How to get more calories into my ADHD son

[TheTreesTheTrees]

My son, 11, is borderline underweight. He's usually around the 3rd (healthy) centile, but can drop to 1st (underweight) before a meal.

He's been like this pretty much his whole life so this isn't new. His dad is very slim and I'm pretty slim as an adult. As a child I was similar to him. I had a tiny appetite and just got full really quickly. My mum told me, much later, that people asked her if I was anorexic. I absolutely wasn't. I've always eaten whatever I wanted but I just get full quickly. At uni drinking beer and eating crap got me to a size 12 but since then I've been an 8-10 most of my adult life.

My son just seems to have a small appetite. I think it's compounded by having ADHD so it's hard to keep him at the table and focused on food. He says he's full when sometimes I think he's just bored and doesn't want to be eating any more. If I left him with a plate of food in front of the TV there's a good chance he'd graze his way through it without noticing.

I weighed him today and he's on the 1st centile (NHS calculator). It says to speak to the GP. I really don't want to make his weight a big deal when my gut is telling me he's fine. He's fit and healthy and has abs like steel. But his bones are pretty visible.

It's already a bit of an issue in a way that it wasn't for me as a child as he goes on about not being hungry like it's part of his identity and my husband does try and tell him he needs to eat. Kids at school have started to say things like "don't you know it's bulking season", although he doesn't seem bothered by this.

Any suggestions for getting him to eat more? Or is it no big deal and he'll develop his appetite when he goes through puberty (feels like some time away!)

He doesn't have a sweet tooth and given the choice would snack on things like cheese, fruit and carrot sticks. Sometimes in the morning I make him huel shakes with extra fruit.

My friend took her son to the GP in a similar scenario who recommended milkshakes such as Nesquick. She managed to get him in a habit of drinking chocolate milkshakes. But it depends what the rest of his nutritional intake is like - does he just need more calories or is he not getting enough protein/fibre/veg etc?

Is he taking medication?

If he needs to eat more and you know he’ll eat more of he’s watching TV…I’d genuinely just give it to screen time. Even if for one meal per day. You could select a family-friendly film or something ‘educational’ (horrible histories etc - my son is a huge fan!)

I know everyone is SO anti screens when eating but personally I’ve found it a saviour for getting very active boys to sit and eat!

And before people then say how awful this is… both my children can eat without screens when we are at restaurants (we have worked hard at this!) But at home for a main meal, screen time really does help them sit for longer and eat. Both a healthy weight.

I grew up watching Byker Grove or Grange Hill with every dinner and I’m a healthy size 10 at 40years old (and I still love eating dinner whilst I watch a series with my husband!)

Is he on medication for his ADHD? I would go for food as nutritionally dense as possible. Avocado's, bananas, cheese, full fat dairy, smoothies with yogurt base,fruit as the extra on the side of the meal, not part of it. Butter and milk in mash potato. There are lots of options.

My daughter's consultant is less interested in the centile itself, more that she stays on it, weight keeps increasing, and height keeps increasing. Dietitian recommended increasing calories per mouthful. E.g adding cheese into sauces, custard with puddings, extra olive oil in recipes. But it's really hard not to worry. I would definitely recommend a trip to the GP in the first instance as you probably need some bloods to rule out Crohn's disease, thyroid issues and coeliac. It probably isn't any of those things, but best to check. Is he on ADHD meds? I believe they can suppress appetite..

I agree with above poster re using the screens to your advantage. Also have an adhd child with the same issue, also medicated so never seems hungry.

Go for energy dense foods that you don’t need loads of to get a good chunk of calories -
full fat milk,
butter on crumpets / toast
peanut butter
cake
chocolate
full fat yoghurts with honey
pork pie / scotch egg

I’d try to go for calorific foods that aren’t going to make him feel too full

Smoothie made out of banana , bit of peanut butter and milk?

Oh, and letting them graze whole platefuls in front of the TV can be a good thing if underweight. My daughter hates sitting at the table with people watching her eat, so we do that to take that pressure away.

He's not medicated partly as we're hoping he's OK without medication but also in part because I know it suppresses appetite and we can't be having that!

It depends on what he likes I guess but I would focus on the high calorie foods he might like (maybe avocado, coconut milk, nuts, red meat) and make incorporate them when you can.

Thanks for the suggestions. All food in our house is full fat. He's slightly lactose intolerant so doesn't drink milk. He loves cheese and yogurt though. Likes toast with butter. He won't eat cake, other sweet things or peanut butter.

If he's given free range to snack it's likely to be fruit and veg, which most people would think was great but I think isn't calorific enough.

I think maybe TV snacks is a good idea, although his screen time is usually gaming with friends so his hands are occupied with that.

Add sources of unsaturated fats to everything. Extra virgin olive all stirred into pasta, add a big plug to the sauce, bolegnaise, whatever too. Make tahini rich hummus to go with the carrots. Add nut butters and/or tahini to smoothies. Would he snack on nuts in front of the tv?

