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Boosting fat and protein intake in cmpa toddler with reflux and feeding issues


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#1 Wonderstruck

Posted 05 March 2019 - 05:36 PM

Hi all.

Looking for ideas for fat and protein intake in cmpa toddler with reflux and feeding issues.

Lily is 2, has severe reflux and is non-ige CMPA (dairy and soy). She can currently tolerate baked dairy but wont try anything else further up on the dairy ladder like cheese and yoghurt.

Her weight gain was sluggish as a baby but improved once she was changed to allerpro baby formula at 8 months and then alfamino/alfamino junior.

Secondary to to the severe reflux and misgiving vomiting and allergies she has feeding issues. Water is a daily struggle and we cant do any mixed textures so she still lives of puree and separate finger foods (no sauces, mashed foods, spag bol etc. We see a speechie and dietitian for this.

She was doing well late last year and we weaned off alfamino junior to oat milk.

Unfortunately, we had a check up in mid Feb and she hadn't gained weight since Nov and her iron was at all time low.

We are back on maltofer and see the speechie and dietician in the coming weeks.

I am now putting half allerpro in her bottles for the fats and protein till we see the dietician and speechie. We only do 180x2 as it's her main calcium source but we dont want to fill her up either.

How do I get my texture/feeding issue child to eat more fats and protein. She cant do soy and has refused them whe  we have tried to challenge the allergy, doesnt like avocado etc and the replacement milks and yoghurts she likes (oat milk and almond milk yoghurt) are low in protein and fat.

She is also getting her bottom molars and her chewing is going backwards.

Looking for ideas.

Please also no advice about being strict or how BLW is the only way and that I shouldn't have ever offered purees - we practice division of responsibility as per our dietician and speechies advice and offered finger foods from a young age and she has poor oral skills and a host of aversions due to severe reflux so that's not the way here.

#2 JBH

Posted 05 March 2019 - 05:47 PM

Would she eat avocado? A smooth humous with plenty of olive oil? Both are high in fat and calories and might fit into her preferred textures.

#3 Ellie bean

Posted 05 March 2019 - 05:47 PM

sorry I’m no help as my dd’s restrictions were not as severe but have you checked out the RISA website www.reflux.org.au I believe they have recipes, and I know there are mums there with similar journeys
My dd pretty much lived off pepti junior to almost 3 when she suddenly became willing to eat if that gives you any hope! (of course I know all kids are different)
How about coyo, or something like the chocolate and coconut Weiss bars that are dairy free?
Good luck, it sounds very tough and I’m sure you’re doing a fantastic job

#4 Riotproof

Posted 05 March 2019 - 05:53 PM

I’m not sure how you might feel about it, but my ds likes avocado chocolate mousse. It’s rich so I add a can of coconut milk. You could obviously reduce the sugar
https://www.wellplat...ocolate-mousse/

Does she like mash? I make mine with unsweetened soy and nuttelex but before I found the soy, I found it worked really well with chicken stock as the liquid. Can also use olive oil.

If she can have eggs, does she like them scrambled? Or a custard with her preferred milk? You could fortify it with a suitable protein powder assuming they have appropriate ones.

If she’s able to have nuts, you can get some very smooth ones now. Could also be used to make biscuits/pancakes.

Edited by Riotproof, 05 March 2019 - 05:55 PM.


#5 Wonderstruck

Posted 05 March 2019 - 05:53 PM

She wont eat avo which is a shame and went off coyo which is annoying. I'll have to try them again as well as hummus which she wont eat.

Thanks Ellie Bean - looks like formula might need to fill some gaps while we work on the textures...so exhausting

Weird kid doesnt like mashed potato or hot chips...or cake!

She wont eat custard and doesnt love eggs. She does love peanut butter which she has on non day care days as they are nut free.

She eats a touch better at day care but still not great.

Edited by Wonderstruck, 05 March 2019 - 06:00 PM.


#6 BBC

Posted 05 March 2019 - 06:22 PM

Would she eat some sort of pikelet or pancake made with almond flour or coconut flour to up the protein/ fat level?
With peanut butter or Nutella maybe?

