Ask the Expert – Healthy Fats for Managing Toddler Underweight

Ask The Expert is a weekly column on The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

We often hear about overweight and obesity in children, but underweight, or slow weight gain can also be a cause for concern.  This week, Registered Dietitian Amy Braglia-Tarpey discusses the importance of including healthy fats in your child’s diet to manage the challenge of underweight.

Amy Braglia-Tarpey, MS RD
  • B.A. in Psychology from the University of Arizona
  • M.S. in Nutritional Science from California State University, Long Beach
  • Registered Dietitian, Certified Nutrition Support Clinician,  and Board Certified Specialist in Renal Nutrition
  • Worked as a clinical dietitian at Salinas Valley Memorial Hospital , with over 10 years of experience working in the field of nutrition
  • Expert in nutrition support and nutrition for Chronic Kidney Disease
  • Twitter: @RD4Change
  • LinkedIn Profile
  • Contact via email –

Question: I have a very underweight toddler. What are the best ways to add calories to food? I am often told to add cream, olive oil, or butter, but that just doesn’t seem healthy.


Many parents are concerned about the quantities and amounts of fats their children are consuming.  Fear of fat has been instilled in us due to recommendations by the American Heart Association to reduce total fat, saturated fat, and cholesterol in our diets.  However, this advice is meant for adults, and is currently under scrutiny as research provides new information about the roles of different fats in our health.  Children require more fat in their diets than adults to support growth.  Moreover, the type of fat is more important than the overall quantity in most cases.  In pediatric underweight, adding calories for growth is extremely important.  Because fat provides more calories per gram than carbohydrate or protein, adding more to the diet is the most efficient strategy to promote weight gain.

In humans, fats are essential for building the membranes of cells.  In childhood, a balance of saturated, polyunsaturated, and monounsaturated fats is necessary to give new cells structure.  Without any one of these components, cell membranes can become too rigid or weak.  Therefore, some quantity of each of these types of fats should be provided by the child’s diet.

While it is true that the majority of calorie additions should come from monounsaturated and polyunsaturated fats, saturated fats in moderate quantities can add calories as well as palatability.  Monounsaturated fats are found primarily in plant oils, although meat fats contain some as well.  Olive and canola oils, avocado, and almond butter are good sources of monounsaturated fat.  Most polyunsaturated fats come from plant oils as well, and appear in the largest quantities in vegetable oils such as soybean oil.  Another type of polyunsaturated fat, Omega-3 fatty acids, are abundant in fish and marine oils, as well as flaxseed and walnuts.  Saturated fats in the diet come mostly from meats and dairy, although smaller amounts are present in vegetable oils.

Adding calories to aid in weight gain can be quite challenging.  Some calorie-dense foods are not well-tolerated by children, and some are rejected due to individual tastes.  If there is an underlying disease or condition that is preventing weight gain, it may be difficult to find calorie additions that adhere to the restrictions of the child’s diet.  Here are some suggestions for healthful calorie additions:

  • Avocado– Add to sandwiches, wraps, and soups.  Spread on toast as you would butter, or make guacamole as a dip for veggies, crackers, and bread.
  • Almond or peanut butter– Add to hot cereals such as oatmeal.  Use instead of butter when making cookies, spread on bread or crackers.  Freshly ground flaxseeds can also be mixed into cereals.
  • Stir extra olive oil or canola oil into soups.  Canola oil has a neutral flavor and can be added to most cooked as well as baked goods.
  • Drizzle olive oil over fish, chicken and pork.   Add olive oil to pastas, sweet potatoes, and other side dishes.  Make pesto, a calorie-dense blend of olive oil, nuts, and herbs (cheese optional).
  • Cheese is a great source of protein, calcium, and phosphorus, as well as calories.  Kids love it!  Try string cheese for snacks, and stir cheese into casseroles and dips.  Melt it over eggs and vegetables.

Choose the majority of calorie additions each day from the above groups.  Cream may also be used, but with greater moderation.  ¼ cup of heavy cream supplies 200 calories, with one third of its total fat provided by mono- and poly-unsaturated types.  Use to add calories to cereals, soups, casseroles, and scrambled eggs.

What has worked for you? Share your experience in comments below.

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Disclaimer – Information provided in Ask The Expert column on is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by


  1. Guggul

       Managing the toddler having the underweight is a big task for the parents…. I will personally suggest the guys to concern the doctor who have the specialization in this field,otherwise it may harm to your toddler..

  2. Veronica Bryant Hanley

    My doctor and I agree that yogurt made from whole milk is a great protein and fat source for my “ity-bity”. Because of family allergies to cow’s milk, my baby eats plain goat yogurt and loves it! The protein/fats in goat milk are similar to human milk and easier for babies to digest. We started her on plain yogurt so she doesn’t mind the tart taste. She gobbles it up with banana bits and a sprinkle of cinnamon, yum! Occasionally she gets the sweetened cow yogurt as a treat, but because it was introduced first, she always prefers the original goat. Yogurt has the added benefit of immune building pro-biotics. 

    We use Sunflower Seed Butter as a rich bread, cracker or banana topping or a dip for carrots or apples. Any nut spread will do, but we have nut allergies in the family and this is a great alternative for us (caution if you have ragweed allergies-sunflower is a cousin).

    Both these foods are easy to find at a natural store Trader Joe’s or Wild Oats.

    When I make bread, pancakes and muffins, I include sunflower seeds, pumpkin seeds, and/or flax seeds to add nutrition. For pancakes/waffles, try adding extra eggs to enrich the recipe and use whole milk. My whole-grain version calls for 5-6 eggs! Much better for toddlers than the starchy mixes. Top with a nut butter or fresh berries and real whipped cream.

    A friend of mine makes smoothies with flax seed oil and the kids don’t even know that good stuff has been added! I add a good quality whey protein powder to give a creamy taste and extra protein.
    Finally, I have continued to nurse my little one into her second year. She is a very picky eater (hates meats) and mom’s milk is always the best source of nutrition as long as I am eating enough Quantity and Quality foods to lovingly pass on to her.

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