Why are children so thin

My child is (too) thin - motivating soup kitties to eat

Children don't always eat the same amount

Children, even of the same age, do not always eat the same amount. In addition, the individual consumption often changes from day to day. Striking descriptions of eating habits range from “eats like a barn thresher” to “soup fool”. Such eating behavior can therefore be completely normal and (alone) does not have to be a cause for concern.

Nevertheless, many children have the “wrong” body weight, based on age and, above all, their height - too high or too low. You have to keep an eye on that, of course. The assessment of whether a child is overweight or underweight, eats “good” or “bad” should not, however, be made as a “snapshot”, as children go through different phases in the course of their development. The proportions of the body change significantly from baby to adolescent. Sometimes the growth in length dominates, sometimes the growth in width, and then again the intellectual development is in the foreground. It is therefore important to always look at the “individual child” in connection with its development over a longer period of time and to document the progression of weight and height.

For example, we have the first growth phase from birth to the end of the 2nd year of life, which is followed by the first extension between around the 4th and 7th year of life. Here the increase in length is stronger than the increase in weight; the appearance of the children appears thinner and leaner (baby fat disappears). We can also record a growth spurt around the age of 10, in which the increase in weight is less than the increase in height. As a result,

  • previously normal-weight children appear (er) skinny and
  • Children who were previously overweight become slimmer (use therapeutically!).

Body weight and development

However, if a child stands out because they are significantly thicker or thinner than their peers for a long time, the pediatrician (and possibly a psychologist) must first clarify possible causes, such as an illness that requires treatment. Adapted to this, one can then try to normalize the weight by changing one's diet and exercise behavior, ie in the longer term to “shift” it to an order of magnitude that is adapted to age and development. But that means neither strict starvation nor fattening.

The “normal” weight

Before we talk about overweight or underweight in children, we must first clarify which weight is actually “normal”. Because of the different growth phases, it is not as easy to specify a normal weight for children as it is for adults. Various options are available to facilitate the assessment.

First of all, there is the (though rather superficial) appearance, preferably unclothed or in bathing suits: If the child is significantly leaner than comparable children and the bones are clearly protruding, it is essential to observe the further development. If there is also loss of appetite, listlessness, poor performance, excessive susceptibility to illness and constant fatigue, the pediatrician must be consulted (now at the latest).

However, it is much better (the doctor) to determine the respective developmental state with the help of formulas (Body Mass Index - BMI), tables and graphs (somatograms). They give specific clues as to whether the child's weight is within the normal range. Narrow, petite children should be in the lower range, strong built, stable children can be on the upper limit.

Somatograms - growth and weight curves

In addition to complicated formulas, so-called growth and weight curves (somatograms) provide information about the developmental status of the child, which the pediatrician should keep track of, if possible, from birth over the following developmental years. With a certain tolerance range, you can see from them which weight range is acceptable depending on body length and age. If the individual values ​​of a child deviate significantly up or down from this pattern over a longer period of time, they are overweight or underweight and require treatment.

To assess the actual situation, this long-term observation is more useful (weight / height development) than a “snapshot” (visual appearance), which can be falsified by growth phases.

Example: Schematic representation of a somatogram

Tables

Tables that are available to the pediatrician offer another way of orientation. The “target” weight can be read from the corresponding body size. Age and gender have little influence until puberty. The tolerable fluctuation range upwards or downwards (+/-) can also be read off. If the child falls clearly “out of this framework”, therapeutic measures are inevitable.

Height and weight over the course of childhood
according to data from the Research Institute for Child Nutrition, Dortmund (1980)

girl

Age in years
(completed year of life)

Boys

Height in cm

Body weight in kg

Height in cm

Body weight in kg

75 +/- 6

9,3 +/- 1,6

1

77 +/- 6

10,3 +/- 2,0

87 +/- 7

12,2 +/- 2,0

 2

89 +/- 6

12,8 +/- 2,0

96 +/- 9

14,5 +/- 2,0

 3

97 +/- 7

14,9 +/- 2,5

103 +/- 9

16,6 +/- 3,0

 4

104 +/- 8

16,8 +/- 2,5

111 +/- 9

19,0 +/- 3,0

 5

111 +/- 8

19,1 +/- 3,0

117 +/- 9

21,0 +/- 5,0/4,5

6

117 +/- 9

21,2 +/- 4,0

122 +/- 9

23,3 +/- 6,0/5,5

7

124 +/- 10

24,0 +/- 4,5

129 +/- 9

26,8 +/- 6,5/5,5

8

130 +/- 10

26,9 +/- 6,0/5,5

135 +/- 10

29,8 +/- 8,5/6,0

9

135 +/- 11

29,6 +/- 8,0/6,5

142 +/- 11

34,5 +/- 9,0/7,5

10

141 +/- 12

33,5 +/- 9,0/7,0

148 +/- 12

38,8 +/- 10,5/7,5

 11

147 +/- 13

37,1 +/- 9,0/7,5

154 +/- 14

43,7 +/- 11,0/10,0

12

156 +/- 14

45,1 +/- 11,0/10,5

 158 +/- 13

46,3 +/- 13,0/12,0

13

161 +/- 16

50,5 +/- 12,0/11,0

165 +/- 11

54,3 +/- 12,0/10,0

14

176 +/- 14

59,3 +/- 11,0/10,0


Underweight - a problem?

Moderately underweight does not pose any particular health risks, though

  • it occurs shortly after growth spurts,
  • the child eats a variety of foods and is healthy and happy at the same time.

Nevertheless: observe the further development critically! And be careful if you lose the joy of eating!

