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As a follow up to our “Failure to Thrive: My child is underweight, what should I do?” blog, I would like to further explain the product Duocal. It may be a good option for a child with failure to thrive (or FTT) as well as other conditions such as multiple food protein intolerance and conditions related to food allergies such as Eosinophilic Esophagitis (or EE), Gastroesophageal reflux disease (or GERD), and Atopic Dermatitis (or AD).

Duocal is a high calorie, protein-free powdered nutritional supplement that can be added to foods or beverages when additional calories are needed to gain adequate weight. Keep in mind that Duocal is not a formula and should not be used as a sole source of nutrition.

Duocal is made up of carbohydrates and fats. It is flavorless and super soluble so there are no changes to the taste and/or texture of the food it is being added to (which also helps with diet compliance). The Duocal 400g can comes with a scoop which provides about 25 extra calories per scoop.

The reason Duocal is unique is the fact that it does not contain proteins. This is important for a child who needs extra calories due to FTT or weight loss secondary to severe food allergies (keep in mind; only proteins can cause an allergic reaction).

Duocal is 100% milk free and is made in a milk free environment to ensure tolerance. Duocal is for children ages 1 and over. The amount of Duocal you or your little one may need per day is to be determined by your doctor or dietitian. The amount of Duocal needed per day really depends on what the specific nutritional needs are for the patient. Duocal is for children ages one year and older, so it can be used throughout ones life stages.

Duocal can be mixed with a wide variety of foods. Here are some quick tips on how to use Duocal to get you started.

(These are approximations, please check with your doctor or dietitian for exact amounts) When using

Duocal for:

· Beverages: Add 2 scoops of Duocal per 4 fl oz.

· Toddler Foods: Add 2 scoops of Duocal per ¼ cup of food.

· Mashed potatoes: Add 3-4 scoops Duocal per ½ cup of mashed potatoes.

· Soups: Add ~6 scoops of Duocal for a 16 oz serving (or one can) of soup.

The MyDuocal.com site has a lot of helpful recipes and complete nutritional information to help you better understand how to incorporate Duocal into your child’s diet.

Have you tried Duocal before? What kind of recipes did you make with it? We are always excited to hear of new ways to use Duocal in helping patients thrive.

Christine

As a parent, it’s hard to hear that your child has been diagnosed with Failure to Thrive, often written as “FTT.” I often talk to parents who are confused by the diagnosis and not sure exactly what it means, so I thought I’d take the time today to answer some basic questions.

For those who don’t know, FTT is a medical term and is used to describe poor weight gain over an extended period of time. It is often used when diagnosing infants, children and the elderly.

What’s the background on Failure to Thrive?

FTT has been used for more than a century when diagnosing those who are unable to grow or maintain their weight properly; however, it still lacks concise guidelines because it describes a condition and not a disease.

Most diagnoses of FTT are in infants and children and can be a result of something else that may be going on -- such as food allergies. The first few years of life are very important for growth and development; therefore it is important to ensure that your little one is gaining the proper amount of weight and has proper nutrition. Most babies double their birth weight by 4 months and triple it by age 1; however, children with FTT often don’t meet those milestones and are lagging on their growth charts.

What causes Failure to Thrive?

FTT can be the result of a variety of social and medical factors.

Social Factors. With obesity on the rise, many parents fear that they are “over-feeding” their children, so they may restrict calories. You will be happy to learn that children (especially young ones) are excellent self-regulators. They lack the desire to eat simply because food is present or out of boredom, which many of us do not! They eat out of necessity and because their body needs the nutrients the food will provide. With that said if you have a young child, follow their hunger cues. If you feel that they are gaining weight too quickly later in life, you may want to consult your doctor or dietitian.

Medical Factors. Most often FTT is caused by allergies or GI conditions such as:

• Gastroesophageal Reflux Disease (GERD), which can cause an irritated esophagus which may cause a child to refuse to eat;
• Chronic Diarrhea which causes the body to rapidly lose important nutrients and calories provided by food;
• Food Allergies to proteins in things like milk which require a restrictive diet that may lead to the inability to maintain or gain weight; or
• Illness when the body goes into overdrive trying to fight the infection, using up all of the nutrients it has stored to do so.

How is Failure to Thrive treated in infants and children?

Depending on the cause of FTT, it may be easier than you think to help your little one gain the proper weight he or she needs to get back on the growth charts. If it’s caused by a disease or condition such as GERD, Short Bowel Syndrome or a milk protein allergy, you may want to introduce an elemental formula such as Neocate. This will not only aid in weight gain, but can also help with the condition itself. Another option would be to add a product that contains additional fats and carbohydrates like Duocal. It is protein-free and virtually tasteless, allowing you to add it to foods or drinks consumed by the most picky and allergy-ridden eaters.

If you have been told that your child has FTT, make sure that you have your doctor note it on any medical necessity letter or documentation. This may provide some leverage when applying for reimbursement for elemental formulas.

Have any of your little ones been diagnosed with FTT? How are you helping them to gain weight?

-Nita

References:

http://kidshealth.org/parent/food/weight/failure_thrive.html# http://www.lpch.org/diseasehealthinfo/healthlibrary/growth/thrive.html

Born at just 34 weeks, Parker was a handsome baby. “The nurses would often tell me how beautiful Parker was as they were making their rounds through the NICU,” says his mother Cat.

But Parker, already a small baby because of his premature birth, started to lose weight soon after his arrival — losing over a pound off of his initial 5 lb. 11oz. birth weight. When his doctors tried new dietary measures to boost his weight, Parker started having gastrointestinal problems, with infrequent bowel movements and severe discomfort.

“He would go 4-5 days without a stool and be in extreme pain. Nothing helped, and his weight gain was very slow,” says Cat. “He went 12 days without a stool, and was admitted to Children’s Hospital of Wisconsin for several days.”

Parker Before Neocate

When he was 8 weeks old, doctors suspected Parker was suffering from food allergies. After trying almost every other type of formula, including Nutramigen AA, Alimentum and Elecare, Cat did some research and decided to ask her doctor about Neocate. He agreed it was a good option and they made the switch when Parker was 14 weeks old. “Instantly, Parker quit fussing and within a few weeks I could see a complete change,” says Cat.

At 7 months old Parker was diagnosed with Eosinophilic Gastroenteritis and Colitis, but his mom still doesn’t have all the answers concerning his condition. He still has severe anaphylactic reactions to a wide variety of foods. “Parker cannot digest any solid proteins, including those found in carrots, avocados, sweet potatoes, apples, wheat, grains and gluten,” says Cat. “And those are just the ones he’s tried!”

However, with Neocate to supplement his diet, Parker began gaining weight. He went from the 2^nd weight percentile for his age to the 33^rd in just two months. Now, at 9 months Parker is in the 67^th percentile.

Parker After Neocate

While Parker has a lot of challenges left to face, he has made some big steps in managing his condition. Best of all, he is no longer in such great discomfort because of his dietary problems.

“He still has some catching up to do developmentally,” says Cat. “But he is the happiest kid on the block thanks to Neocate!”

If you want to share your before and after photos, we’d love to see them! Send us an email at FoodAllergyLiving@shsna.com.