When and how to boost caloric intake for children with poor growth or weight gain

A high-calorie diet increases the calories and protein of food intake without significantly increasing the volume of food intake. Depending on underlying conditions and nutritional needs, the plan for power packing will vary by individual and be carried out at home. When calorie boosting occurs at home, the primary care clinician and dietician are often involved with recommendations. Establishing the underlying cause of poor weight gain and treating it is fundamental to helping children with faltering growth. In addition, increasing caloric density can help with gaining and maintaining weight. Below are general tips for boosting caloric intake for babies, children, and teens. The Resource section has information about detailed recipes and support for families.

Other Names

• High-calorie diet
• Increased caloric density
• Power packing
• Supplemental nutrition

• In general, the easiest way to pack food with calories is to add fats and carbohydrates and include more high-protein foods.
• No honey in children < 1 year of age, raw or cooked into food (including bread, graham crackers, Honey Nut Cheerios) due to risk of botulism infection.
• Be aware of the child's ability to safely swallow different consistencies, textures, and temperatures. Feeding & Swallowing Problems in Children has further information.
• Encourage caregivers to compare food labels for calories.
• Families can use a blender or food processor to adapt the texture of the high-calorie foods.
• If unable to attain adequate nutrition or fluid intake, consider the placement of a feeding tube. See Feeding Tubes & Gastrostomies in Children for more information.

For infants, the primary recommended way to increase calories is to concentrate or fortify the breast milk and/or formula, typically to 22-24 calories per ounce. Fortifying Breast Milk (Minnesota Health) ( 67 KB) has instructions for fortifying breast milk. Duocal can also be used to add caloric content. Formulas and Fortifiers for Premature and Low Birth Weight Infants ( 98 KB).

If an infant is older than 4-6 months old and able to start solids, options include:

• Add 1 teaspoon of vegetable oil (such as corn oil or olive oil) or liquid margarine to each baby food jar.
• Mix any dry infant cereal with infant formula rather than water.
• Use a blender to puree high-calorie table foods. See Thickened Liquids & Modified Foods.
• Use whole milk, custard-style, unsweetened yogurt without fruit pieces (such as Noosa, Stoneyfield, and Chobani).

For toddlers and older children:

• Add oil, margarine, butter, and/or cream cheese to bread, crackers, pasta, rice, and vegetables.
• Add gravies, sauces, dips, and toppings to the child’s favorite foods.
• Give the child whole milk to drink. Limit juice, water, and soda. Some children “fill up” on water, juice, or soda and then refuse to eat.

Here is “food for thought” on ways to power pack, organized by sources of fats, proteins, and carbohydrates. However, providing a combination of fats, proteins, and/or carbohydrates typically increases calories the most.

Fats

• Butter
• Sour cream
• Margarine
• Whole fat or custard style yogurt
• Oils
• Powdered milk
• Mayonnaise
• Evaporated milk
• Cheese (including cream cheese and cottage cheese)
• Nut butters and seed butters
• Whole milk and cream
• Olives
• Ice cream
• Coconut milk
• Avocado

Proteins

• Eggs (avoid raw egg)
• Tofu
• Dairy products (see above)
• Textured vegetable protein
• Nuts and seeds
• Tempeh
• Nut or seed butters
• Beans or hummus
• Meats (including jerky) and seafood
• Protein powder
• Beans and legumes

Carbohydrates

• Sugar
• Dried fruits
• Agave syrup
• Jams or jellies
• Maple syrup
• Instant breakfast
• Ovaltine and other drink mixes (but avoid the ones with artificial sweeteners)
• Honey (not for use in babies <12 months)
• Cornstarch or tapioca starch (these often serve as thickeners but add calories as well)
• Molasses Polycose (a powdered carbohydrate supplement available in pharmacies)

Supplemental Nutrition

Many ready-to-use bottles, pouches, mixable beverage powders, and packets of supplemental nutrition are available in most large grocery or drug stores. Some high-calorie mix-ins include Duocal, Benecalorie, and Polycose. Supplemental formulas include PediaSure, Kindercal, Boost Kid, Ensure, Resource, Orgain, Instant Breakfast, Ovaltine, and NIDO. They are fortified with vitamins and minerals to varying degrees, a good source of calories, and convenient to use. Some come with added fiber. See Formulas for Toddlers & Older Children ( 296 KB) for more information on supplemental nutritional formulas and mixes. The drawbacks of these products are that they may replace normal food and cause a picky or selective eater to have worse eating habits. They should not be used as a meal replacement.

• Eat meals and snacks together so children feel a part of the family. Place the highchair at the table.
• Be positive about food and eating to create a pleasant, stress-free setting. This will make eating more enjoyable.
• Schedule meals and snacks 2-4 hours apart to encourage a good appetite. Offer eating 5-6 times per day (3 meals and 2-3 snacks).
• Allow enough time for each meal or snack, at least 15-30 minutes.
• Do not allow children to graze or snack between eating times.
• Don’t get upset or force a child to eat; children can be picky eaters. Do not push a child’s favorite foods, as that can cause food aversion.
• Minimize distractions that may take a child’s attention away from eating. No TV, phones, or other electronics during mealtime.
• Involve the child in planning and preparing food. Children’s cookbooks, parenting magazines, and websites are great resources for fun food ideas.
• When the child wants the same food day after day, this is called a food jag. It is common, and it’s okay to give the preferred food for a few days with small amounts of other foods.
• Allow the child to feed themselves. Offer finger foods, and use a baby-sized spoon and cup with handles. Use plastic dishes so children can feed themselves safely. Expect messes.
• Offer small portions, and then give more when they finish what was served. Large portions can be overwhelming. Many children like plates with compartments to improve visual presentation.
• Try different forms of the same food, such as fried eggs, scrambled eggs, and/or boiled eggs.
• Choose foods that are easy to chew and swallow, especially if the child has physical or neurological deficits.

Dieticians and Nutritionists (see NM providers [1])
Consult with a dietitian to develop feeding plans and provide guidance on appropriate calories, nutrients, and fluid intake for individual children.

Other referrals that may be helpful:

• WIC Assistance (see NM providers [0])
• Feeding & Swallowing Disorders (see NM providers [2])
• Nutrition, Metabolic (see NM providers [11])
• Eating Disorders Counseling (see NM providers [0])