Quick Answer: If your child is not gaining weight as expected, the goal is not simply to give them more food. The first step is to determine whether your child is experiencing faltering weight and why. Once a healthcare provider has identified a need for additional calories, increasing the calorie density of foods, adding appropriate nutritional supplements, and establishing a structured eating routine can help support healthy growth.
There are several ways to increase a child’s calorie intake, but it is important to begin with the bigger picture. A child who is small or who eats less than other children does not necessarily have a growth problem. What matters is the child’s individual growth pattern and whether their weight gain is meeting their nutritional and developmental needs.
What does underweight mean?
Parents often use the word “underweight” to describe a child who appears thin, eats very little, or does not seem to be gaining weight. Clinicians, however, look at a child’s growth over time.
In 2026, the American Academy of Pediatrics (AAP) and North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), published a clinical practice guideline that uses the term faltering weight instead of “failure to thrive.”
Faltering weight means that a child’s weight gain does not meet expected growth standards. It can sometimes be associated with undernutrition or malnutrition. Importantly, these conditions do not develop into severe malnutrition overnight. Early recognition and appropriate nutrition intervention can help children get back on a healthy growth trajectory.
What are the signs of faltering weight?
Possible signs that warrant a conversation with your child’s healthcare provider include:
- Weight loss or slow weight gain.
- Little or no increase in height or length over time.
- Persistent decreases in food or fluid intake.
- Difficulty eating because of gastrointestinal symptoms or other medical concerns.
- Feeding difficulties or significant food refusal.
- Decreased activity or less interest in play.
How can I help my child gain weight?
One of the simplest ways to increase calories is to choose foods that provide more calories in a relatively small amount of food. This can be especially helpful for young children who have smaller stomachs. If your child’s healthcare provider determines that additional calories are appropriate, there are several strategies that may help:
1. Offer higher-calorie foods without giving them to the whole family
The goal is not to replace a balanced diet with foods that only add calories, but to improve the calories that are being provided:
- Add extra oil or butter to one serving of pasta.
- Add nut or seed butter on your child’s bread.
- Serve whole milk with your child’s meals.
- Add extra cream and maple syrup on their oatmeal.
2. Choose high-calorie foods when your child eats small portions
If your child can only eat a small amount at a time, the calorie density of the food matters. For example, consider three possible dips for apple slices or raw vegetables:
- Hummus: approximately 25 calories per tablespoon.
- Cream cheese: approximately 50 calories per tablespoon.
- Peanut butter: approximately 100 calories per tablespoon.
When volume is limited, choosing a more calorie-dense food can provide more energy without requiring your child to eat a larger portion. See the chart at the bottom of this blog post for suggestions or download it here.
HELPFUL TIP: Purchase small packages and individual servings. This will help you avoid food waste while you’re experimenting with different types of foods.
3. Follow a structured meal and snack schedule
It may seem logical to let an underweight child eat whenever they want. However, constant grazing can sometimes make it harder for a child to eat enough at meals.
The “Division of Responsibility” approach to feeding gives parents responsibility for deciding:
- What food is offered.
- When food is offered.
- Where food is offered.
The child’s responsibility is to decide whether to eat and how much to eat from what is offered. A typical structure for young children may include three meals and two to three snacks each day, depending on the child’s age and individual needs. Avoiding frequent snacking immediately before meals can also help a child arrive at meals with an appetite. In general, a child should have enough time between eating to become hungry again.
4. Consider nutritional supplements when recommended
Some children with faltering weight benefit from an oral nutritional supplement in addition to food. Examples include:
- PediaSure®.
- Boost® Kid Essentials™.
- Kate Farms® Pediatric Beverages.
- Orgain® Kids.
- Carnation Breakfast Essentials® (This is for adults but can be used in kids if discussed with health care provider).
In my practice, I may recommend using a nutritional supplement as one tool for increasing calorie intake while we work on improving nutrition from food. These products provide approximately 200 calories or more per 8-ounce serving, although the exact amount varies by product and formulation. Too much supplemental nutrition can sometimes decrease a child’s appetite for meals, so the appropriate amount and timing should be individualized.
Important to know: Some nutritional supplements may be covered through programs such as WIC or, in certain circumstances, insurance.
5. Infants need a different approach
For infants younger than 12 months corrected age who are experiencing faltering weight, increasing calories should be done with guidance from the child’s healthcare provider and, when appropriate, a pediatric dietitian, lactation consultant or speech therapist. There are ways to increase calories in:
- A baby who drinks human milk.
- A baby who drinks formula.
- Babies six months or older who are ready to eat solid foods.
Parents should not add or increase calories of human milk or formula without working with a healthcare provider or registered dietitian.
THE BOTTOM LINE
If you are concerned about your child’s weight or growth, talk with your pediatrician. They can review their growth history and determine whether additional evaluation or nutrition support is needed. If it is recommended that your child needs to eat more calories, consider a referral to a registered dietitian.
