Doctors’ Notes


Healthy High-Carlorie Foods

With all of the sobering statistics about childhood obesity, it’s hard to imagine that there are still a few children who struggle with the opposite problem – being underweight. But some children have medical problems that prevent them from digesting food or using the calories that they take in, while others simply prefer very low-calorie foods or have very small appetites. Either way, parents often struggle with getting these children to eat enough to grow.

We don’t want these kids just eating junk foods, of course, so — what to do?

First off, talk with the provider who knows your child best, to make sure you are offering foods that your child’s body can use, and that will not make any medical conditions worse. Ask if your child needs detailed calorie and nutrient counts, specific vitamins, or supplements to work around any known digestive problems or special medical needs. A dietitian may be helpful here, to make sure your child’s diet is meeting all of her macro- and micro-nutrient needs.

Once you know that your child has no underlying medical issues affecting his weight, then it becomes a task of creatively getting him to eat more healthy calories, while avoiding battles about food. That can be quite a task!


For all children, regular family mealtimes, where the adults in the family model healthy eating habits, can be a very powerful tool. Provide healthy food options that come from all food groups, along with a happy, relaxed environment. Don’t fuss over the child’s eating. But don’t make separate meals for picky eaters, either – if kids learn they can hold out for chicken nuggets or cookies, that’s what they’ll do.

Once they learn that a separate meal is not coming, they’ll start being more interested in trying the healthy foods that are offered. For the child in the family who needs extra calories, though, you can add more calories (more on this below before the food comes to the table, so that what she does eat packs more of a punch.


Kids also really benefit from regular, healthy snacks – 2 or 3 each day, for kids who have small appetites and need to gain weight. Look for foods that have protein, healthyfats, and complex carbohydrates. Nut products are great snack foods, as long as you’re watching choking hazards for younger children (and obviously avoiding them if your child has allergies to nuts). Adding peanut butter or other nut/seed butters to fruit, crackers, bread, ice cream, etc can be a great way to add extra calories. Cheese, yogurt, eggs, butter, and ice cream can also add calories, as well as calcium. An apple is always a great snack, but add some peanut butter or cheese to go with it!

Kids love dipping foods, so dip fruit in whole-fat yogurt, or veggies in hummus, guacamole, or ranch dressing. Butter, olive oil, cheese, and eggs can often be added to cooked foods before the kids see them, sneaking in more calories to preferred foods. Milk shakes or smoothies at night before bed can pile on whole milk (or Pediasure, a commercially available nutrient shake), plus ice cream, fruit, peanut butter, etc to top off the day’s caloric needs without worrying about “spoiling” a meal in a few hours. These, of course, have the added bonus of being a fun treat.


For younger children, presenting foods in a fun way can entice them to eat. Make smiley faces out of foods on their plate, cut cheese into fun shapes with cookie cutters, or create a car out of a whole grain roll, with cucumber wheels, tomato headlights, broccoli people, and hummus or guacamole in the hollowed-out center of the roll. Get creative and have fun!


Older children will often enjoy getting to choose their foods. Take your child grocery shopping, and look for healthy foods that he finds interesting. Trail mixes, protein bars, and other “high performance” foods for athletes often have a “cool factor” that can be attractive to school-aged children. Cheese sticks, whole milk yogurt, whole grain crackers, lean lunch meats, hard boiled eggs, peanut butter or nuts (when allowed at school), and protein bars all make great school lunch items, for those kids who don’t eat much, but need their small intake to pack a bigger punch. Allow older children to help plan meals, pack lunches, and help cook — they’re more likely to eat what they have had a hand in planning. There are many cookbooks for children and teens; get some from the library, and allow your child to help plan some family meals.

It’s easy to say, but hard to do — don’t fight with your under-eater about food. That’s a control battle you can’t win. Instead of fighting, use these tricks to add healthy calories and make them think that eating is their idea, and you’ll make progress. Be sure to keep up with the provider who sees your child, to make sure that her growth is progressing, and that you’re not – gasp! – over-shooting that intake goal!

Dr. Sarah Springer, a shareholder in the practice, is the Medical Director of Adoption Health Services of Western Pennsylvania.