Help My Child Gain WeightDietary advice for children who need extra nourishment

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Dietary advice for children who need extra energy

Dietary Advice For Children Who Need Extra Nourishment

Some children grow more slowly than expected, this may be because your child:

• Cannot manage to eat enough food, for example due to a poor appetite

• Has higher energy needs, for example due to illness

Although this can be very worrying, try not to get too anxious about what your child is eating. Your health professional (Health Visitor, School Nurse, GP or Consultant) can refer your child to a Dietitian.

Please note that the advice in this leaflet is for children who need extra energy, therefore it is not recommended as advice for the whole family.

What can Ido to help?

Eating a combination of foods from each food group will give your child all the nutrients they need. Your child also needs extra energy from foods that are higher in fat and sugar

If your child has a poor appetite it is important to offer small meals and snacks – give 3 meals and 3 nutritious snacks each day

Always offer a savoury and dessert course at each mealtime

If your child is only able to manage small amounts at mealtimes, follow the“Energy boosting tips” to make sure that these foods contain as many calories as possible

Offer more foods higher in fat and sugar – rather than low fat, low sugar or diet varieties

Make meals colourful and interestingOffer small portions of

food as children with poor appetites can be put off by larger portions – a second helping can be given, if requested

Try not to make a fuss if your child does not eat and never force your child to eat as these often make things worse

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Constipation

Try to serve fruit with another high-energy food, for example:- Bananas with cream or fromage frais- Stewed fruit with full-fat custard or evaporated milk- Apple crumble with custard or ice cream- Fruit, such as strawberries, dipped in chocolate

Roast vegetables in oil as an alternative to boiling

Try grating or meltingfull-fat cheese over vegetables

Add double cream to vegetable soups

Serve sticks of raw vegetables with a dip or hummus

Melt margarine or butter over vegetables

Serve a cheese sauce (made with full-fat milk and full-fat cheese) with vegetables, for example cauliflower cheese or broccoli bake

Add salad oils or dressings to salad vegetables

Top pizza with vegetables and make sure you add extra cheese

Constipation can contribute to poor appetite. To prevent this:

• Offer fruit and vegetables regularly with the high-energy foods, as these are a good source of fibre

• Make sure that fluid intake is adequate

• Alternate wholemeal breads and cereals with lower fibre versions

However, do not give your child bran as it can interfere with the absorption of essential minerals such as calcium and iron.

Always try to offer fruit and vegetables with the majority of meals and snacks. Fruit and vegetables give you vitamins A and C, fibre and some contain a little iron. Avoid overcooking or soaking vegetables because this can destroy some of the nutrients. Generally, fruit and vegetables do not contain much energy and can be quite filling, so always try to offer high-energy foods at the same time.

Fruit and vegetables

Dietary Advice For Children Who Need Extra Nourishment

Constipation

Energy boosting tips

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Breakfast is a very important meal as it gives us the energy boost we all need in the morning. Good choices for a high-energy breakfast include:

• Cereal with milk (add extra cream and sugar)

• Spread toast, chapatti, crumpets or pancakes thickly with margarine or butter with extra jam, honey, marmalade, chocolate spread or lemon curd and a glass of milk

• Cooked breakfast

Serve one of these foods with each meal. These include breakfast cereals, bread, potatoes, chapatti, pasta, rice, couscous, millet, yam, cornmeal, cassava or green banana. Foods made with flour, for example pizza bases, buns and pancakes, are also in this group.

These foods will give your child plenty of the starchy carbohydrate that is needed for energy. They also provide B vitamins, fibre and some iron and zinc.

