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.

I have crohns, short bowel etc and see a dietician regularly as I hover around the ok/ underweight situation. They tell me to eat little and often (six little meals a day which I struggle with) and I add lots to food and drink. I can have fortisip and complan but I don’t like the taste.

sounds like you have some good ideas :) and some I steal!

Will he eat ice cream? DS is nearly 15, has ASD and ADHD and is on the 4th centile for weight, but his BMI is below the 1st centile. Interestingly, GPs in the UK never considered this an issue, but we recently moved to the US and the paediatrician here basically “prescribed” ice cream every day and has made it clear that getting calories - and specifically protein - into him is more important than traditional notions about healthy eating (especially given all his pickiness and anxiety around food). She also recommended avocado, peanut butter and protein shakes.

Solidarity though OP, it’s tough isn’t it? I worry about DS not being nourished enough to reach his potential height. DH is 6.1 and I’m 5.10, so he has the genes to be tall, but he’s only 5.6 so far. Fingers crossed he’s just a late bloomer…

Do you sit at a table for dinner? Is he allowed to leave the table early and go and play? Have a family rule that no- one leaves the table until dinner is finished and he may eat more if he has to wait.

^^ This post reminds me of another tactic I use; if DS leaves food on his plate, I leave his plate on the table while I clear everyone else’s, and he’ll often return to have a few more bites later in the evening. Part of DS’s problem is his wonky interoceptive system that prevents him from knowing when he’s actually full, so he might change his mind about being “done” 20 minutes after dinner. Fortunately he doesn’t seem to care whether his food is cold!

Remember his body has been used to his regular levels of food so it might take a little time to adjust to higher levels of snacks/food. Keep going but accept that it might take a few days - weeks to build up his appetite and the amount of food his body is used to

@MrsFrumble he won't eat icecream unfortunately, although I could likely get it into a smoothie. We've been out quite a few times to places where DH and I get icecream and DS come out of the shop with nothing. I do wonder what people think when they see that!

@menopausalmare We do pretty much always sit at the table for food but it's very hard to get him to sit at all, let alone stay seated, so he usually stands and wanders around and tried to wander off. Sometimes I think he might eat more if he had something else to focus on, with eating (which he finds boring) as the side activity.

I'm also thinking, as some suggested above, that bagels with cream cheese would be a good breakfast or snack option.

I left the scales out (which we actually only bought to weigh the dog) and he keeps getting on them and going on about how little he weighs like it's an achievement so they are now firmly back in the cupboard.

Yikes, the scales thing does sound a bit worrying. My DS is also weirdly a bit proud of being so light - I think because his friends at school make a big deal if it and pick him up and carry him around - but we’ve also managed to instil the idea that gaining weight is good, and having a target to reach (whatever 100lbs is in kilos… my brain is stuck in US mode 😬) suits him because he likes a good challenge!

Does your DS like eggs? That was another protein source suggested by our paediatrician, but unfortunately my DS won’t touch them.

There’s a few alarm bells in your posts but this is the biggest one.

Has he always disliked chocolate, cake, crisps and other high calorie foods or is it more recently that he’s refused them?

Eating disorders are insidious and very sneaky, my dd cut out some higher calorie foods, then cut down on breakfast, and then would say she wasn’t hungry or was full or felt sick…

Anorexia is very much a biological illness that is caused by weight loss affecting the brain.

Please take him to a Dr and get his physical health checked.

Suggest snacks in the car OP, or any other time he is “trapped”, like in a queue. One of mine is also hard to get to stay at the table but she will eat when bored as a form of entertainment.

Keep nuts in the car (unless he has allergic friends), and a crunchy bar or flapjack in your handbag.

If he likes to snack on veg at home, great, would he have them with hummus or full fat tzatziki?

I’m lactose intolerant and as a treat I’ll have a milkshake made with coconut milk and they’re so good. Also coconut milk in dishes that would normally contain dairy. You can make a decent cooking “cream” out of blended cashew nuts too.

The lactose thing does rule out a lot of things that might help him gain a bit of weight, but decent alternatives can help. Good luck!

@Girliefriendlikespuppies he's not really cut anything out. He's just never had a sweet tooth (although he likes actual sweets) - I'm the same. He did stop eating most icecream about a year or two ago but I think it's because he's genuinely not fussed by them. Even when he was little they would be half finished and I think he finally realised he didn't have to eat them just because everyone else does. He does like very tart lemon icecream and lemon drizzle cake as long as it's not got loads of icing.

Luckily he does like sweet smoothies!

This morning he drank his whole smoothie which had half a small yogurt pot, same amount of coconut milk, a banana, some red berries, some mango, half a plum, quarter of an apple, teaspoon of nut butter, teaspoon of ground mixed seeds and a quarter of a scoop of huel. I realised after I could have topped it up with something other than water. I know huel isn't designed for kids but I'm thinking of getting the protein version and using a small amount of this.

He's not massively keen on eggs. He might pick at a small amount of well cooked scrambled eggs but that's it.

I do think the issue, at least at this stage, is having a genetically small appetite coupled with high levels of distractability - so plying him with calorie dense snacks on top of calorie rich dinners is the way to go for now. That said, I am keeping an eye on his attitude towards food and his skinniness.