And yes, ADHD meds are known appetite suppressants so one to watch if he's on them. I lost a stone without trying in under three months on mine; and I was a size 10 to begin with.

He does really like nuts, that's a good shout. I gave him carrots with hummus as a snack yesterday and he left the hummus.

I do have in mind that if we don't get enough nutrition into him it might stunt his growth. I have an identical twin and I was vegetarian from 13-20 and am now a good inch shorter than her.

I agree - the fruit and veggies aren’t calorific enough so I would suggest trying to reduce him filling up on those and make the calorific foods more available - maybe crisps to dip in hummus or mayo or Philly ?? Instead of carrot sticks ?

DD2 had to gain weight - 2 stone iirc. She could not increase the volume of what she ate. The advice from the NHS dietitian was:

1. Forget healthy eating - full fat milk, yogurts, etc. I think she could have Jersey milk.
2. Use milk instead of stock in things like stew
3. An extra teaspoon of oil or grated cheese on her meals
4. 4 meals a day - she was prescribed high calorie shakes for the 4th meal at bedtime
5. a mid morning snack of say full fat yoghurt, cheese, etc
6. a mid afternoon snack of cake or biscuits
7. at Xmas, sit around eating sweets and chocolate; not going out for a walk
8. at school, have a big cookie after lunch, not fruit

I found these individual chocolate sponges with fondant inside at Waitrose - 550 calories each! What a find!

(She was diagnosed with ADHD some years later - could never sit still!)

Good suggestions here, thanks everyone. I think there's something here about my behavior - in that I should just keep putting food in front of him regularly rather than focusing it all on meal time when he says he's full quickly.

He's watching TV I've just given him a yogurt and 2 cheese crackers which disappeared quickly. On other occasions I may not have offered anything else before bed.

Great !!
yes, undereaters do feel full easily and then don’t want to keep eating, eating smaller portions of energy dense foods often is usually a better way to go than trying to accommodate all the calories in 3 meals - when someone is needing to gain weight

Can anyone suggest an energy dense snack I can send him to school with? Ideally not sweet.

Savoury flapjacks, or cheese scones.

Full fat milk before bed would be good. I’d probably spread the food out over 4 meals is a calorie dense drink… you can get lactose free milk. Or barista oat milk would work.

high cal savoury foods would be sausage rolls / scotch eggs / full fat cheese / full fat yogurt pouch / cheese scones

Nuts
Homemade trail mix
Nomadic yogurt tubs
Yogurt pouch and a banana
Cheese & oat cakes

DD had to gain a few stone after being unwell and it was little and often. If in doubt add cream to curries, pasta sauces etc. Nuts in Asian style dishes. Oil and butter when cooking .

How much is he actually eating? I would take him to the GP, it’s quite easy for a skinny teen to slip into anorexia which is triggered by weight loss.

Id want his observations checked as well as bloods and an ecg.

You need to aim for 3 meals and 3 snacks a day and make everything as calorie dense as possible. You can add butter and double cream to pretty much everything.

When my DD was borderline eating disorder we had a 3 meals and 3 snacks regime which both tackled her aversion to eating and got calories into her. I think when they don’t eat they do feel full quickly so little and often is better. We did something like porridge or a smoothie for breakfast - with double cream, oats and peanut butter in the smoothie, butter in everything, higher calorie main meals eg lasagne, steak pie etc. snacks were veggies with Philadelphia for dipping, flavoured rice cakes with calorie laden dips, hot chocolate with cream, fruit with chocolate sauce for dipping, ice cream with fruit compote (home made so an eye to sugar levels). Crumpets are great for hiding a tonne of butter, I also made flapjacks, carrot cake, rice pudding, sausage rolls, pastry pizza pin wheels fruit breads. It did feel like we were a bit food obsessed for a while but her weight came up and she has a better relationship with food.

Its really about getting calories into him, my DD was no higher than 3rd centile for all
of her primary years, she’s now 10th centile but doesn’t look quite so thin.

During the school week he eats on average 2 pieces of toast with butter and marmite and a bit of fruit for breakfast. A wrap (ham, cherry etc), satsuma, biscuit and crisps for lunch. He ate a pack of blueberries in the car home, a small slice of Greek spinich and feta pie for dinner with carrot and cucumber then a tub of cherries. We don't normally have blueberries and cherries as they only last half a day as you can see.

He then had the yogurt etc I mentioned earlier. And some olives.

I'm disinclined to take him to the GP as I don't want to make food a 'thing'. I think his weight is a combo of genetics and ADHD. He does move a LOT.

There are lots of good food ideas like cheese scones and Philadelphia which he'd like. He loves cheese straws and I keep meaning to teach him to make them so maybe that's a weekend plan.