I Need a High Fat Diet!

Try making smoothies. Add an avacado in with some banana, you cant taste the avacado, you can make it thick to pass it off as a dessert.

Ravioli? get the small round ones and they can eat like finger food grilled cheese sandwich grilled with butter, trying to think of things they'll love
my Dr said add olive oil to pasta, add butter,
I say give snacks as well like bananas and ice cream shakes, make home made whole wheat peanut butter cookies.

You want to make sure what she does eat is very good for her. Not just high fat to get her to gain weight. You can give her things like avocado, whole wheat pancakes with added wheat germ (it has good fats in it and extra calories and can be hidden in lots of stuff like baked goods, waffles,pancakes, spaghetti sauce, etc), put olive oil on her veggies ( a better fat choice), peanut or almond butter (tiny amounts smeared thin on crackers or little pieces of wheat bread).

Honestly, I would continue to offer her healthy meals and snacks with the rest of the family and not make a huge deal of it or worry yourself. And give her a toddler mulit-vitamin since she isn't a big eater. If you make a big deal of it you could turn it into a huge, long-lasting food battle.

And here's another thought-my son was early and never, ever was on the growth charts till he was over 2 and you know what? I wasn't concerned. He was a healthy child, he did eat, he was very active. But I think they push the "being on the charts" way too much. The growth charts they use are based on formula fed infants and neither of mine were that.

Why didnt their doctor suggest ways to improve their weight???

Besides just telling you your girls need to gain weight... the Pediatrician SHOULD BE giving you, the "how to do it" advice, OR sending you/your kids to a Nutritionist.
And telling you what foods, are healthy but advantageous, for them. Per their diet needs.

So, talk to your Pediatrician.... and ASK for advice, pertinent advice and/or a referral to a Nutritionist.

Feed them healthy. "High fat diet" does not mean, junk food.

Also, were they premature?
Twins are often smaller/lower weight as well.
Did the Pediatrician take these aspects into consideration???
If not, she should.

Your one daughter is 19 lbs and the other is 20 lbs, and he's worried about the one that is 1 lb less than the other? Has she always been smaller than average? If so, I wouldn't worry. Does she look super skinny and sick or does she look healthy? Sometimes doctors over worry and make something out of nothing. Then again, maybe she looks unhealthy to you, and it really is a problem.

My kids really like fruits and veggies. They also really like lunch meat to munch on. I wouldn't go for a high fat diet...unless it's healthy fat (we certainly do need fat!). Whole milk might help.

It sounds like you have other suggestions taht are great. I'd just make sure to look at your daughter and see if she looks unhealthy to you or other people. If she looks fine, and is just small, then I wouldn't worry too much. My daughter was 17 lbs at 2 yrs and 19 lbs at 3 yrs (she does have a growth problem, though!). Some kids are just smaller.

Try ensure plus protein shakes, they are tasty if they are really cold.
Carnation instant breakfast is another good option my kids love them

Avocados, almond butter, full fat yogurt and milk. Mac n cheese with veggies. Aside from healthy natural fat, I wouldn't force higher calories.

My son was similar (he had a minor drop in weight percentile that was concerning). This is what we did/do:

Be _very_ conscientious about 3 meals + 2 snacks per day. We were having trouble fitting in the morning snack and I think that was part of our problem.

With snacks, treat them as mini meals: offer fruit/veg and a protein or dairy or whole grain. We did stuff like: whole fat yogurt with granola; slices of apple with a cheese stick; cold black beans (seriously, my kid loves cold stuff) with fruit (berries, etc) or veg (broccoli, carrot sticks, cuke or zucchini slices).

We also stuck with whole milk (he's almost 3 and per the doc's recommendation, are continuing on with the whole milk). Full fat yogurt, full fat cheese, etc.

We make smoothies as a snack after dinner fairly often:
1 cup whole fat yogurt
1.5 cup frozen fruit (ripe bananas add sweetness w/o sugar)
optional:
1-2 tsp wheat germ
1-2 tsp ground flax seed
small handful of fresh spinach (it will turn the smoothie green unless you use blueberries, but the you can't taste the spinach)

The above also freezes into yummy popsicles.

Avocado is a healthy fatty food. Scrambled eggs with shredded cheese. Cottage cheese pancakes are good (higher in protein then reg. pancakes, with eggs & cottage cheese). I have a good recipe for cottage cheese pancakes, so message me if you'd like it.

