Making Every Bite Count: Increasing Caloric Intake
Nixie Raymond, M.S., R.D., Newton-Wellesley Hospital
The poor growth that is often seen in children with IBD is thought to stem from a number of factors. The primary cause, however, is believed to be inadequate caloric intake, which can occur for a number of reasons. Poor appetite due to pain associated with eating, restricted diets that eliminate favorite foods, poor absorption of nutrients, increased losses of nutrients and possible increased energy requirements may all be contributing factors.
Whatever the cause, the goal is to increase caloric intake to promote growth. As most parents know, this is easier said than done. The following suggestions are ways to help increase oral caloric intake:
1. Encourage three meals plus three "mini-meals" each day. While there may be some slight decrease in mealtime appetite, overall total caloric intake actually improves with the help of mini-meals.
2. Include a source of protein at each meal, such as meat, chicken, fish, peanut butter, egg, cheese, tofu, yogurt.
3. Encourage mild products (whole milk, cheese, yogurt) as tolerated, as these are excellent sources of calories, protein, vitamins and minerals. If your child is on a low lactose diet because of lactose intolerance, try using Lactaid mild and Lactaid caplets to allow increased milk intake. You can make your own Lactaid milk using whole milk by adding Lactaid drops (available at drugstores). This milk not only has more calories than the Lactaid milk at the store (which is lowfat milk), but it also may be better accepted by your child because it is more like "regular" milk. Keep in mind that many people with lactose intolerance are able to tolerate yogurt that contains live cultures (i.e. Dannon) as the bacteria help break down the lactose. Aged, hardened cheeses (Cheddar, Swiss, etc.) are quite low in lactose and may be well tolerated.
If your child is on a very strict, lactose-free diet due to severe lactose intolerance, you can use soy milk, soy based ice cream (Tofutti) and soy yogurt as dairy substitutes. The soy products have about the same calories as the milk based foods, but have less protein and little calcium.
4. Use extra fats as tolerated. Fats are a concentrated source of energy, providing more than twice the calories per gram than carbohydrate or protein. Although some people with IBD have difficulty tolerating extra fat in their diets, many people do not and thus are able to get a significant amount of extra calories from using liberal amounts of butter, margarine, oil, mayonnaise, etc. If cholesterol is a concern, use soft margarine instead of butter, use canola, safflower or olive oil (high in polyunsaturated and monounsaturated fats) and cholesterol free mayonnaise.
5. Try to limit low calorie food and beverages as they can fill up a child and displace higher calorie foods. For example, a bowl of broth based soup is quite low in calories. Try a milk based soup (i.e. chowder) or stew instead. Soda, contrary to popular belief, is actually quite low in calories (12 calories per ounce) when compared to juice (15 calories per ounce) or whole milk (20 calories per ounce).