I have covered poor growth for underweight young children in my first two blog post. This post is aimed at families who has older children, around five years old and above who are struggling to gain enough weight.
It is not common for a child who has previously been growing well to become underweight when they are well established on solid foods. Here I am referring to healthy, normal developing children, who may have some likes and dislikes around food, but are not incredibly fussy eater.
As mentioned in my previous post, it is essential to exclude any medical conditions that could lead to sudden poor growth, such as malabsorption, food allergies like coeliac disease, or in extremely rare cases, cancer.
Working with Families of Older Children
Older children can provide some insight into what they eat, food preferences, and sometimes they are able to articulate why they are not eating well. Some of the common reasons why older children may eat less includes:
- Low self-esteem due to comments from families or friends about their eating, weight or appearance. Even seemingly innocent comments like “You look a little chubbier around the belly compared to the last time I saw you” can lower a child’s confidence and self-esteem.
- Increased stress at school such as being bullied, or struggling to fit in with peers.
- Changes in the home environment such as having a new sibling, parental separation or divorce.
- Peer pressure such as friends not eating their lunch at school.
- Being too busy playing and prioritising playtime over eating during breaks times and recess
- Social media influence, especially from influencers raving about a new diets.
- Wanting to try a new diets, such as vegetarianism, veganism, or new fad diet such as keto diet, paleo diet or intermittent fasting diet
- Spending their food or lunch money on other things such as going to the movies or buying new gadgets.
What to Do When Your Older Child Is Not Growing
After getting the all clear from doctors and paediatricians to exclude any underlying medical reasons for poor growth, it is time to assess what your child is eating. For younger children, this might be easier to track as parents often prepare their meals and lunchboxes. However for preteens and teenagers, assessing their food intake can be more challenging especially if they are eating outside of home or if you are not present to observe their food intake.
Sitting down and having an open and clear communication about their eating habits is a good first step. You can include conversations around concerns about their food intake and your plans to help them. Here are some strategies to help support your child:
- Involving your child more in meal preparation.
- Making time to eat meals and snacks together as a family whenever possible.
- Speaking with teachers to understand what is happening at recess or break times
- Addressing any identified stressors that may be affecting their appetite.
- Explaining the importance of nutrition (although, in my experience, children are often more receptive to health professionals than their parents!).
- Identify any disorder eating behaviours
What is disorder eating behaviours?
Disorder eating behaviours are behaviours that may indicate the early stages of an eating disorder. While a child may not have a diagnosed eating disorder, recognising and taking steps to address these behaviours early before it escalates can help prevent developing an eating disorder which is more severe. Disorder eating behaviours can vary from restrictive eating to compulsive eating.
Some common behaviours that you might see (or suspect) include:
- Experimenting with different diets.
- Restricting food with various excuses such as wanting to be ‘healthier’.
- Avoiding social situations that involve food.
- Showing an increased interest in preparing meals for others but not eating themselves.
- Using the toilets right after meals
- Large quantities of food disappearing overnight (e.g., entire packets of biscuits or chips, tubs of ice cream, loaves of bread, or cereal), which may indicate binge eating. Since most binge eating occurs in secret, children will try to hide this behaviour.
- Excessive exercise, including secretly working out in their rooms late at night or early in the morning.
If you suspect your child has an emerging disorder eating habits, the Raising Children Network has some good resources and the National Eating Disorders Collaboration can provide valuable guidance.
What to do if you suspect your child has disorder eating behaviours?
Getting professional help is key, as the longer disordered eating behaviours are left unaddressed, the more likely a child may develop an eating disorder. Your GP should be the first point of contact and will refer you and your child to see a paediatric psychologist who has experience in eating disorders. Eating disorders are a mental health issue needs to be taken seriously rather than assumed to be a phase that will pass with time.
It is also important to model healthy attitudes towards food and body image as a parent. Avoid making negative comments about your own appearance, such as, “I look fat in this outfit,” as this can negatively influence your child’s body image. Similarly, skipping meals due to being too busy can send the message that skipping meals is acceptable.
Take the time to sit down and go through social media together while discussing unrealistic standards of beauty on social media. Help your child develop a positive body image by focusing on their skills, personality, and other qualities. Celebrate and accept that everyone will have different body shapes and sizes.
A paediatric dietitian can provide guidance on nutrition-related concerns, but ongoing psychological support is necessary to address underlying mental health issues.
By taking proactive steps and providing a supportive and loving environment, parents and caregivers can help children develop a healthy relationship with food ultimately supporting healthy growth and development.
This concludes my three part series on ‘the underweight child / poor growth’. Underweight children require more attention and care around their nutrition intake and growth, and as you can see, different life stages require very different approaches with different interventions. If you are unsure about how to manage your underweight child, speak to a paediatrician to get a referral to a paediatric dietitian.
