Fussy Eating and Poor Weight Gain in Children — Real Causes and How to Fix Them

Dr. Sandip Gupta

A podcast episode on fussy eating and weight gain — why children stop eating, what parents get wrong, and how to handle it at home. Why children don't want to eat — three causes: 1. Age-appropriate behaviour (slowing growth). In the first year growth speed is very high — a 2.5 kg baby becomes 8–9 kg, and height goes from about 50 cm to 75 cm. In the first year weight increases 6–7 kg and height 25 cm. In the second year weight increases only 2–3 kg and height 12 cm. After that, weight increases only about 2 kg a year and height 5–6 cm. Because growth slows, the child's appetite is not as high, and they will not feed the way a newborn fed every two hours — they will eat after a gap of three to four hours. It is important to understand that the child will not eat every single time. 2. Force-feeding creates food aversion. Parents often stuff food in forcibly, and the child starts hating food. If you force anyone to do something they don't feel like, they will refuse even what they would have done. The child gets irritated, starts crying at the sight of food, runs away, and creates trouble. When the child doesn't want to eat, leave them for a while — even if they stay hungry, they will feel hungry later and eat. Do not force-feed milk at that point just because the child seems hungry — milk fills the stomach but does not have all the nutrition. Give solid food at solid food time and milk at milk time. Don't think the child will fall ill from staying hungry; they will feel hungry three to four times, and on an empty stomach they will eat. You have to wait a little. 3. Iron deficiency — the most common cause. Iron deficiency is common in Indian children and it reduces appetite. If your child is not eating, check whether the child has iron deficiency — talk to your doctor and get a test. Correcting iron deficiency often brings the appetite back. This is an important factor many people don't know. Also — constipation. If the child is constipated, the intestine is already loaded with fecal matter, so the child doesn't feel hungry. To prevent constipation, give age-appropriate quantities of water, fibre-rich green vegetables, and fruits like kiwi, prunes and papaya, which help the child pass motion. If the child passes motion regularly, they feel hungry and eat. On weight gain and "chubby means healthy": In India most people believe a chubby child is healthy and a thin child is unhealthy — a psychological concept lodged in us for a long time. Even if parents are content, grandparents, friends and relatives keep pointing out that the child doesn't look chubby, so parents become nervous and confused. Weight is not a fixed number — it runs in a range for each age. A 5-year-old anywhere between about 18 and 25 kg is fine. Only when the child goes outside the range do we call it under- or overweight. Force-feeding a child to make them fat has no benefit; obesity causes many problems in children. How do you know if a child is underweight? Through growth charting — weight is plotted by age every six months to a year. If it is far below the range it shows on the graph and the doctor will tell you. Why children are underweight: Usually nutrition has not been given correctly. Every parent tries to feed, but weight gain happens properly only when the right nutrition is given and balance is maintained. Avoid junk food and nutritionally inadequate food — tea with biscuits, milk with biscuits, chips, burgers, pizza. Commercially made outside food is about ten times tastier, and a child is instinctive: they will want whatever tastes better. Adults have self-control and know it isn't healthy; children have no such self-realisation. Give a child biscuits daily and they will not eat roti or rice. Give chips and kurkure and they won't eat halwa. Give Maggi and they won't eat khichdi. Then parents struggle to feed home food, the child eats very little, parents get frustrated, and weight does not increase. What correct diet looks like: The Indian mixed thali concept — rice, dal, sabzi, and something like halwa. A variety of food in one meal so the child gets protein, carbohydrate, fat, and vitamins and minerals; salad or fruit salad adds minerals and vitamins. Eat every kind of food, but home-made food. Do powders added to milk increase weight? No. If you are not feeding roti, rice, dal, sabzi — the major principal foods with carbohydrate, protein and fat — the child's weight will not increase. Adding a powder to milk does not do it; that is only an additional supplement, meant to fill a gap in normal food, not to replace it. Along with this, correcting iron deficiency is a critical point — correct the iron, the child feels hungry, eats, and weight increases automatically. Force-feeding an iron-deficient child who has no appetite simply doesn't work. How to move a child off junk food: Parents have to give up junk food first. When the child was born they did not know these things existed — they see us eating outside food, so they eat it and develop the habit. If you cannot bring self-restraint on yourself, expecting it from the child is unfair. Once a month, or when you go somewhere, is okay; every weekend regularly is not. Make the same food at home. If the child likes Maggi, get atta noodles and make it yourself. If they love french fries, make them at home — you will use healthy cooking oil, the food quality will be better, and you can regulate the quantity. Make home-based alternatives for pizza, burger, cookies and halwa. Adjust to the child's taste preference. If they like spicy, make it spicy; sweet, make it sweet; bland, make bland — upma is bland but healthy, and you can add blended vegetables, cabbage, carrot or potato, which don't add much taste but do give nutrition. If the child likes pasta, make atta pasta with vegetables. If they like biscuits, bake cookies at home. Relevant for: parents whose child refuses food or spits it out; parents whose child's appetite dropped after the first or second year; parents who force-feed or fill the child with milk when solids are refused; parents asking whether iron deficiency causes poor appetite; parents whose constipated child isn't hungry; parents worried their child looks thin or is called underweight by relatives; parents asking what a healthy weight range for an age is; parents whose child eats only Maggi, chips, biscuits or outside food; parents asking whether weight-gain powders in milk work; and parents looking for homemade alternatives to junk food. Disclaimer: This video is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Every child is different — please consult your pediatrician for testing and treatment of suspected iron deficiency, before giving any supplement, and if your child's weight falls below the normal range on the growth chart.