#7 22Fruitmincepies

Posted 05 March 2019 - 06:23 PM

Will she have smoothies? You can hide avocado in them, and freeze into icy poles too (I’m trying to get my 15mo reluctant eater to try new flavours in icy poles, and having some success).

#8 cabbage88

Posted 05 March 2019 - 06:39 PM

Firstly- allerpro is really not great for a severe CMPA. You need pepti junior or get off it altogether- it's likely causing the weight gain issues by keeping her gut inflamed. Allerpro is only partially broken down. My kids reacted to it although obviously not as bad as fill diary formula, it still kept them reflux and sick. If it was a newborn you would try elemental formula but a 2YO won't take it because it tastes terrible.
We fattened them up with-
Stopping all formula (even pepti junior- the fully hydrolysed formula, next up from allerpro and on script) made them sick.
Chia pudding with coconut cream
Coconut yoghurt
Pancakes made with banana egg oats chia seed kale all blended up
Chocolate slice made with cocoa fat, seeds, ground almonds nuts etc
Apricot balls- made with almond meal, coconut, seeds whatever in food processor with sweet condensed coconut milk

#9 Wonderstruck

Posted 05 March 2019 - 07:03 PM

View Postcabbage88, on 05 March 2019 - 06:39 PM, said:

Firstly- allerpro is really not great for a severe CMPA. You need pepti junior or get off it altogether- it's likely causing the weight gain issues by keeping her gut inflamed. Allerpro is only partially broken down. My kids reacted to it although obviously not as bad as fill diary formula, it still kept them reflux and sick. If it was a newborn you would try elemental formula but a 2YO won't take it because it tastes terrible.
We fattened them up with-
Stopping all formula (even pepti junior- the fully hydrolysed formula, next up from allerpro and on script) made them sick.
Chia pudding with coconut cream
Coconut yoghurt
Pancakes made with banana egg oats chia seed kale all blended up
Chocolate slice made with cocoa fat, seeds, ground almonds nuts etc
Apricot balls- made with almond meal, coconut, seeds whatever in food processor with sweet condensed coconut milk

She was on amino acid formula but is tolerating small amounts of dairy now and didnt try allerpro till after her weight slowed. She actually loved elemental formula but I haven't refilled the script yet as she was on the toddler version which her dietician and gastro thought as it's a complete food and she cant eat most things it wasnt necessary anymore.

I'll give some of those things a try and see how we go. Thanks for the ideas.

Edited by Wonderstruck, 05 March 2019 - 07:04 PM.


#10 QuirkyMum

Posted 05 March 2019 - 07:13 PM

I'd try organic chicken/lamb bone broth.
Add some salt and bay leaf and a touch of black pepper.
If you use whole chicken or at least chicken leg, it will have lots of fat. Added salt will make her want to drink ( Grandma's way to teach kids to drink more water by making them thirsty this way).
I freeze mason jars (from Bonne maman jam) of broth, then defrost, reheat and my toddler drink it from the jar.
We also use this stock for adding to rice, veggies, lentils, mash because we can't use dairy milk/butter.

OP, I know coconut products are trendy now:) They are also safe for many people with allergies.
I have really bad atypical/silent reflux ( bad enough to be hospitalised as an adult), so does my first son. I cannot tolerate coconut yogurt and some "fresher" coconut products ( overcooked coconut milk in curry and sweets made from dry fine flakes are somewhat ok). Dietician said it is not uncommon. Many people have intolerance to coconut and it can  make reflux worse. But more often coconut fat makes people sick because it is harder to digest than any other vegetarian source of fat and than some animal fats ( like fatty salmon will be digested more easily).
So even though it is technically safe, I was told to try and introduce it with caution( to my son who was little at that time).
My DS1 refused it though and only tried it when he was 5 or 6 years old and didn't like it ( and felt heavy after coconut rice so never again: ( ).

Edited by QuirkyMum, 05 March 2019 - 07:26 PM.


#11 PrincessPeach

Posted 05 March 2019 - 07:18 PM

Expensive, but would she be willing to try eating say lamb from a cutlet?

Good option for protein & iron in one hit, although you need to include something with vitamin c to assist the body with the iron absorption.

#12 QuirkyMum

Posted 05 March 2019 - 07:33 PM

View PostPrincessPeach, on 05 March 2019 - 07:18 PM, said:

Expensive, but would she be willing to try eating say lamb from a cutlet?

