How to help your child with ADHD gain weight

Dan reached out to me for some help with his son Braden, who has ADHD and needs to gain weight. “I’m not sure when it started, but suddenly Braden lost weight and his doctor tells us that we have to do something about it right away,” says Dan. “We’re really trying, but we feel totally stuck. Braden says he’s not hungry and rejects almost everything we offer him. We don’t know what else to do!”

I get it. Eating issues are common when you have a child with ADHD. And while it’s not easy, Dan and his partner Eric can make a big difference. They can improve Braden’s lifelong health by addressing this right away.

The link between ADHD and eating issues

People with ADHD are more likely to develop eating disorders than the general population. One study found that 31% of adults diagnosed with eating disorders also had ADHD. This is much higher than the general population, of which 3-10% of people have ADHD. About 36% of people who have bulimia and anorexia with a binging/purging subtype and 18% of people with anorexia have ADHD. Eating disorders have been described both as a symptom of and/or a coping mechanism for the emotional dysregulation that is common with ADHD.

Why it can be hard for a child with ADHD to eat

There are many reasons why eating issues are associated with ADHD. First, people with ADHD are usually highly sensitive to their five senses (smell, touch, taste, sound, and sight), all of which are involved in eating. This can lead to picky eating and a limited palate. They are also more sensitive to their interoceptive state, especially their digestive system, which can lead to disorganized hunger and fullness cues and/or feelings of nausea and other gastrointestinal distress. 

They are also highly attuned to neuroception, the sensation of other people’s emotional states, which can impact eating habits especially if family meals are stressful or chaotic. Together, these sensitivities combine to increase emotional dysregulation, making eating more difficult. A child who is both highly sensitive and has low emotional regulation skills is more likely to adopt coping behaviors like an eating disorder.

Also, a person with ADHD may not notice they are hungry or, even if they do, they may not be motivated to feed themselves. This tendency to be distracted and/or procrastinate eating can cascade into eating disorder behaviors. Most eating disorders begin with under-eating, either intentionally for weight loss or unintentionally due to distraction or avoidance. 

In cases of anorexia and ARFID, the person continues to eat too little. In cases of binge eating, the person restricts then binge eats. And in cases of bulimia, the binge eating episode is followed by purging. Either way, postponing and avoiding eating is a precursor to most eating disorder behaviors.

Finally, the medication used to treat ADHD can interfere with hunger cues, further affecting eating, weight, and digestion. This does not mean you need to discontinue medication, but it’s a good idea to check with your child’s psychiatrist to see if there are any adjustments that might help with eating.

Your child’s weight curve

A big thing to keep an eye on is your child’s weight and height curve. You should see a nice growth curve from birth through today, with your child staying approximately within their natural weight and height curve. This indicates your child is growing according to their body’s unique genetic blueprint. 

For example, if your child was born at the 95th percentile for weight and was there at age 2, 4, 6, and 8, but they have now dropped to the 65th percentile, your child may be weight suppressed. Though it surprises many parents, we don’t want a child from the 95th percentile to drop down to the 65th percentile. And if they do, you’ll likely see an increase in disruptive behaviors and a lower appetite, which leads to more weight suppression, more disordered eating, etc. 

If your child has dropped off their weight curve, they will need help eating enough food to get back to their healthy weight. The further they are from their natural weight, the harder it may be for them to eat. Nonetheless, it’s essential that you step in and intervene, as it is a serious medical and psychological issue. If your child has ADHD and needs to gain weight, please keep in close contact with your child’s doctor to monitor their health.

How to get a child with ADHD to eat

Getting a child with ADHD who has fallen off their growth curve to eat is extremely challenging. It’s also essential medical therapy. Start by seeking advice from a physician and/or registered dietitian (RD). However, beware of a professional who thinks it’s a good thing if your child has dropped off their childhood growth curve. That just means they’re stuck in outdated understanding of weight and health. Find a provider who recognizes that your child’s historical growth path should inform their weight trajectory. 

Assuming they agree that your child needs to gain weight, you can work with them on a plan for feeding. If your child is medically compromised, they may need residential treatment. But in most cases you will be told to feed your child more regular meals. You may get a meal plan with ideas for what to feed your child. But in my experience most parents already know what to feed their child. What you really need to know is how, given ADHD, you can feed your child enough food for them to gain weight. In these cases, parents need a behavioral intervention that won’t trigger their child’s oppositional tendencies or emotional dysregulation.

