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.

If he likes nuts, would he e.g. like apple slices to dip in almond or cashew butter as a snack? Nut butter on crackers aren't too intimidating size wise, but pack in more calories and fat from the nut butter. Or if he really likes carrots but he can't be faffed dipping, try making carrot boats with nut butter in them and raisins on top.

I assume school is nut free? Will he eat raisins? They're quite calorific for their size. Olives would be good for school snack too.

Look at energy ball recipes (loads online) Either with nuts or made with things like ground sunflower seeds for school. You can flavour however he might like. If he is okay with the sweetness dried apricots and medjool dates are good ingredients for these as they are nutritious and calorific.

If you can afford blueberries and cherries daily then give them to him, although I appreciate that might not be the case. A cheaper option is to buy them frozen and add to porridge made with full fat milk or cream.

Will he let you sprinkles things like sesame seeds on his meals? I put them on my son's marmite bagel for example.

You can always see his GP without DS to express your concerns whilst explaining you don't want to make an issue of it with him. They can then order any tests that might be useful and make a separate appointment to examine him if necessary where they don't discuss your concerns. I've done this a few times and GPs have always been underfunding about this and just framed any follow-up as a general check-up without speaking to my child about my concerns. Whilst they might check height and weight as part of that, they can do it alongside e.g. listening to his chest and checking his abdomen and not pass any comment on the measurements in front of him. It is worth investigating any underlying causes but also ask them to check for any resulting deficiencies so you can target these as needed.

Oh also frozen blueberries and cherries can make a good crumble. Again. Add nut butter to the crumble topping. Reoccurring theme here. I feel like I'm an expert nut pusher as a result of efforts to keep weight on my child.

It's also possible to fortify milkshakes by adding milk powder to them. In addition - if the OP's son will tolerate them - you can be prescribed fortified drinks - Ensure. You get different flavours. Some are like thick shakes; some are fruitier.

Could you do a smoothie in the morning with his toast? Easy to add a dollop of double cream for calories. Even veggie smoothies- carrot, ginger, yellow peppers, with an avocado if he prefers savory.

Make sure your using 10% fat greek yogurt not crappy stuff. Just try to increase the calories of everything he's already consuming. Drizzle olive oil on his pasta, add butter to everything, use the higher fat mince for bolognaise etc.

Lots of easy to eat little bite size snacks should help. Lots of cheese in cubes. Nuts, small savory pastries, cheese and veggie flapjacks are good.

I would avoid huel- it's very processed , I'm not sure they're recommended for kids.

I'd aim for 5 small meals rather than the usual 3. I know that's harder to do when they are in school.

A plate of snack foods while he watches TV in the evening. My carer loves snacks and chocolate so I have a 'snack basket' filled with crisps, nuts, other snack food.

On the milk / cream front I can't drink cow's milk without loosing half my bodyweight in the toilet half an hour later.

I can tolerate cheese and goat's milk is lower in lactose so might be worth a try.

A selection of cheese on crackers might make a snack / supper.

You said he doesn't like peanut butter has he tried other nut butters?

Other supper ideas, eggs - I was thinking boiled with soldiers but that's not really TV friendly. But bread dipped in egg and fried, boiled eggs, pickled eggs maybe.

Toast with butter, a 'nutty' bread if he will eat it, sausage rolls, crispy streaky bacon just on a plate so it can be eaten with one hand.

The food he’s eating just doesn’t have enough calories in it, will he eat crisps, cake, biscuits etc?

He needs the high calorie foods.

If he eats toast make sure it’s the thick sliced toast, with butter, would he have peanut butter rather than marmite?

Can you add in a pudding with dinner, when dd needed to gain weight adding in a pudding made a big difference. Lots of old fashioned puddings such as crumbles with cream or custard, sponge puddings, rice pudding etc.

Wraps aren’t very high in calories, a baguette or bagel would be better.

I still think a GP check would be a good idea, if he’s a low weight this can be a strain on his heart etc and kids tend to compensate until they suddenly don’t any more.

My son was on ritalin for ADHD which suppressed his appetite. We gave him Milo chocolate flavoured milkshakes which are also a food supplement

I have no suggestions as we have a similar issue here, but hoping posters have good ideas!

