Dietary Recommendations

Below are educational resources regarding dietary recommendations for babies with faltering weight. For additional resources on the diagnosis and management for faltering weight, see the CPG homepage.

• Providers should estimate the adequacy of calorie intake by comparing observed or recorded consumption of foods and beverages with age- and sex-based energy requirements. Based on these estimations, caregivers of children who are not meeting energy requirements should be educated on appropriate strategies for providing increased calories of foods.
• Infants who are taking baby cereals can be served these items fortified with infant formula instead of plain water.
• In older children and infants eating solid foods or pureed foods, calorie-dense additives such as oil, avocado, cream, butter, peanut butter can be served to increase energy density.
• Caregivers should also be educated on factors that can impede intake of adequate calories from healthful foods. Children should be assessed on volume of fluids consumed as excess fluid intake may lead to inadequate intake of foods.  Certain fluids—such as sugar-sweetened beverages (soda/pop, tea, Kool-Aid), juice, milk, and even water—may need to be limited, since they can suppress the appetite for solid foods.
• Factors that support diet adequacy should be reviewed with caregivers. These include structured family mealtimes and modeling of preferred mealtime behaviors. Families should be instructed on avoidance of grazing, force feeding, or catering to limited food preferences.
• Caregivers who are instructed to offer high-calorie foods should be advised of the importance of regular follow-up to monitor for excess weight gain and the importance of continuing to offer a variety of healthful foods. Adjustments to foods served should be made if excessive weight gain occurs.
• Refer to a dietitian to help implement high-energy, high-protein nutrition therapy.
• Can use oral nutritional supplements high in energy and protein to provide 25-50% of measured or estimated energy/protein needs.
• Have family keep a food journal to track protein/energy intake for a specified period of time.
• Children can become selective in their food choices to express their independence and desire for autonomy.  Offer the same type of food multiple times and in a variety of forms to increase acceptance.

Additional Resources

• HealthyChildren.org
• Pediatric Nutrition Care Manual (PNCM®) from Academy of Nutrition and Dietetics
• Dietary Guidelines for Americans
• My Plate