Paediatric Cystic Fibrosis (CF) – Increasing energy in your child’s diet

Introduction

Eating well is important for everyone, and is especially important for children with CF. Having a well-balanced, varied diet will help your child get the nutrients they need to stay healthy and grow.

Children with CF sometimes need extra energy, for example:

• When they have a chest infection and their lungs are working hard to help them fight infection and to prevent weight and muscle loss
• For a short period following an infection or illness, to help repair muscles and body tissues and help to re-gain weight
• If they are underweight, losing weight or not growing well

Some children with CF need extra energy to maintain a healthy weight, even when they are well.

How to add extra energy when needed

If your child is unwell or needs to gain weight offering some foods high in fat and sugar will help your child get the energy they need

• Choose full fat foods where possible, avoid foods labelled ‘low fat’, 'diet’, or ‘lite’
• Aim for 3 meals a day, with 2 - 3 nutritious snacks in between meals
• Offer 2 courses at mealtimes, a savoury course followed by a sweet course
• Large portions can be overwhelming, offer a small portion initially, offer a second helping if needed
• Have a variety of snacks readily available

Drinks

Encourage your child to drink frequently throughout the day

• Avoid offering drinks just before a meal or snack, as this may affect your child’s appetite. Offer drinks with or after meals and snacks, and in-between mealtimes
• Offer a selection of high-energy milky drinks, milkshakes or hot chocolate. Use full fat milk, then add cream, ice cream or milk powder, or use Channel Island, gold top milk
• Offer sugary drinks with meals to avoid damaging your child’s teeth

Breakfasts

Start the day by offering an energy boosting breakfast, suggestions include:

• Breakfast cereal, muesli, granola or porridge with full fat or gold top milk
• Sweet waffles, pancakes, croissants, pain au chocolate or brioche rolls
• Toast or crumpets with butter, jam, honey, chocolate spread or peanut butter
• Baked beans, cheese, avocado or scrambled or fried egg on toast
• Cooked breakfast, bacon, egg, sausages, hash browns, fried mushrooms, eggy bread.

If your child is not keen on eating early in the morning, offer a milky drink and biscuits as an alternative.

Main meals

Offer at two main meals each day, suggestions include

• Pastry, pies and quiches, sausage rolls, Cornish pasties
• Roasted or fried foods and foods fried in breadcrumbs or batter, chicken in breadcrumbs, fish and chips, roast potatoes, roasted vegetables, fried rice
• Cheese, cheesy sauces, lasagne, macaroni cheese, carbonara, pizza
• Higher energy meat and fish salmon, sausages and burgers and meat free alternatives
• Takeaway meals and fast foods are often higher in energy when compared to home cooked meals.

Desserts

Offer a high-energy dessert after each main meal, for example

• Full fat, Greek or luxury yogurts, creamy desserts, mousses, trifle, cheesecake, fruit fool, ice cream, tiramisu
• Cake or pastry desserts, apple pie, fruit crumble, jam tart, profiteroles, sponge pudding
• Milky desserts, custard, rice pudding or Angel Delight.
• Combine desserts; add custard, cream or ice cream to cake, pastry or fruit desserts.

Savoury snacks

Offer small portions of savoury snacks in-between meals, larger portions can be offered as a first course at mealtimes.

• Sandwiches, toast, toasted sandwiches, crumpets, try double fillings, eg ham and cheese, avocado and cream cheese or bacon and mayonnaise.
• Pancakes with savoury fillings, eg cheese and ham or cheese and bacon.
• Crackers, oatcakes or breadsticks with cheese, full fat cream cheese or houmous
• Cocktail sausages, sausage rolls, pork pie, scotch eggs, Pepperami, salami, cheese cubes, olives
• Crisps, chips or nachos with a cheesy dip or guacamole

Sweet snacks

Waffles or pancakes with sweet fillings, eg syrup, cream banana and chocolate spread

• pastries, croissants, jam tarts, mini apple pies
• Biscuits, cakes, cereal bars, shortbread, flapjacks, rocky road.
• Toast, crumpets or scones with butter and jam or chocolate spread, malt loaf with butter
• Full fat yogurt or fromage frais, custard pots or rice pudding or ice cream
• Toffee popcorn, dried fruit, coated raisins

Nutritional supplements

Your dietitian may recommend a nutritional supplement to boost your child’s intake; these are high in energy and are available as milk, yogurt and juice style drinks.

Nuts

Nuts are an excellent way of adding extra energy to your child’s diet, whole nuts should not be given to children under 5 years old, as they are a potential choking hazard. If your child is under 5 years old use nut butters instead.

Milk and dairy foods

Full fat milk and dairy foods such as yoghurt, cheese, fromage frais, custard and milk puddings are good choices. These are rich in energy and also protein, calcium, and vitamins. Jersey (‘gold top’) milk is the most energy dense. If your child has a plant based alternative to cow’s milk choose higher energy options, ask your dietitian for advice.

Fats and oils

Monounsaturated and polyunsaturated fats can help protect against heart disease, try to use these where possible. Monounsaturated fats are found in olive and rapeseed oils and spreads, avocados and seeds and nuts such as almonds, cashews and hazelnuts, Polyunsaturated fats are found in sunflower oils and spreads, oily fish such as salmon, mackerel, sardines and nuts such as walnuts, almonds and peanuts.

Fruit and vegetables

These provide vitamins and minerals and are an excellent source of fibre; however, they are low in calories and can be very filling. Offer higher energy options such as roasted or stir-fried vegetables, vegetables in cheese sauce, or with added butter, oil or spread. Serve fruit with custard, cream, evaporated milk or Greek yogurt. Incorporate fruit and vegetables into other dishes, eg apple crumble or lasagne.

Fortifying foods

Many dishes can be easily fortified, choose from the following options

• add grated cheese, cream cheese, sour cream, crème fraiche or cream to foods such as soup, mashed potato, pasta and chips
• add olive or sunflower oils or butter or spreads to vegetables and potatoes and pasta
• use extra butter or margarine on toast, bread and sandwiches
• use oil based dressings or mayonnaise with salads
• add pesto to pasta, rice dishes and vegetables
• instead of grilling or baking or steaming food, try frying in oil or butter
• add creamed coconut or tinned coconut milk or ground almonds to soups and curries

Enzymes (Creon)

If your child takes enzymes, it is important they take to appropriate amount with food and milky drinks to ensure the nutrients are absorbed. Additional enzymes will be needed with higher fat foods; your dietitian will be able to give you more advice.

If you require any further information, please contact your dietitian.

Department of Nutrition and Dietetics: 01223 216655.