I'd see your GP and ask for a dietician referral. It doesn't have to be able his weight being a problem it can be about getting advice on his current diet and suggestions on how to make small adjustments to improve the nutrition in the food he is getting. It might mean he gains weight or it might mean he stays the same but is getting everything he needs from food nevertheless

My daughter is under dieticians due to food allergies. Now it's less about the allergies and reintroductions and more about a check in every 6-12 months to ensure she's getting all she needs. One thing we struggle with is iron as she's allergic to beef and other good sources of iron. She has porridge for breakfast most mornings and one of the dieticians suggested was to do 3/4 porridge oats 1/4 ready brek. From a food perspective it's better to have the porridge oats but porridge oats aren't fortified like the ready brek is. This is a way of sneaking in some extra iron and 1/4 of ready brek doesn't change the consistency of the porridge enough for her to notice.

She has oatly barista for her milk due a dairy allergy. It's the equivalent to fat as whole milk and is fortified with calcium, iodine and other essential vitamins usually found in milk. The dietician is happy if she has 2 x 200ml cups of this a day. She's dairy and fish free so doesn't have sources of iodine in her diet and this also covers her need for calcium

I have thought of one thing: DD will eat a tin of flapjack if she's helped make it herself. It's really quite calorie dense.

I think it’s not just the quantity that he is eating but what he is eating. Other than the crisps & biscuit, it is very low calorie. There is also minimal protein. And not a huge amount of carbs.

Why, for example, is he having blueberries only as an after school snack? I haven’t met a child who doesn’t hoover down a whole lot of food immediately they walk through the door. Are you actually offering him food then? I would suggest doing him a “grazing plate” with a mix of things like nuts, cubes of cheese, chopped up ready cooked chicken, some chopped up pancake/crumpet/scone/flapjack & some crackers with cream cheese. If you make them bite size, they require less effort to eat and, whilst it’s counterintuitive, actually want that.
And then introduce a bowl of cereal
or something before bed.
You say he’s mildly lactose intolerant. Have you tried lacto free milk?

Strongly agree with this! If he’s got ADHD mealtimes at a table will likely be excruciatingly unbearable. I have ADHD and I hate eating at the table. I never put any pressure of myself to “conform”. If if I/we are having a day where happier in front of a TV, that’s where we eat. (I have an ADHD child too.)

The best ADHD advice I ever got (Russell Barkley) is you can’t change the child to fit the environment, you have to fit the environment to fit the child.)

Having said all that, as much as your time/budget allows try and focus on healthy whole foods. I changed my diet this year and I am so much fuller eating this than processed stuff and my ADHD is better too. But I know it’s hard, it really is. Failing everything else - ice cream will fatten him up! Good luck!

Peanut butter energy balls made with oats and protein powder?

It's really hard. Dd had to take medication as a toddler which affected her appetite and I think ability to process nutrients. Snacking is a good strategy. Slices of cold pizza or cold quesadillas if he will eat them. Cheese and onion rolls. Sausage rolls. Mini scotch eggs. All quite high calorie. I used to make dd cauliflower cheese soup as well.

Mince pies!

I have a dc with afrid and asd. At 16 she's just into the third percentile (it varies between 1st and 3rd).
We were refered to a dietian (because of other health issues) and the advice was very minimal re weight (and were discharged after 2 appointments).
What I did take from it was to have 3 meals, 2 snacks and a calorific drink (eg hot chocolate/milkshake) every day plus supplements (a-z vitamin, vitamin d and calcium were the important ones mentioned).
We were also advised to add pudding where we can eg rice pudding with nuts/ fruit puree or fruit Crumble and custard. So trying to keep it reasonably healthy but calorific rather than empty calories.
Also was advised to add extra sides because even if its a small amount it adds up so it might just be half a pitta, handful of tortillas, a poppadom but if you do that every evening it adds up (this seemed to be the biggest theme).
Every snack has a piece of fruit or veg with it so flapjack and banana or carrot battons and breadsticks. Which the dietian said encouraged healthy choices whilst adding calories (this really worked for us as dd would have just had the carrot, now she knows she needs something with it).
We also have a snack cupboard which dd can then choose from which I think helps -she's more likely to eat something she fancies. We have crisps, crackers, breadsticks, rice cakes, popcorn, dried fruit, cereal bars, a homemade snack (this week its flapjack she chooses, next week its a chocolate traybake). Having some lighter snacks is good because if their not very hungry a heavy snack will put them off and they may not have anything (better to have a cracker or popcorn than nothing).
We're in a good routine now and its become second nature, the best thing i did was write meal plans including snacks (till we got into a routine) because it stopped it becoming a big issue/always needing a descion. I just sat down once a week and wrote it then just put it in front of dd at the set times. Its getting that balance of making sure food is always coming at them without overwhelming them or you.