Bread, rice, potatoes,pasta and other starchy food

Dietary Advice For Children Who Need Extra Nourishment

Breakfast

Try having roast potatoes or chips

Fry left-over boiled or mashed potatoes

Add extra butter, cream or cheese into potatoes or yam

Add melted butter to pasta and then servewith meat, tomato or cheese sauce with extra grated cheese

Use fortified breakfast cereals, for example cornflakes, Rice Krispies, Shreddies or Weetabix served with full-fat milk (extra cream can be added to milk to increase the calorie content)

Spread butter or margarine thickly onto bread, hot toast, chapatti, pitta bread, plain biscuits, crackers, fruit loaf, bagels or crumpets (see below)

Add jam, marmalade, chocolate spread, lemon curd, cheese spread or peanut butter to give even more energy

Energy boosting tips

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Don’t cut off visible fat before cooking because this will help boost the energy content

Leave chicken and turkey skin on because it contains a lot of fat for extra energy

Try to fry meat dishes rather than grilling or baking, eg sausages, beef burger

Tuna (preferably in oil), cold meats, pastes, pâtés, mashed sardines, hummus or peanut butter make great sandwich fillers or use them on toast spread with butteror mayonnaise Fish is quick and easy to

cook – fish in batter will provide more energy, fry fish fingers or serve fishin a white sauce

Eggs can be fried or scrambled (with extra cream added)

Omelettes or eggy bread are different ways to serve eggs (extra cheese and cream can also be added to these)

Many children prefer meat to be soft and moist, such as in shepherd’s pie, meatballs,spaghetti Bolognese or lasagne – you can also add extra cheese on top

It is important to offer iron-containing foods regularly.

• Good sources of iron are red meat, pork and chicken, and fortified breakfast cereals

• Iron is also found in: - Oily fish, for example sardines, mackerel and salmon mashed or baked potatoes, pasta, savoury flans - Pulses such as lentils, chickpeas and beans - Egg yolks - Dark green leafy vegetables

• Iron is absorbed better from meals which include foods high in vitamin C, for example oranges, tomatoes and fruit juices

• Avoid giving tea to drink with meals as it reduces the absorption of iron

Offer your child foods from this group at least twice-a-day. These foods provide protein to help your child to grow. They also provide iron, zinc, B vitamins and vitamin A. Some also provide good sources of omega-3 fats.

Meat, fish eggs, beansand other non-dairysources of protein

Dietary Advice For Children Who Need Extra Nourishment

Iron

Energy boosting tips

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Young children can sometimes seem to want drinks when really they are hungry. Too many drinks can fill your child up, which can reduce their appetite at mealtimes. Alternatively children who don’t drink enough can develop constipation which can reduce their appetite. Water is the best drink to quench thirst:

• Frequently offer drinks from a cup, after food, instead of immediately before or with meals• Aim for around 600mls (1 pint) of milk per day as it is nutritious and full-fat milk is high in energy• A small drink (125mls) of pure unsweetened fruit juice with meals, is a useful source of vitamin C – children under 5 should have this diluted one part water to one part juice• Fruit juice drinks, squash and fizzy drinks, including low-sugar varieties, have limited nutritional value, can damage tooth enamel and contribute to tooth decay

Offer your child three servings of milk, yoghurt or cheese each day. As well as giving your child extra energy these foods provide protein, calcium, B vitamins and iodine.

Milk and dairy foods

Dietary Advice For Children Who Need Extra Nourishment

Milk is a very nutritious drink (use full-fat milk rather than semi-skimmed or skimmed milk as it contains more energy)

Adding cream or ice cream into full-fat milk will provide even more energy

Choose full-fat yoghurts, yoghurt drinks, fromage frais or ready-to-eat desserts, as a pudding or snack between meals – extra cream can also be added to these

Avoid low-fat or cottage cheese Cheese is very high in energy

- Try grating cheese or adding full-fat soft cheese into scrambled eggs, mashed or baked potatoes, pasta, savoury flans- Add cheese to a white sauce to make macaroni cheese, cauliflower cheese or cheesy broccoli bake

- Grated cheese, cheese spreads or cheese portions can be used as sandwich fillers, on toast or as a snack

- Cheese can be added onto burgers or extra cheese added on top of pizzas - Use paneer in curries and serve with full-fat yoghurt

Drinks

Energy boosting tips

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Fats and oils contain the most energy and should be added to meals and snacks to boost your child’s energy intake.