A possible serious problem is pathological anorexia nervosa, predominantly in young girls or women. Refusal to eat - sometimes coupled with binge eating and subsequent vomiting (bulimia nervosa) - is systematically pursued to maintain a slim or super-slim appearance. Significant weight loss or significant underweight in this group should therefore be a warning sign that an early consultation with the doctor is necessary in any case (see chapter “When eating becomes a problem”).

What can you do? Practical nutrition tips for those with (too) low body weight

In order to achieve (moderate) weight gain in children, one must skillfully increase the energy density of the accepted amount of food, preferably through (hidden) fortifications with high-energy ingredients. In most cases, little can be achieved by increasing the amount of food in absolute terms, because the children simply do not want or cannot eat “more”. Large portions put them off. Exercise and play in the group, on the other hand, stimulate the appetite, which can be satisfied with lots of energy-rich snacks.

Nutritional tips for underweight (supplementary diet)

aim: Energetic enrichment of the food:

  • high-calorie fruits such as bananas, grapes, cherries instead of berries or melon
  • Cream yogurt instead of skimmed yogurt
  • Enrichment of dishes with vegetable oils / cream (sauces, soups)
  • Egg as an alloy in soups
  • Cheese for gratinating
  • Double cream cheese (sweet and savory)
  • Cream ice cream instead of fruit ice cream
  • Dried fruits, nuts - in between for nibbling and in muesli
  • Make drinks high in calories (cocoa, pure fruit juices)
  • Nut nougat cream, peanut cream as a spread
  • for snacking: muesli bars, fruit slices
  • many small meals instead of a few large ones
  • Variety increases appetite
  • Don't forget the decoration: eat with your eyes!

But: Do not “fatten” children, otherwise there is a risk of a reversal to obesity!

The soup kasper - motivating problem eaters

Some children can drive their parents to despair by their constant “I don't like this”. All attempts to bring a healthy diet to the table fail with these little refusers. In order to avoid the war at the table, but still ensure a full-fledged diet, one can use a few tricks with the help of which the actually rejected food can then (without compulsion) get into the child's stomach. Here is a selection in keywords:

Tips against listless poking around in food:

  • the environment has to be right (atmosphere, society)
  • exemplary behavior by parents / carers
  • Affection
  • regulated table times
  • no snacking between meals
  • appropriate portion sizes
  • do not force them to eat if the child does not like something
  • Assign fantasy names (Popeye spinach, princess quark)
  • Participation in the menu
  • Offer your favorite dishes more often
  • Dessert: pieces of fruit, quark dishes
  • Create a varied menu
  • Involve the children in the preparation of the meal (place pizza themselves, etc.)
  • Serve food in a visually appealing way (you eat with your eyes)
  • Table decoration
  • Use the instinct to play (finger food), make eating an experience

Note:

  • Children don't always eat the same amount
  • Phases of large and small appetites alternate
  • Fluctuations in the daily amount are normal and sometimes considerable

Yet: Make sure to have a doctor clarify possible disease-related causes for prolonged loss of appetite!

Tips: How to help those who are grumpy about breakfast
Possible reasons for refusing breakfast are:

  • getting up too late
  • Family situation (parents don't have breakfast either)
  • Schoolstress
  • Family conflicts

What to do?

  • wake up earlier so that the appetite can also awaken
  • Offer at least one warm drink
  • "Stock up" on lunch
  • optimal: family breakfast together
  • Discuss problems in peace

Trick "refusers":

Some children reject certain foods or dishes for reasons that are inexplicable in some cases. Often this is only a limited phase and not a matter of concern. Unfortunately, the "healthy" foods that the child actually needed for healthy development are often rejected. With a few tricks, however, they can still be incorporated into the nutrition plan.

Fruit:

  • Fruit salads
  • Fruit bites in between
  • Mixed milk drinks with strained fruits
  • Fruit muesli (possibly dried fruit)
  • Freshly squeezed juices
  • Compote (if necessary)
  • small fruits instead of too large or bite-sized pieces (especially with small children)

Vegetables:

  • Carrots, peas, and sweetcorn are more popular than cabbage, leeks, and legumes
  • Preferences change frequently, which is why you should always vary your selection and preparation
  • Spinach can, but does not have to be eaten (incentive: Popeye role model)
  • "Hide" vegetables in pasta sauces, casseroles, mashed soups, mashed potatoes
  • Raw vegetables are often nibbled on their own rather than eaten in a salad (finger food)

Dairy products):

  • Drinking milk as cocoa or fruit shake,
  • Pudding and mashed potatoes
  • Use cheese in cooking
  • Quark dishes with fruits

Meat fish:

  • Minced meat is often more popular than whole pieces of meat
  • Poultry (finger food) to nibble on
  • Fish only as a fillet without bones

Important is exemplary behavior: the family members / carers should set a good example!

Conclusion

Often you can get problem eaters to eat the actually unpopular food with simple tricks, for example by “hiding” them under the actual dish by chopping / passing them through. Or you enrich the food secretly (with cheese, cream, milk). Interesting “packaging” (omelette, green mashed potatoes with mashed peas, face-up pizza), an appetizing and child-friendly presentation or an interesting story about the dish (e.g. Popeye's preference for spinach) often help the kids to enjoy a healthy diet close. Forcing the children to eat is not a solution, however!

Further contributions by the author can be found here in our family handbook

Author

Dr.oec.troph. Eva-Maria Schröder (M.P.H. postgrad.) Is a nutrition and health scientist, freelance journalist and head of the nutrition advisory service in Tutzing.

Contact

Dr. oec.troph. Eva-Maria Schröder
Nutritional advice service
Unteranger 1
D-82327 Tutzing

Tel: 08158/993263

Created on June 23, 2003, last changed on March 30, 2010