I also keep whole wheat crackers and no-sugar-added applesauce containers (Motts & Mussleman both have several varieties) on hand and they are portable so travel well for snacks on the road.

This was me. My Dr had my mom feed me the Carnation instant drink mixes b/c I literally only ate about 2 bites of food a day... but I wouldn't soley use that.

Then, keep introducing new foods, feed lots of healthy high protein items such as eggs, cheese, avocado, fish, trail mix, nuts, hummus on crackers, peanut butter...

Cut out any empty sugars and calories. Also, she may be getting full on drinks (especially milk), so give drinks after she eats, with just a few sips with the meal if needed. Limit drinks to whole milk, water and pure orange juice, or fresh, healthy smoothies.

Well, my 15 month old is 26 pounds so that does seem small, but really...twins are smaller to start off with, right? And there's such a huge range of normal...the only issue is if they aren't really gaining weight.

Peanut butter. Not that you'd just give them huge globs, but you can thinly spread some on crackers or toast, or make peanut butter cookies.

Coconut milk. Your ped would say its high in cholesterol, but that really isn't the truth. Coconut milk is high fat, but the good kind of fat, and it raises good cholesterol. And plus, it's super yummy. I like Silk Pure Coconut original.

Black olives. 20 olives is one serving, but they're high in nutritional fat. I asked a question about them the other day and then did the research myself...those are great for a snack.

Cheese. :)

PUT. BUTTER. ON. EVERYTHING.

Toddlers don't worry about cholesterol like we do. My eldest daughter was itty bitty and scrawny... my pediatrician told us about the butter thing... her weight improved within about 6 months, slowly but surely. Toast, veggies, melt some on popcorn, cut muffins in half and add butter... it helps even the pickiest of eaters!!

Also, give her pediasure instead of milk, it has more calories, the good kind.

Feed her more protein. Hummus, eggs, fish, peanut butter, etc.

All of these helped SO MUCH for my baby girl; her little sister is as big as she is now, but she's getting there :) Best wishes!!

Here are some good suggestions...

http://www.framinghampediatrics.com/High%20Calorie%20Food...

Hope it helps =o)

I agree about getting advice from a nutritionist. This could backfire if it causes them to have unhealthy eating habits.
I do like the smoothie with avocado idea. You can cover the color and taste with blueberries. Much, much more healthful than pediasure and Carnation instant breakfast.

Don't worry much yet. My daughter still weighed 20 pounds at 5 years and didn't hit 30 until she was 7 and that gain was because she started going to gymnastics 4 days a week and gained some muscle. The doctor wasn't concerned because she had always been small and there was not a DROP in her percentile. She was always right off the bottom. The one thing he did tell us was to give her ice cream everyday. She got extra milk and calories all in one.

I wouldn't rush to add fat to their diet. My daughter is now 13 and has been very consistently in the 4th percentile of her age group. She gained weight each visit but only in small amts. Her development and milestones were right on in every other way. One year she grew 4 inches in one year, but still just that one year was under 10th percentile. Me and my mother aren't big. If they are developing in all mental and physical ways as normal, my dr. would note in her file that she WAS gaining weight and developing. He was never concerned and from early on told us she was just going to be petite. If your situation isn't the same, I bet you'll get some wonderful suggestions on this site.

My 26 month old has always been on the smaller side. Right now, she is only 22 pounds and her doc isn't worried one bit. She has said the only time you should worry is when there is a sudden drop in percentile. Even then, it is more of watch and wait. Just keep offering good foods like avacados and full fat yogurts and milk. My daughter's favorite snack now--peanut butter!

Wow one pound creates an 18% difference - never would have thought that. Anyway, try giving her some Pediasure a couple of times a day and I believe you will see a difference. I had the same problem with one of my foster kids and this is what the Dr. had me to do.

Good luck - I know it concerns us all as parents when our kids won't eat right.

2nd percentile is still within average, so what's the problem? hmmm....hemp milk has all the right fats and none of the bad ones - but get vanilla flavored, b/c it's not naturally delicious. coconut milk is tasty and rich, whole milk yogurts with slivered almonds - avocado and fruit smoothies can be made quite rich and with added protein... that's what I got off the top of my head :)