Strategies to increase calories (or other nutrition) are used to stabilize a child’s nutritional status (e.g., improved height to weight ratio) and promote catch up growth. Calories are added by selecting calorie rich food when menu planning and/or adding calories to foods already well accepted by the child (e.g., adding fat). Another strategy is to increase the typical volume of intake by the child at meals.
Background Education for Providers
Pervious studies have shown that increasing caloric intake in undernourished children helps to achieve catch up growth. Children need calories for both metabolic energy expenditure but also for growth and weight gain. By increasing the caloric intake a child presumably will accelerate their growth velocity to a point which energy intake will exceed calories used.
Calorie rich foods – Choosing foods that are higher in fat content will increase calorie intake by the child.
Adding calories-Adding calories to foods that the child already accepts will also increase calorie intake. Typically fat is added in the form of oil, butter, creams, sauces etc.
Increased intake-Increased volume of intake also increases the total number of calories consumed by the child. Strategies to increase the volume typically stem from behavioral interventions including goal setting with differential reinforcement applied for reaching volume goals.
Typically, children will have an easier time drinking calories than eating them (e.g., whole milk, formula). Fat content of foods/beverages will also increase caloric intake. It is important to remember that the nutritional quality of the foods remains important. The general goal is to maintain a healthy diet while increasing the calorie intake. Families may inquire about increasing calorie dense “junk foods” which should be avoided as these foods offer little nutritional benefit. Instead, families should be encouraged to use one of the strategies described above to increase the intake of nutritious foods.
Instructions for Provider
First, a dietary assessment of the child’s current intake should be completed. This is typically done by way of 24-hour recall interview or by written diet record. Gross assessment of food intake can be estimated, and strategies to increase calories may be discussed with the family.
Generally, adding a high calorie beverage is the easiest intervention. Switching a child to a 30 calorie per oz formula is the first step (e.g., PediaSure, whole milk with Carnation Instant Breakfast, whole milk with heavy whipping cream). Next, clinicians should consider having the family add calories to already accepted foods (e.g., adding oil, butter, cream). Families should also consider switching menus to include new foods that are more calorie dense (e.g., ice cream v. popsicle for a snack, introducing guacamole, smooth puree foods with higher fat content). Generally, behavioral interventions to increase the intake of currently accepted foods is the most difficult in the outpatient setting, and therefore should be considered last. These techniques may require the support of an appropriately trained behavior therapist. Typically, these techniques include volume goal setting, differential reinforcement techniques, and adjustments to the feeding schedule to promote hunger at the expected times.
If you have been working with a family for some time and you are not seeing a positive change to the growth velocity, then you should consider a consultation with the Nutrition Network staff. Typically, infants and young toddlers should be monitored more frequently than school age children.