medical issue.
    Tesyaa: Yes, that fits in with my point about irregular appetites.
    Ariela: Sensitivity disorder–that’s what I referred to as sensory issues.
    Baila, interesting point about the food aversion.

  10. Well I knew I wasn’t imagining this:

    “The findings, Forouhi noted in an email to Reuters Health, show that “it is more important to aim for a healthy lifestyle including a balanced healthy diet and regular physical activity, than to focus on fat intake alone as a factor for weight gain.””

    Fat intake has nothing to do with how fat or thin you are.
    Fatty foods do not make you fat. Too many calories and not enough exercise make you fat. Stop depriving your children of butter. 🙂

  11. Since I can’t edit, i will say that the second to last sentence is a bit hyperbolic. But especially when it comes to children, again, unless the child is obese or borderline obese, I think worrying about fat intake unnecessary. I’m not saying to overload, but I don’t think children should be following a low fat adult diet.

  12. But Abbi, I just never make my pasta with butter, so why would I do it just to add something to my child’s diet that I don’t think she is lacking? As infants and toddlers, my kids drank whole milk until they were two years old (at which point we switched them to low-fat milk–we are also big milk drinkers),ate yogurts, and cheeses and fruits and vegetables. And in my family, where obesity runs rampant, I do have to worry about them becoming used to the way things taste–why get them used to pasta with butter, if it’s not necessary? It’s also the reason I started cooking with ground turkey instead of meat, baking my shnitzel rather than frying it, and using whole wheat pasta and rice from the time they were that age.

    I’m not saying noone should eat butter or give their kids butter, but for me personally, it wasn’t something that I would deliberately ADD if I didn’t think it was necessary.

    (And BTW, I was right. That child of mine who was denied the butter is a beautiful teenager today, who seems to be quite well-adjusted when it comes to food).

  13. This is such a sore subject with me. When our daughter was 4 months old, she was classified as FTT for slow weight gain, even though she was happy, healthy, and developing normally. Now, at nearly a year, she is still tiny, even though she eats plenty of solids as well as nursing. She poops every time she eats. I’m thin and can’t keep any weight on, no matter how much I eat. I’m so HAPPY I didn’t listen to the pediatrician, but instead called LLL, who were awesome and told me to continue breastfeeding. Breastfeeding could have been ruined because of that stupid doctor. I never returned to see her again. Just thinking about her gives me high blood pressure.

  14. When my eldest daughter (now a mother of 4 herself) was a baby she really didn’t do well on breastfeeding. I think that was mostly a psychological issue (on my part). I was very isolated in Israel at the time, no family, no phone, and in complete shock at having to care for a baby on my own. Tipat Halav advised me to give her “daisa” (cereal or porridge) in addition to breastfeeding or formula, and when she still didn’t gain weight as fast as they liked, they advised me to add tablespoons of oil (!!!) into the daisa. I drew the line at that! She had started gaining nicely without the oil and I could see absolutely no point in adding empty calories. Epilogue: My daughter is now rather on the overweight side…

    One of my granddaughters (not from my daughter) is also having eating disorder issues now. She is 15 months old and the only food she can keep down is formula with a bit of daisa. She will eat “grown-up” food, in fact she likes it, she chews it, then spits it out. If she swallows it she throws up. She is now in the middle of tests to figure out the problem (in Tel Hashomer at the pediatric speech therapy clinic). She is gaining weight, but slowly. On the other hand she is extremely active and curious so the pediatrician is not overly worried. It’s a very strange phenomenon.

    • Annie, I know of a child who was breastfeeding and also chewed and spit out all solids until a year and a quarter. She was small but growing well. At around that age she did start eating solids and is fine now as a preteen. (You know her mother.)

  15. Something about the comments intrigues me – why are speech therapists involved in food-related issues? Is it the mouth/throat connection?

    I stutter quite dramatically and went through extensive speech therapy with many different therapists until my teens, when I met one who actually understood the issue as a biological one and taught me how to circumvent it.

    But I never imagined any of these therapists working with people who had eating disorders! Are they related specialties?

  16. Mrs. Krieger, speech therapists are involved in the actual feeding part of the food-related issues. Some, (and definitely not all) therapists work with infants and toddlers and have a great deal of training and experience in the physiological way food is transported from the lips through the mouth, to the swallowing mechanism. I work with very young children who have a variety of disabilities which cause feeding issues. We work with parents and caregivers in consultation with nutritionists, medical professionals and even breastfeeding specialists in order to normalize feeding (including sucking, chewing and swallowing) as much as possible.

  17. Hannah, these food and baby issues that you write about are so important. Please keep it up.

    I find that Tipat Halav (baby wellness) clinics are overwhelmingly ignorant about breastfeeding and the larger issues of infant health beyond the numbers on a growth chart. Using weight as the bottom line for infant health is myopic and potentially damaging to parents’ and children’s perceptions of health and nutrition long-term.

    ~ Maya

  18. Thank you, Maya, your comment made my evening.
    In defense of Tipat Halav, their job is to make sure that ill or neglected children don’t fall through the cracks. Once they have raised an issue, though, it’s usually best to consult a doctor you trust.

  19. Thank you for a great post that validates breastfeeding and feeding nutritional solids. Maya’s comment is well-taken–it seems Tipat Chalav (and many of the doctors we encountered in the US) is obsessed with growth charts, even though they’re not based on breastfed children. It’s as though they cling to that to cover up their general lack of knowledge about child development. I’ll stop there for now.

    A friend of mine and I both have very healthy, well-developing babies who prefer nursing over solids. I’m forwarding her a link to this post.

  20. Annie and motherinIsrael – I also know a child who could not keep down solids. She finally refused to swallow anything from a spoon.

    Reflux was finally diagnosed (close to 1 year?) because the brestmilk never bothered her. Significant therapy was required after they started reflux meds to get her to *try* again. Also gained, but slowly. So it may be worth the ped. checking for reflux, just in case.