Sugar and sugary foods are high in energy and will help to boost your child’s energy intake. However, parents are often worried that these foods will cause damage to teeth. Tooth erosion and decay can be prevented by:

• Giving milk (full-fat) and water as the main drinks

• Offering sugary and/or sweet foods with other foods as part of a meal, rather than as snacks

• Brushing your child’s teeth twice each day and visiting the dentist frequently

These foods will provide the best source of energy, although they have fewer nutrients. When using fats and oils, choose ones with a high content of omega-3 fats, for example olive oil, walnut oil and rapeseed oil.

Food and drinks highin fat and / or sugar

Dietary Advice For Children Who Need Extra Nourishment

Fats and oil

Energy boosting tips

Sugary foods

Spread butter or margarine thickly on bread, hot toast, crumpets, pancakes and crackers

Add chocolate spread or peanut butter for more energyFry chips rather than using oven chips

Cream can be added to full-fat milk to make an extra creamy drink or poured over breakfast cereals, used in porridge or instant oat cereal

Cream can also be stirred into puddings, for example custard, rice pudding or yoghurts, or whipped and added to hot chocolate drinks

Always offer a pudding after a meal, for example cake, biscuits, jelly and ice cream, fruit pies or crumbles

Instead of grilling, baking or steaming foods, fry them in oil or margarine to increase the calorie content, for example sausages, burgers, fish fingers and eggs

At meal times, try to include sugar in puddings or desserts and sprinkle over cereals

Encourage pastry foods such as apple pies, sausage rolls, steak pie and quiches

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Snacks Salty foods Vitamins Allergies

Very few children have reactions to foods or food additives, and restricting foods unnecessarily may be harmful. If you think your child is intolerant to any food, consult your health professional, who may refer your child to a Dietitian.

• All children under five should have vitamin drops containing vitamins A and D. For information on NHS Healthy Start vitamins see:

www.healthystart.nhs.uk • Vitamin drops should be available at your NHS health centre and retail pharmacies sell a range of them• If your child is taking vitamin and mineral supplements, make sure you give the correct dose for their age, according to the recommendations on the label • Be careful about using more than one preparation as the Recommended Daily Allowance (RDA) may be exceeded

Offer your child a small high-energy snack in between meals such as:

• Toasted bread fingers or biscuits with peanut butter, cream cheese or cheese spread

• Cheese cubes or cheese triangles with crackers or chapatti

• Breadsticks with cream cheese, hummus or peanut butter

• Small sandwiches

• Full-fat yoghurt, fromage frais or cream with fruit slices

• Vegetable-based crisps and nuts

• Eating too much salt on a regular basis can contribute to developing high blood pressure in later life• Snacks high in salt (also shown on labels as sodium) should be limited• Use mild spices and herbs to flavour foods rather than adding salt at the table or in cooking

Dietary Advice For Children Who Need Extra Nourishment

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Main points for happy, healthy mealtimes• Plan meal and snacks so your child eats regularly – this will allow them

time to build up appetite and they won’t be too hungry or too tired to eat

• Offer a variety of foods from each of the food groups each day as this will provide them with the range of nutrients they need

• Offer two courses at lunch and the evening meal

• Make meals colourful and interesting so they are fun and appealing

• Allow enough time for meals, however do not let meals drag on too long

• Whenever possible eat together as a family so everyone can enjoy the meal and make it a social occasion

• The space you have to eat should be clean, warm and bright and free from distractions such as television, computer games and toys

• Offer small portions of food on a small plate as many children are

put off by large portions

• Use appropriate sized cutlery, plates and cups – this will help your child eat independently

• Try not to use favourite foods as a reward to encourage children to eat foods they do not like as favourite foods used in this way simply become more valued – instead reward your child for trying a new food with non-food items such as stickers

• Do not make a fuss if your child refuses to eat, this is a normal part of growing up – if you are concerned, talk to your Health Visitor, School Nurse or GP

c BDA Paediatric Group 2014, Illustrations Jan Smith

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