Good option for protein & iron in one hit, although you need to include something with vitamin c to assist the body with the iron absorption.
Good point, PrincessPeach!
My DS1 ate only limited number of products and I bought him lamb cutlets and salmon and prawns ( just for him) even though they were expensive, but these were his protein and fat foods.
I'll never forget how other mums at preschool attacked me that i dare to waste! so much money on his food and feed my child what he would eat and not what is given ( vegimite sandwich and yogurt - to GF and dairy free kid, yeah).

#13 SplashingRainbows

Posted 05 March 2019 - 07:43 PM

I’ve had two kids now with oesophagitis. Food aversions is their number one sign. Treating the oesophagitis has led to an increase in foods eaten.

Where is the reflux treatment at? Does it need review? She’s not going to want to eat anything if she knows it makes her feel sick.

#14 #mocha

Posted 05 March 2019 - 07:47 PM

My daughter is older but has suffered reflux for years.  Try poached fish or chicken. Steamed or raw veggies.  Small servings.   She hardly eats fats as they make her feel worse.

#15 Wonderstruck

Posted 05 March 2019 - 07:50 PM

View PostQuirkyMum, on 05 March 2019 - 07:13 PM, said:

I'd try organic chicken/lamb bone broth.
Add some salt and bay leaf and a touch of black pepper.
If you use whole chicken or at least chicken leg, it will have lots of fat. Added salt will make her want to drink ( Grandma's way to teach kids to drink more water by making them thirsty this way).
I freeze mason jars (from Bonne maman jam) of broth, then defrost, reheat and my toddler drink it from the jar.
We also use this stock for adding to rice, veggies, lentils, mash because we can't use dairy milk/butter.

OP, I know coconut products are trendy now:) They are also safe for many people with allergies.
I have really bad atypical/silent reflux ( bad enough to be hospitalised as an adult), so does my first son. I cannot tolerate coconut yogurt and some "fresher" coconut products ( overcooked coconut milk in curry and sweets made from dry fine flakes are somewhat ok). Dietician said it is not uncommon. Many people have intolerance to coconut and it can  make reflux worse. But more often coconut fat makes people sick because it is harder to digest than any other vegetarian source of fat and than some animal fats ( like fatty salmon will be digested more easily).
So even though it is technically safe, I was told to try and introduce it with caution( to my son who was little at that time).
My DS1 refused it though and only tried it when he was 5 or 6 years old and didn't like it ( and felt heavy after coconut rice so never again: ( ).

Our dietitian wasn't a huge fan of the coyo as its a lot of fats and not much anything else. I think she didn't love it as its so rich.

#16 Wonderstruck

Posted 05 March 2019 - 07:52 PM

View PostPrincessPeach, on 05 March 2019 - 07:18 PM, said:

Expensive, but would she be willing to try eating say lamb from a cutlet?

Good option for protein & iron in one hit, although you need to include something with vitamin c to assist the body with the iron absorption.

I'll have to try that. She ate a little lamb off a souvlaki the other day which was new but she gets lazy with chewing.

I'll have to keep at her to encourage the chewing, she was doing well so I backed off a bit but shes off it again. The speechie at day care has been trying too.

#17 Wonderstruck

Posted 05 March 2019 - 07:54 PM

View PostSplashingRainbows, on 05 March 2019 - 07:43 PM, said:

I’ve had two kids now with oesophagitis. Food aversions is their number one sign. Treating the oesophagitis has led to an increase in foods eaten.

Where is the reflux treatment at? Does it need review? She’s not going to want to eat anything if she knows it makes her feel sick.

She was on a whopping 40mg Somac from 14 months to 2 - split into 2 20mg doses (morning and night) (prior to that really under dosed by doctors) - weaned to half as per her paed gastro and she seems to be sleeping OK and happy - the gastro wanted her off completely but has decided to stay on the half dose until we sort eating.

She's considering booking in a scope at our visit in May if things haven't improved. She hasn't been scoped before.

#18 SplashingRainbows

Posted 05 March 2019 - 08:04 PM

Who was the check up with in mid Feb? Your paed gastro or someone else?
If the paed hasn’t seen her for a while I wouldn’t hesitate to be in contact.