Here are my top four tips for feeding kids with ADHD:

1. Structure

It’s common in our culture for meals to be chaotic and grab-and-go style. Everyone eats separately and parents may be short-order cooks, feeding each child a different meal at a different time. However, a child with ADHD who needs to gain weight needs structured meals that acknowledge the ritual of eating as important and meaningful. We are social animals – we were never meant to eat alone. 

Create an eating and feeding schedule that involves you serving your child food on a plate, at the table, together with other family members as often as possible. Meals should feature high-calorie foods you know your child will accept as well as other foods they may currently avoid like fruits and vegetables. This will model for your child what a healthy meal looks like even if they are not ready to expand their palate yet. 

Keep the atmosphere at the table “light, bright, and polite.” Any criticism or negative discussions will result in emotional dysregulation and either a loss of appetite or a tendency to binge eat.

2. Fed is best 

If your child is weight-suppressed they need a lot of calories to make up the deficit and get back on their growth curve. While it’s common for parents to worry a lot about the nutritional content of their kids’ diets, at this point your main focus is on feeding a lot of calories as efficiently as possible. Worry less about the nutritional content and instead use the saying “fed is best” to remember that your primary goal is to feed your child enough food regularly so they gain weight. 

Offer fruits and vegetables and other non-preferred foods at every meal. Put them on the table so your child sees them. But your focus is high-calorie, high-fat foods that will help them gain weight. You will have a lot more flexibility and can expand their palate more as they gain weight.

As your child with ADHD achieves weight gain, you will notice that rigid or chaotic eating patterns reduce and you’ll have a lot more leeway for increasing food flexibility.

3. Validation + Expectation

Kids with ADHD are extremely sensitive to demands and criticism, and yet many adults use these techniques to try and motivate them to do things. You will have a lot more success if you change your approach and consistently use a combination of validation and expectation. Here’s how this works: 

1. Validate that they have an opinion, complaint, or resistance
2. State your request or expectation

Always do these two things together, not apart. And resist the temptation to add defensive arguments or compelling incentives. Keep your communication kind, short, and direct.

Here’s a good example of validation + expectation: “I understand that you’re playing a video game right now, but I’d like you to come to the table.” Or “I get it, you don’t want to eat right now, but I think you can handle it.” You may have to repeat yourself several times, varying the words a bit, but this technique is 100% more effective than arguing, negotiating, and debating with a child who doesn’t want to come to the table. 

4. Build emotional regulation skills

While eating and weight gain are the outcome we’re seeking, emotional regulation is the underlying skill that will keep eating and weight, and therefore health, on track for life. Building emotional regulation skills is essential for any child with ADHD, and it will make a difference in every aspect of their health, including their ability to maintain a healthy weight. Parents can do this by building kids’ emotional regulation skills, and we are actually the best people to do this since we’re biologically wired with our kids. Building emotional regulation skills includes:

• Emotional literacy – building an emotional vocabulary so kids can label, name, and talk about their feelings. 
• Emotional co-regulation – regulating your child’s emotional state with your calm, regulated emotional state. You may want to get some training and coaching to do this.
• Skill-building – teaching your child the emotional regulation skills they need to process their emotions rather than coping with automatic, subconscious behaviors. My emotional regulation worksheets can help with this.

Measuring success

If your child with ADHD is weight suppressed it’s important that you restore their weight as quickly as possible. This will not be easy, but it is possible. And many times parents are the best people to help a child in this situation because you know your child best. Your aim is to achieve steady weight gain every week until weight restoration (getting back in their original growth curve) is achieved. Please remember to maintain close contact with your child’s medical and therapeutic providers and get support for yourself, too!

Checking back with Braden

Dan and his partner Eric met with me over the course of several months to optimize their meal structure, behavioral interventions, and emotional regulation skills. They put tremendous effort into Braden’s health, and it paid off. Braden slowly but steadily restored his weight and is back on his growth curve. And the family structure is now set up to support Braden’s nutritional needs.

They have noticed a big difference in Braden’s emotional regulation skills, and their own! Braden is still fairly picky, so Dan and Eric are working on food flexibility, but overall he’s doing great, and the family is closer and more connected than before. “The best part of all of this is that we’ve become much better parents to Braden and partners to each other,” says Dan. “We feel a whole lot more confident about what we’re doing now.”

For privacy, names and identifying details have been changed in this article.

See Our Parent’s Guide To Eating & Feeding A Child With An Eating Disorder

This site is designed to provide information and resources. It is not intended as, nor should it be used as medical advice pertaining to any individual person’s healthcare. People should always consult with a qualified medical professional regarding their specific health needs.