I sometimes have to put weight on and I drink chocolate Complan or Meritene as an extra drink a couple of times a day which are sachets I can take out with me. Or I make my own milkshake if I’m at home.

He won't eat chocolate, chocolate flavored things, or cake so those are out. But I'm thinking about making shakes which include dates or prunes, coconut milk, tahini and almond butter or mixed nuts, plus fruit from the freezer for breakfast. I'll minimize or eliminate the huel content.

@RedwallMattimeo some good snack ideas there. The blueberries happened to be in the car with me when I picked him up from school. Usually he will snack when home on dairy or fruit.

I'm definitely going to push the nuts and seeds too as he does like these.

I've just put a little bowl of cheese cubes, olives and seeds in front of him whilst he's gaming with a friend and he asked why and said he's not hungry as he had a big lunch (half an adult ham and cheese panini, a few chips and a bit of salad) but he does seem to be absent mindedly picking at it.

If DD2 is diagnosed with ADHD, then DH clearly has it. As a child, he wore his parents’ carpets out, pacing about. When I met him, he used to pace about, eating breakfast and lunch, or drinking coffee. His idea of taking a break is not sitting down with a hot drink - it’s pacing about!

He only sat down at dinner, because he had to use a knife and fork. Even so, the second he has finished, he’s off!

Having twins wore him out, and now he does sit down for breakfast and lunch - but he’s in his late 60s with a heart condition!

OP, would DC eat this:

https://moorlandseater.com/fruit-tea-loaf/?amp

I make it for DD1, because it’s fat free (she has high cholesterol), and dried fruit is good for iron, especially dried apricots. (As advised by her NHS dietitian for a specific diet)

Let him graze whilst watching TV or doing homework.

Tea and toast as soon as he gets home.
A snack of A pot noodle with extra chicken or salmon.
Continue to leave out bits of cheese, saucisson, nuts and bread olives etc

crisps and biscuits left out for the school journey home.

encourage breakfast at home and a mobile breakfast 2nd course for the journey. Milkshakes (but check ingredients).

Home made Smoothies incl avocado and full fat Greek yogurt. I also add strawberry jam to mine made up of spinach, cucumber and yoghurt. Was surprisingly excellent!!!!

This is very similar to my son - now 19 and still thin but filling out. Always hovering on the 1 percentile.

Breakfast: smoothies with full fat Greek yogurt and added chia seeds. Scrambled eggs were good as very quick. Porridge.

Lunch: at school so whatever he would eat, even if that was a pesto wrap. He spend a year eating just plain rice.

Tea: easy food that didn’t need much chewing/ cutting (that might be his teeth misalignment though) so he would eat more spag Bol than a roast. There was always pudding.

We had (still have) free flow snacks,biscuits, crisps etc… and I still occasionally put food in front of him he is absorbed in something as he just doesn’t seem to feel that hungry. If he likes cheese, breadsticks and Philadelphia?

I was thinking about this yesterday and in to my head popped pancakes.

Who doesn't like pancakes? I know most people have them sweet in the UK but I prefer savoury. Make a batch and then fill with mushrooms, cheese, crème fraiche, marmite I'm sure you can come up with a few more. Freeze individually and microwave for breakfast.

Better still get him making them.

Would he eat cereal for breakfast? You can substitute orange juice for milk or use yoghurt instead.

The cheese straws is a good call, pastry of any type might help so maybe add a mini pork pie to his plate or those mini pasties you get at the supermarket.

So having got a load of snacks in him yesterday afternoon he (perhaps understandably) said he was too full for dinner. Point blank refused to eat anything until much later when he had a yogurt and some cheese.

Tonight is chicken stew with tartiflette with loads of olive oil and cheese.

Tomorrow am is high calorie smoothie time for breakfast.

You’re doing an amazing job!