With SPOON Foundation established, Cindy and I began to explore our options for helping to improve the nutrition of institutionalized children. Our original idea was to ship multivitamins to Baby Houses in Kazakhstan, but we quickly realized this idea had several problems; most importantly it was not a sustainable model. We also needed to make sure that the multivitamins were an appropriate intervention, and we were not qualified to make that judgment. Luckily for us, Dr. Dana Johnson from the International Adoption Clinic at the University of Minnesota took an immediate interest in SPOON’s new Orphan Nutrition Project as did several of his colleagues. Our medical advisers, along with our partners in Kazakhstan, helped us plan a more sustainable model of intervention, one that relied on local resources and aimed to answer a question that surprisingly hasn’t been answered before now: what is the best way to improve the nutrition of orphans overseas?
Even though many of the children appeared to be getting sufficient macronutrients, our initial analysis determined that they needed more fat, calories, and protein. We were somewhat surprised to find out that these chubby, stocky kids were malnourished. I was reminded of the time I was chided by an orphanage doctor for feeding Bakha an orange: “If you keep feeding her, she’ll get fatter and never walk.” She couldn’t walk because of rickets. She looked stocky but didn’t have an ounce of fat on her. She had a slightly chubby appearance because of stunting which is a condition sometimes seen in preemies and internationally adopted kids in which their frame is too small for their weight. The children are not chubby from excess fat, but from excessively short length. Stunting reflects not just inadequate calories, but also hormonal changes, triggered by stress hormones such as cortisol, that stunt linear growth. It is probably a mixture of stress and malnutrition that produces the body type that mistakenly leads parents to think that their adopted children are well-nourished.
When Bakha came home at age 5 weighing 28 pounds and only 32″ tall, her developmental pediatrician encouraged me to feed her a diet high in fat, calories, and protein, the same type of diet that children are encouraged to eat when they’ve been diagnosed with “failure to thrive.” She assured me that the calories would go to height and not girth. Here are some of the tips I followed to increase fat and calories (for more tips click here):,
- Top crackers with cream cheese, hummus, cheese spread, egg salad, or meat spread.
- Sprinkle parmesan cheese in soups, on vegetables, meat, or pasta.
- Puree legumes and add to sauces and soups.
- Add yogurt to a fruit shake.
- Fold butter or oil into pasta, meat, vegetables, hot cereal, and rice.
- Add avocados to sandwiches or mash them up for a dip. Puree into yogurt or smoothies.
- Stir in some hemp or flax seed oil to sauces, soups, or a fruit shake.
- Whisk salad dressing, whipping cream, or cream cheese into scrambled eggs before cooking.
- Add a tablespoon of cream or coconut milk to 1 cup of milk or milkshake.
- Buy whole fat dairy, such as yogurt, cream or cottage cheese.
- Use whole milk instead of water when preparing hot cereals or soups.
- Cod liver oil comes in many flavors and can be hidden in yogurt and smoothies.
The pediatrician was right. The extra calories all went to height. I punched up Bakha’s food with so many extras, she grew like a weed.
Here is Bakha, age 5, standing next to her 3 year old cousin. This was taken the day after we got home:
And here are the two of them 16 months later. You can see that Bakha’s high-fat, high-calorie diet went straight to height.
Do you have tips for sneaking extra nutrition into your child’s food?