This is part 3 of a 3 part series on calorie packing.
Part 3 Calorie Packing For Bigger KidsA nutritionist is generally going to first look to liquid calories first as they are easier to quantify. Liquid calories are awesome, but sometimes REALLY hard to get into a stubborn kiddo (like mine). If you can do liquid calories, fantastic. There are a number of great options out there. Smoothies and shakes are a great way to hide nutrition and calories in a quick drinkable form. My favorite recipe page is the Golisano Children's Hospital recipe page. In general, avocado, oils, nut butters, heavy cream (a little goes a long way), and protein powders are a great way to calorie pack any liquid shake. However, you should talk with your nutritionist to make sure you balance how you add calories into your child's diet. You don't want to overload their system (for example, too much protein can be hard on the kidneys). Beyond home made smoothies and shakes, there are a range of high calorie commercial drink options. First, of course, there is the ubiquitous carnation instant breakfast. This standby is a pediatric goto for getting kiddos to up their calorie intake. From there, you can get into some boxed drink options like pediasure, ensure, and boost. The creamy type drinks can also be made into ice cream and shakes. If your child doesn't like the creamy/milk based drinks, there are some commercial options for you as well. Boost Breeze is a juice based option and comes in a variety case of 3 flavors. Ensure Clear is another clear drink option which last I checked came in apple or mixed berry.
My child, of course, would have none of that easily quantifiable liquid calorie intake. Instead, we were stuck with calorie packing our solid food offerings. This is, to me a more difficult proposition. Especially if your child (like mine) won't take anything of a liquid or puree consistency. In general, your calorie packing options for solid foods revolve around heavy cream, butters and oils. We found, for example, that adding coconut oil to dole fruit cups would make them taste like pie filling. Cheese is another great option for calorie packing. My son's spaghetti always got an extra dose of olive oil and a large helping of cheese. For anything that uses eggs, you can add extra egg yolks, which is a great way to boost calories in baked goods. In general, calorie packing in the solid food arena is all about unobtrusive additions of oils and fats. My rule of thumb has been to add coconut oil to anything sweet and olive or rice bran oil to anything savory.
In my kiddo's case, we got pretty desperate to add calories, so I went into the full on medical calorie packing options. The main options here are Benecalorie and Duocal. I found that Benecalorie was pretty dang gross and for me, not much better than an oil when added to food. Duocal on the other hand, was awesome. We could send it to daycare so they could add it to his lunch. Also, in small quantities (we found about a scoop per 5 oz water) it can add calories to water without really affecting the taste. Every little bit counted, so "white water" became our goto drink.
In the end, one of our best tools has been Periactin as an appetite stimulant. Periactin is an allergy medication that has a side effect of boosting appetite (it can also help with cyclic vomiting issues). Over time, the side effect of appetite stimulation wears off. We have found that taking one week off per month gets us the best bang for our buck. The down side is that the first 2-3 days he goes back on Periactin are pretty miserable. He's tired and grumpy, and super hangry. We get a lot of weight gain, but a few days of the grumps at the same time.
I found that the focus on eating has led to a lot of anxiety and stress over the whole eating and weight process. My best defense has been to employ the Ellyn Satter Division of Responsibility in Feeding. I have to be careful to find balance, because if I completely relax, he tends to stop growing, but if I pay too much attention, I make myself crazy.
We have recently started working on recreating foods he likes with purees. Check out the cookbook Deceptively Delicious for more information.
I hope this helps, please let me know if I missed anything or if you have any questions.