Children with cystic fibrosis (CF) often have poor weight gain. This can happen even when they get enough calories. Infections, breathing problems, and the body's inability to take in certain nutrients (malabsorption) can all lead to the need for extra calories. Children with CF should have a diet high in calories. With extra calories, most children with CF are able to grow and develop normally.

Children with CF should eat 3 meals and 2 to 3 snacks a day to help meet their calorie needs. Adding extra fat to meals and snacks can help meet these needs. Pancreatic enzymes will often be needed to help digest this food. These are often given as pills at mealtime.

You can add extra calories to your child's meals and snacks with these steps:

• Add butter, margarine, or vegetable oil to:
  • Breads, toast, crackers, or sandwiches
  • Potatoes, hot cereals, rice, noodles, soups, or casseroles
• Add sour cream to:
  • Potatoes, rice, pasta, or vegetables
  • Use as a dip for vegetables, or chips
• Add mayonnaise to:
  • Sandwiches or crackers
  • Dips, salad dressing, or sauces
  • Meat, fish, eggs, or vegetable salads
• Add cream cheese to:
  • Fruit slices, raw vegetables, bread, toast, or crackers
• Use heavy creams in:
  • Soups, sauces, batters, custards, puddings, shakes, mashed potatoes, or cooked cereals
• Use whipping cream on:
  • Pancakes, waffles, fruit, ice cream, pudding, hot chocolate, or other desserts
  • Mix in cream soups, hot cereals, mashed potatoes, pudding, and custards
• Add brown sugar, maple syrup, or syrup to:
  • Hot cereals, cold cereals, fruits, ice cream, or puddings
  • Use as a glaze on meats, or vegetables
• Add powdered milk to:
  • Cereals, potatoes, cream soups, eggs, puddings, gravy, and casseroles
  • Add 2 to 4 tablespoons of powdered milk to 1 cup of whole milk to make super milk
• Add cheese to:
  • Sandwiches, burgers, toast, crackers, eggs, potatoes, noodles, and snacks
• Add peanut butter to:
  • Sandwiches, crackers, toast, fruit slices, vegetables, ice cream, or milkshakes
• Use high-calorie drinks, such as:
  • Homemade milkshakes or commercial liquid nutrition supplements

Vitamins are important for correct growth and development. Vitamins A, D, E, and K are known as fat-soluble vitamins. Many children with CF don't get enough of these vitamins from the foods they eat. That's because they have trouble digesting and absorbing fat. When this happens, your child may need to take extra vitamins. Your child's doctor can advise you about the type and amount of vitamins to give to your child. There are vitamins specifically made for children with CF. Ask your child's doctor for more information.

Your child will need additional iron and calcium during puberty and when their bones are growing. Zinc is also important to your child's growth and wound healing ability. It also helps the immune system work correctly. Discuss your child's vitamin and nutritional supplement plans with the doctor and CF dietitian.

Children with CF need extra salt in their diets. This is because they lose more salt in their sweat than other children. Add extra salt by using the salt shaker at meals and including salty foods and snacks. These include chips, pretzels, fast foods, French fries, pickles, nuts, and lunch meats. Extra salt intake is important in the hot weather, when children are playing outside and sweating.

Sometimes children with CF don't grow or gain weight even with a high-calorie diet. This can happen if your child's appetite is poor, they have frequent infections, or your child has malabsorption. Tell the doctor if feeding your child butter, sour cream, cream cheese, or other fatty foods leads to symptoms of malabsorption (see below).

Symptoms of malabsorption include:

• Bloating
• Passing gas (flatulence)
• Bad-smelling stools
• Belly pain
• Watery diarrhea

If your child can't eat enough food for normal growth and development, then they might need supplemental oral or tube feedings, as directed by your child's doctor. For short-term feedings, your child may have a small tube inserted through the nose and into the stomach. The tube is called a nasogastric tube. You can then give your child a high-calorie formula or supplement through this tube.

Some children with CF need calorie supplements over a long period of time. In this case, a feeding tube (gastrostomy or G-tube) is placed through the stomach wall. Talk with your child's doctor for more information.