Many children face a challenge that we adults can’t relate to: the challenge to consume more and to gain weight. In a society filled with weight-loss products and get-skinny-quick advertisements, we may joke that we “wish we had that problem,” but it can actually be a serious issue that is quite concerning for physicians and parents.
Roughly 5-10 percent of US children are diagnosed with failure to thrive (FTT) at some point. This diagnosis means that a child’s current weight or rate of weight gain is significantly below that of other children of similar age and gender. Failure to thrive is one of many possible signs and symptoms of food allergies in young children. (Read more on FTT here.)
FTT can be caused by inadequate energy (calorie) intake, insufficient energy absorption, or excess energy expenditure. But, regardless of the cause, the long-term goal for children with FTT is to boost calorie intake and normalize growth. So, in today’s post, we’ll discuss some ways to add calories to your child’s diet.
Managing Failure to Thrive in Infants
For infants, the solution is usually fairly straight forward. Your physician or dietitian may recommend concentrating your child’s infant formula. There are several ways to concentrate your child’s formula and you should only do so under the direction of your child’s healthcare team. (Preparing formula that’s too concentrated can result in severe harm.)
Concentrating formula makes it more calorically-dense. The standard concentration for all infant formulas is 20 calories per fluid ounce. Making formula more concentrated means that your baby is taking in more calories while still drinking the same volume of formula. The concentration of the formula can be increased, for example to 24 or 27 calories per fluid ounce.
Some infant formulas come in high-calorie versions which are already more concentrated. With powdered infant formulas, like Neocate, the formula can be concentrated by adjusting the way you mix it.1 Healthcare teams may have other strategies to try to increase calorie intake, such as increasing the number of feeds.
Managing Failure to Thrive in Children
For children eating solid foods, it may take a little more creativity to add calories into the diet, especially when your little one has food allergies limiting the types of calories they can consume. Find tips and allergy-friendly, high-calorie food ideas.
When children rely on formula, concentrating it may be an option, again only under healthcare team guidance. In some cases, instead of concentrating the formula, the healthcare team may advise adding fats, carbohydrates, combinations of both fat and carbohydrates (such as Duocal2), or occasionally protein, to the regularly-prepared formula.
How have you added calories to your infant or child’s diet? What has worked for you? What advice would you offer other parents?
1) If your physician or dietitian has recommended that you concentrate Neocate, ask them to provide you with mixing instructions for what volume water to mix with what quantity of Neocate powder. For patient safety, Nutricia directs caregivers who request mixing instructions at non-standard dilutions to their healthcare team for guidance.
2) Duocal is a modular medical food not for use as an infant formula or as a sole source of nutrition. Always consult with your child’s healthcare provider before making any nutritional changes to the diet.
Maggioni A, Lifshitz F. Nutritional management of failure to thrive. Pediatr Clin North Am. Aug 1995;42(4):791-810. Cole SZ, Lanham JS. Failure to thrive: an update. Am Fam Physician. 2011 Apr 1;83(7):829-34. http://www.aafp.org/afp/2011/0401/p829.html
Rabinowitz SS. Nutritional Considerations in Failure to Thrive. Medscape Reference. July 2, 2012. https://emedicine.medscape.com/article/985007-overview
Last Updated February 11, 2019