Underweight child never hungry

Hi,
My daughter will turn 3 in two months. She has never been a great eater. Till two years of age she suffered from reflux and vomited often. We have since controlled the reflux by altering her diet and timings. But she is still never hungry. She never finishes her lunch. Never feeds herself and eats very very small portions. She has had all sorts of test and everything is normal. But I want to know how much weight is too less? She has been on the -1 percentile since she was almost a year old but she was born 19 1/2 inches and 6lb 3 oz so more an average baby than a tiny one. Her growth curve is more or less flat and I am a very worried mom. Is there anything I can give her to increase her appetite? There is nothing I wouldn't do to hear the words "Mom, I am hungry!" three times a day!

[Renee Radenberg]

Her weight is below the 3rd percentile for her age. Due to her reflux, suggest feeding her 5-6 small meals a day and do not have her lay down before an hour after a meal. Give her high nutritional value foods so she gets as much protein and calories as she needs. For example having a protein source each meal --- meat / fish or cheese or yogurt; with a carbohydrate --- bread, pasta, rice, cereal; and a fat ---- pat of butter or mayonnaise if you made a sandwich. Protein sources are all meats, chicken, fish, beef, pork, etc. and dairy products such as milk, yogurt, cheeses, pudding, and ice cream. Here are some additional tips for extra calories/protein: If she likes pasta, then add meat or cream sauces to the pasta instead of plain tomato sauce or plain pasta. Add dry milk to oatmeal, mashed potatoes, gravies, creamed vegetables, and creamed soups (add additional meats to soups) for additional protein and calories. Use all fat dairy products for now until she starts gaining weight, and then start using low fat in later years. Suggest giving her Pediasure or milkshakes (milk and ice cream blended) in place of milk/fluids at all meals and snacks for additional calories and protein. The most important thing is to RELAX. You do not want mealtimes to be a battle of the wits between the child and the parents. Remember meals need to be joyous for parents and the child. If she will not eat a certain food, do not make a fuss over it. Give her some other food alternatives. Then let it go and enjoy the meal. Slowly introduce new foods, and if she does not want it, do not make a fuss over it. Let it go and enjoy the meal. Try again in a few weeks. Hope this helped you.