What About Drinking?

After the first year, most children do not need to rely on infant formula or breast milk to achieve good nutrition. At this point, children can have whole milk to drink. Children with CF should not be offered reduced-fat milk, as the greater fat content and calories of whole milk are needed for good growth and nutrition.

Here are some other tips:

• Limit the amount of water. Water does not have the calories your child needs.
• Limit juice to 4 ounces per day until your child is 6 years old. It does not have the same fat and calories that are found in whole milk. Children also may learn to favor the sweet taste of juice over milk, which may lead to them not drinking milk.

What About Eating?

At this age, your child can eat any food, as long as it is in a form that is safe for him to chew and swallow. This includes soft and ground meats, chopped finger foods, soft-cooked vegetables, and well-cooked pasta. Boost calories by adding butter or olive oil, cheese, cream, gravy, mayonnaise, dressing, or peanut butter.

Here are some examples of high-calorie finger foods:

• Noodles with Alfredo sauce (with butter, cream, and cheese)
• Grated whole-milk cheese
• Crackers with cheese or peanut butter
• Blueberry muffins
• Pancakes or waffles
• Sliced avocado
• Scrambled eggs with cream cheese
• Tuna or egg salad sandwich with mayonnaise
• Breaded fish or fish sticks

Let your child use a child-sized spoon. He can practice holding it as you feed him. The more practice, the faster he will learn to eat on his own. Try offering spoon-thick foods such as these:

• Ice cream
• Whole-milk cottage cheese or yogurt
• Pudding made with whole milk and cream
• Thick cream soups (potato, cheese, broccoli)
• Mashed avocado and refried beans

Be sure to offer small safe pieces of finger foods and supervise your child so he doesn't choke. Chunks of hot dog, raw apples, grapes, carrots, raisins, candy, and popcorn can cause choking.

Breakfast gets the body ready for the rest of the day. Try to offer two different types of foods for breakfast, such as scrambled eggs and bacon or sausage, or fruit packed in heavy syrup.

You can offer three different types of foods for lunch and dinner. Try offering food such as bite-sized chicken, green beans with margarine or butter, pasta or a grilled cheese sandwich, and soft fruit.

Offer two to three snacks a day. Always serve snacks that require enzymes so your child can get the high-calorie and high-fat diet he needs to grow. Toddlers with CF lose more salt when they sweat than toddlers who don't have CF. Add salt to your child's food and plan salty snacks, like pretzels.

Try not to let your child “graze” (eating and drinking small amounts throughout the day). Allowing your child to eat outside of regular meal and snack times can lead to many challenges. It makes it harder to give enzymes if he is always eating. Your child will also not be as hungry during meals. This can lead to eating less at meals.

Meals at Daycare

If your child is in daycare, plan high-calorie meals and snacks with the daycare center staff. Tell them why your child needs extra calories. You may have to send extra high-calorie foods, if the daycare menu can't be changed. Daycare center staff should give enzymes before meals and snacks and should report changes in bowel movements.

What Do I Do If My Toddler Refuses Enzymes?

Some toddlers don't want food and enzymes mixed together. If you are having this trouble, try giving your toddler just the beads in a spoon or small medicine cup before meals and snacks. Enzymes should not be chewed or crushed. Do not put beads in food ahead of time for use later that day.

If your toddler refuses enzymes, try giving him some choices and control. Let him open up the capsules and pour the beads out. Let him choose the food and mix it with the beads.

If your child still refuses to take enzymes, talk to your CF dietitian. When fat is not absorbed, fat-soluble vitamins are not absorbed. Your toddler may need a prescription for special multivitamins that have more easily absorbed forms of vitamins A, D, E, and K. Some children refuse the liquid multivitamin but will take it in a small amount of juice or food. For older children, there are chewable multivitamins.

Measuring Your Child’s Growth

Growth charts help your child’s care team track your child’s growth. At 24 months, your child’s care team will measure her or his growth using a different growth chart than they did when your child was younger. Because each chart is different, your child’s percentiles may change. The handout, “Understanding Growth in the First Two Years," can help you understand the different growth charts your child’s care team may use and help you when you discuss any questions you may have with your care team.