2 is a hard age as many toddlers are naturally fussy at that age.

Is OT worth looking into if chewing is an issue. They may have some ideas.

#19 a letter to Elise.

Posted 05 March 2019 - 08:08 PM

I went through similar issues with my daughter (now 6), but with additional allergies (nuts,wheat, and legumes).

She was on weight gaining regimens all through the toddler years, and we still have to go back to it sometimes.

I used to make baked chocolate custard, with egg, coconut milk, mashed bananas and cocoa, which she loved. You just put in in the blender, wiz it up, then bake until firm. I baked it in silicone cup cake trays, in a baking dish with a little water at the bottom.

She also loved avocado and banana chocolate mousse, and liked to dip things in it, like berries.

Lots of soft baked things, like banana bread or muffins.

Potatoes baked in lots of olive oil

Smoothies - I added a suitable formula to these.

Getting her involved in baking helped. She loved making cookies, and was keen to try what she'd made. This helped with her being willing to chew things.

Tasting plates, with no pressure to actually eat things, but encouragement to see how they felt in her mouth.

Lamb cutlets.

It's still a bit of a battle at times. She doesn't eat any vegetables except potato, and won't eat anything that is mixed together (stew, stir fry, curries, bolognaise etc). I serve everything to her separately. If her eating is very poor, she goes on a vitamin supplement, and I make the things I know she loves to try and encourage her.



#20 Wonderstruck

Posted 05 March 2019 - 08:09 PM

Was with her paed gastro.

Her day care has an OT visit once a week. I'll ask

#21 Riotproof

Posted 05 March 2019 - 08:20 PM

View PostWonderstruck, on 05 March 2019 - 07:52 PM, said:



I'll have to try that. She ate a little lamb off a souvlaki the other day which was new but she gets lazy with chewing.

I'll have to keep at her to encourage the chewing, she was doing well so I backed off a bit but shes off it again. The speechie at day care has been trying too.

What about pulled meats? Lamb, pork and chicken, beef brisket  all work well slow cooked and shredded.

#22 MooGuru

Posted 05 March 2019 - 08:22 PM

DS needed increased fats and proteins with CMPI. He was a little younger and didn't have the texture issues.
I'll have a search if I've still got the notes from the dietician if you want? (although they were useless in many respects there were a few good ideas)

We used neocate for cooking so in mashed potatoes etc.

Would she suck on bones? DS used to love gnawing on the bone and he'd get bits of the marrow (I was grossed out watching it).
Is mince too chunky? We got told to use the lower grade mince as there's  more fat (but possibly lower nutritional content)

He went nuts for mashed potato with the sauce from like a goulash, he'd eat the chunks of meat too.

Mashed bananas with neocate and peanut or almond butter.

IF you get offered a dairy free protein shake type drink CHECK THE INGREDIENTS.  The one the hospital used and said was dairy free was actually lactose free and made with Whey protein.

#23 Wonderstruck

Posted 05 March 2019 - 08:36 PM

View PostRiotproof, on 05 March 2019 - 08:20 PM, said:

What about pulled meats? Lamb, pork and chicken, beef brisket  all work well slow cooked and shredded.

The biggest struggle I have is we both work full time and she eats at 5 - usually from frozen batch cooked stuff... as winter comes  I'll probably do more of that sort of us - main thing is to take it out of the sauce

Definitely worth a try!

#24 iwanttosleepin

Posted 05 March 2019 - 08:51 PM

Does she do frozen things?  You could make ice blocks.

#25 Riotproof

Posted 05 March 2019 - 09:04 PM

View PostWonderstruck, on 05 March 2019 - 08:36 PM, said:



The biggest struggle I have is we both work full time and she eats at 5 - usually from frozen batch cooked stuff... as winter comes  I'll probably do more of that sort of us - main thing is to take it out of the sauce

Definitely worth a try!

On the weekend, you could cook up a big roast in the oven, low and slow or slow cooker or pressure cooker and then portion it out to freeze.



I really hope you get a solution. I understand worrying about weight gain, and allergies but reflux is not in my experience. I apologise if I suggest something obviously not suitable based on that.




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