Inadequate Weight Gain in Children

Inadequate weight gain is a very critical issue that worries most parents, so that they go for multivitamins or appetite stimulants as a solution. But is it the best option, or does it have harmful effects?

To answer these questions and more, I interviewed Dr. Evelyne Khoraity to discuss the causes of inadequate weight gain in children, its solutions and other lingering questions.

For my full interview with Dr. Evelyne Khoraity, click on this Link.

Mirna Sabbagh Adult and Child Nutritionist: Inadequate Weight Gain in children

Question Number One: What is a normal weight and growth rate for children?

This is a very important question since weight is a major indicator of the child’s health.

The best way to know if a child is growing normally is to look at growth charts. There is a chart known as the Growth Chart, which indicates the child’s growth based on their age and weight compared to global percentages. If your baby falls between 3-5% and 95-97% it means your child is normal and in the healthy range.

You can enter your Childs details on the following link.

This doesn’t end here, a child’s growth is monitored by their last growth rate history - the overall trend- to compare whether the curve is growing at the same rate “following the curve” or if it’s fluctuating. If the growth percentages are decreasing by time, then this is where our problem lies.

Question Number Two: Let’s focus on babies aged 0-3 months, what is the reason for their irregular growth rate?

The reasons for that are endless! So I would like to classify them into 3 main causes:

  1. The child is not receiving enough nutrition: he/she’s not eating enough. This is one of the most frequent causes that is luckily easy to solve!
  2. The child is somehow losing his/her calorie intake. That is caused by excessive throwing up, Reflux, or diarrhea, and other digestive problems.
  3. The child needs more calorie intake compared to children his/her age, which is characterized by a high metabolism. It may be caused by heart problems, glands, diabetes, and many others. To identify this issue, a parent is advised to make a feeding log for their child for about a week to make sure a problem exists. If confirmed, history and physical exams are made to detect the origin of the problem, then the child is referred to a specified expert for medical tests. 

Note: If you want to know if breastfeeding is effective on your child’s growth, weight is the ultimate indicator. If an irregular growth rate is detected, it may be due to low amounts of milk produced, or mechanical problems with the baby while breastfeeding (inability to grab or suck, tiredness…). A knowledgable doctor will be able to tell you where the issue is and you probably have to visit a lactation consultant who can improve your latch and help you with your milk supply.

It is very important to know that the first three months in a baby’s life are the hardest and he/she may cry out for many natural reasons. It is not always being hungry. You don’t always have to worry!

Question Number Three: What about older kids?

Many parents worry and claim that their child is not gaining enough weight during these ages. What are the procedures and indicators then?

The answer is: Whether it is age Zero or 21, weight and height are the best basis, along with a child’s nutrition.

However, at the age of 1+, a child is too busy discovering their surroundings rather than eating. Hence, they might be too “busy” to eat, bored, or picky eaters. 

Besides, parents usually compare their children to others their age, which is mostly wrong. Make sure that every child is different in their habits and growth, so it’s fine as long as it’s healthy. 

Note that a growth rate normally decreases by time so that it is:

  • Ages 0-3 months: between 20-30 g weight gain per day
  • Ages 3-6 months: an average of 20 g per day
  • Ages 6- 12 months: an average of 10 g per day
  • Lower rates after 1 year until it reaches 2 kg per year at age of 2+

Also, a growth rate might fluctuate as the child grows, starts going to school and getting sick. That’s totally normal!

Always seek a Pediatrician for accurate results and don’t just depend on your own or your surroundings’ judgments.


Question Number Four: Are there actually efficient appetite stimulants for children?

There are effective weight gain supplements for children, but they should NOT be given unless their situation requires that. Serious health issues like cystic fibrosis and other weight problems that can’t be solved by food alone are examples where supplements should be given. Other children (which are the most frequent) like picky eaters do not require stimulants or formulas. A healthy long-term solution should be found and applied based on each child’s unique situation. 

Try substituting supplements with healthy food like peanut butter, avocados, or and other healthy meals that are rich in calories and don’t cause future eating disorders or obesity.

Note that genetics have a major role in your child’s weight, so don’t try to stuff your child!

Also, do not give medicine, stimulants, or vitamins unless prescribed!

Question Number Five: What about children who are underweight, and with no appetite?

Are there special reasons for that?

The answer is: As long as they’re following a normal curve with their weight gain, it’s normal.

However, if the curve is heading downwards, then there’s a problem. This could be a result of many reasons that include:

  • Food aversion: this means that a child doesn’t like specific types or textures of food which is more frequent with premature children. 
  • The parents took a long time to start feeding their child solid food (more than 1 year of age). Therefore, the child will find a hard time adapting to eating solid food.
  • Mechanical problems: a swallowing problem. In this case, a child is referenced to a feeding specialist for extra detection and help.
  • Behavioral Problems: Autism or sensory disorders.
  • Environmental Habits: wrong eating methods, or the absence of proper hygiene.
  • Reflux, allergies, or intolerances on specific food types. 

Each underlying reason should be excluded by your doctor and you should be given a solution or referral if any of the above options exist.

Question Number Six: Is it important to screen picky eaters for specific vitamin or mineral deficiencies, like iron, B12 or zinc deficiencies?

A blood test is usually not preferable for children. However, if a child clinically appears to be underweight, a picky eater and has an unhealthy diet, then they might require tests to scan vitamin deficiencies. 

Question Number Seven: Do you usually recommend multivitamins or specific vitamins for children, especially with underweight cases?

Some vitamins are needed for babies, like Vitamin D during breastfeeding, or Iron for ages 4-6 months, or for those who are receiving a low amount of formula. 

However, for children aged 1 year and more, nutrition is the best source of vitamins! If they have a problem receiving adequate amounts of vitamins and minerals through their food, a blood test is made to specify the needed vitamin rather than giving them multivitamins. Afterward, if the future child’s blood test shows no deficiencies but they are not eating well, then multivitamins are given.

 Note that a multivitamin is not a substitute for a healthy diet!


Mirna Sabbagh Adult and Child Nutritionist: Inadequate Weight Gain in Children


Keep in mind that every child is different and might have different growth rates, appetite, and eating habits!

We hope this information was helpful!

To view my full interview with Dr. Evelyne Khoraity about inadequate weight gain in children, click on this Link.


Mirna Sabbagh, an adult and child dietitian, nutritionist, and lactation consultant. She also has several digital courses: Pregnancy Nutrition Course, breastfeeding course,  starting solids 6-12 months courseand also child nutrition for all children including picky eaters, that you can sign up for from the comfort of your home.

The courses are pre-recorded. As soon as you make the course purchase, you will receive a link to watch the course from your phone or laptop.

You can also e-mail Mirna for questions on

Mirna is no longer doing consultations. Her online courses and webinars cover 95% of parents common concerns.