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

Happy Thanksgiving!  This month, my colleagues Sarah, Mallory, Christine and I decided to do a series of “Why I’m Thankful” blogs.  I hope my post finds you in good health and enjoying the long, holiday weekend!    

To start off, I am thankful for my family and friends — without them I would not be the person I am today.  They bring support, happiness and laughter into my life.    

Like Mallory, I am also thankful for the improvements in science and how far we’ve come.  When I was a little girl, I suffered from milk allergies and was very underweight.  My family did everything they could to ensure I gained weight properly and I was able to thrive without milk in my diet. Still, it was quite a struggle, as I’m sure you know firsthand from your experiences with your little ones!  Like so many allergy kids, as time passed I finally outgrew my allergies and eventually I even outgrew my nickname “Spaghetti Legs”.  This came as a huge relief to both me (after years of being unable to do so, I could finally eat ice cream!) and my family.

Neocate formulas and Duocal would have been optimal for my growth; however, they were not available when I needed it.  Both Neocate and Duocal provide families with options I did not have when growing up with a milk allergy and underweight.  Families can rely on our hypoallergenic, amino acid-based formulas and not have to worry that their child isn’t getting the proper nutrition they need to grow properly.  Although I wasn’t able to benefit from Neocate or EO28 Splash, I am so thankful the families I talk to everyday are able to feed their children these formulas which are able to alleviate some of the stress of parenting a child with food allergies. 

Lastly, I’m thankful for you!  Since starting here at Nutricia, I have learned more about your families, and been able to provide resources and assistance to make your lives easier.  It has been a joy getting to know you and helping your little ones!    

What are you thankful for this Thanksgiving?

- Nita

You may have read Sarah’s “Why I’m Thankful” post last week. If you missed it, we are doing a series this month where we each share what we are thankful for in our own lives. This week is my turn!

I’m thankful to be living in a time with such advanced medical care. Every day I work with families of children whose lives depend on a special food or a special way of receiving nutrients. It scares me to wonder what happened to these children before we had such technology. Some of our Neocate users are allergic to just about everything. Before there were amino acid-based formulas, how could these children thrive or in some severe cases, even survive?

This issue also touches me on a personal level. My little sister, Caroline, has special needs and has depended on various products of technology throughout her life. When she was little, it was a struggle to get enough calories into her and she grew very weak, falling further and further off the growth charts. Her doctor prescribed Duocal, which allowed her to get enough calories to maintain weight and stay healthy. She now has a feeding tube due to dysphagia (swallowing problems) and she is doing great with it! The development of enteral nutrition has allowed children who can’t physically ingest food to get all the nutrients they need to survive and thrive – another great example of an obstacle that medical advancements have allowed us to overcome!

How have medical advancements/technology been a blessing to your family?

- Mallory

Hearing “failure to thrive” (FTT) from a doctor can be disheartening for parents. Unfortunately, when babies and children have food allergies, it can be hard to make sure they are getting all of the nutrients they need to grow. And I often get phone calls from confused parents who are not sure what they can give their child to ensure they get all the necessary nutrients when they are allergic to so many key foods.

Because of this, FTT, a term used to describe the children who have failed to develop and grow as expected, is a common, but extremely fixable, symptom of babies and children with food allergies.

For more information on FTT, click here.

Since FTT often occurs because a child is not receiving adequate calories, a high calorie supplement is needed. This is where Duocal, a high calorie, protein-free nutritional supplement that can be added to foods or beverages, comes in. This milk-free product is great for little ones who have milk protein allergies and are on specialized formulas. However, it can be given to children who are not taking formula as well and is perfect for those children who just require a little catch-up growth.

Do you want to know the best thing about Duocal? It’s an unflavored powder so you can add it to your child’s normal diet! That’s right busy moms — there isn’t any additional cooking on your end and you don’t have to worry about your child not liking it. You can just add it to whatever your child is eating.

If you feel like your child has been missing that one last piece of the nutritional puzzle, a supplement like Duocal, or a similar supplemental medical food, could be right for him or her. And remember, products like this should be taken under medical supervision.

For complete information on Duocal, click here.

Do you have any questions about FTT or Duocal? Please send them my way!

- Christine