Pediatric Nutrition in Practice

Increasing Dietary Energy and Nutrient Supply 321

4

glycerides (MCT) from coconut oil can be added
in stepwise increasing concentrations from 1 to 4
g/100 ml, which adds ∼ 5.1–10.5 kcal/100 ml
milk/formula. The concentration should be in-
creased stepwise according to individual toler-
ance. Usually, mixtures with vegetable oils pro-
viding long-chain fats should be used. Mixtures
with MCT are only indicated in cases of severe fat
malassimilation (e.g. marked cholestasis). MCT
may be quickly hydrolysed when added to human
milk, which can limit tolerance.
Disadvantage: The supply of essential nutri-
ents per kilocalorie is reduced.

Addition of Oils or Fat Emulsions
Vegetable oils can be mixed with milk/formula
and provided at ∼ 1 g/kg body weight per day (9
kcal/g). Added oils tend to separate (oil droplets
on the surface) and, depending on the mode of
feed delivery, may only be delivered in part to the
recipient infant. An enteral vegetable oil (long-
chain triglyceride) in water emulsion providing
4.5 kcal/ml is available which can be mixed with
milk/formula.
Disadvantage: The supply of essential nutri-
ents per kilocalorie is reduced.

Use of Enteral Infant Feed
High-energy infant feeds ( ∼ 1 kcal/ml) with a bal-
anced nutrient composition are a preferable alter-
native to adding energy in the form of carbohy-
drates or fat, which dilute the nutrient density
(content of essential nutrients per 200 kcal), par-
ticularly for infants who need a high energy and
nutrient density over prolonged time periods.

Children: Preferential Choice of Energy-
Dense Foods, Drinks and Snacks

• Energy-dense foods, e.g. deep-fried foods
  (French fries), fatty foods


• Energy-dense drinks, e.g. milk shakes, high-fat
  milk/chocolate drinks. For many children it is

easier to drink extra calories than to take them

with more solid foods

• Energy-dense snacks, e.g. ice cream without or
  with extra whipped cream, chocolate, choco-
  late mousse or energy-dense puddings (with
  cream), potato chips (fried in oil), nuts, nuts
  with raisins

Children: Options for Increasing the Energy

Density of Foods

Addition of Fats and Oils to Foods

Use of extra butter/margarine/vegetable oils/

cream/fatty cheese, e.g. extra fat, cream and

cheese with vegetables, starchy foods, milk prod-

ucts. Increase the concentration stepwise accord-

ing to individual tolerance.

Disadvantage: The supply of essential nutri-

ents per kilocalorie is reduced and may not always

be sufficient, particularly for catch-up growth.

Addition of Glucose Polymers to Drinks and

Semisolid Foods

Glucose polymers can be added in stepwise in-

creasing concentrations up to 5–10 g/100 g (19.5–

38 kcal/100 g) for preschool children and up to

10–15 g/100 g (38–58.5 kcal/100 g) for school-age

children to drinks (e.g. milk, tea, juice) and semi-

solid foods (e.g. soups, pureed vegetables). In-

crease the concentration stepwise according to

individual tolerance.

Disadvantage: The supply of essential nutri-

ents per kilocalorie is reduced and may not al-

ways be sufficient, particularly for catch-up

growth.

Use of Liquid Feeds with High Energy and

Nutrient Density

High-energy liquid feeds (sip feeds, ∼ 1–1.5 kcal/

ml) with a balanced nutrient composition are a

good alternative, particularly for children who

need a high energy and nutrient density over pro-

longed time periods.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 320–321
DOI: 10.1159/000375193