Is Your Child Underweight? Healthy Smoothie Alternatives To Pediasure, Ensure, Boost

Posted by on Mar 16, 2012

So your child is underweight, not eating well, not growing well. You’ve been told to give him calorie dense drinks like Ensure, Pediasure, or Boost; lots of butter, pudding, whole milk, and cream; and of course, lots of ice cream. Is this healthy?

Seeing these common recommendations is one of my least favorite findings as a dietitian in private practice working with kids. There are four problems here that can interfere with restoring your child’s robust health:

One, these drinks and foods are made with conventionally raised dairy products, which can contain bovine growth hormone, pesticides, traces of genetically modified feed corn proteins, and antibiotics, not to mention possible heavy metals from agricultural chemicals. All of these agricultural interventions have been linked to problems ranging from higher incidence of ADHD to earlier onset menses, other hormone disruptions in boys and girls, allergies, and neurological disorders.

Two, the child’s underweight status may be at least partly due to an undiagnosed milk protein intolerance or allergy – which irritates and inflames the gut, making nutrients and energy even harder to absorb. Be sure to get this sorted out before relying on any milk protein sources in your child’s diet.

Three, milk protein (casein) is often a constipating protein source, especially in children with some digestive insufficiency issues, like reflux or imbalanced gut microflora. Healthy gut microflora (bacteria) add enzymes to help us digest and absorb food, and keep bowel habits on track. If your child is unable to comfortably pass a soft formed stool most every day, then appetite can weaken – exacerbating the problem of packing in calories.

Last but not least – drinks like Ensure, Boost, and Pediasure rely on refined sugars and corn syrup (in various forms) to up their calories. I don’t like this because corn syrup is noted for containing a bit of mercury in every teaspoon, thanks to agricultural processing. Corn is also a genetically modified crop. Emerging research suggests that proteins in foods from genetically modified crops can trigger allergy. More allergy = more gut inflammation = more difficulty absorbing nutrients and energy = poor growth and gain. And, there is no sound argument for relying on refined sugars as a major strategy for growth and gain in children.

You can do way better.

First, make sure you are not battling undetected food sensitivities or food allergies. Get tested! You may need to avoid milk protein sources entirely, in order for your child to feel hungrier and digest more comfortably. Many labs and providers can assist with this, and this is a specialty in my practice too. Make sure you look deeper than just IgE allergy responses with a conventional MD allergist. For more information on this, see either of my books.

If eggs and nuts are allowable, get a powerful blender or food processor – the sky’s the limit, with those two ingredients adding creaminess without milk or ice cream. Everything on my list below is organic, no added sweeteners in the milk substitutes, and raw where possible. When using nuts, blend those first to smooth consistency with ice and a small amount of the recipe’s liquid. Then add remaining ingredients til smooth.

Banana Cream: ¼ cup raw cashews, 1/2 ripe banana, 1 cup almond milk, dash vanilla flavoring, 1/2 c crushed ice, 2 TBSP sesame tahini, 1/8 teaspoon stevia powder, hefty dash cinnamon. Add cacao nibs or if you don’t have those, organic mini dark chocolate chips (1 teaspoon) for additional zip. Blend ice, cashews, tahini, and 2-3 ounces of almond milk together first, until smooth and creamy. Add vanilla and remaining almond milk, and blend again til smooth. Add cacao nibs and blend to desired consistency.

Raw cashews, tahini, and banana with ice, almond milk, vanilla, and stevia make this smooth and creamy.

GI Soother: 2 peeled apples, 3 stalks celery with leaves, 5 mint leaves, 1/3 seeded peeled cucumber, 2 teaspoons ground flax seed or ½ teaspoon flax seed oil, ½ – ¾ cup white grape juice, 2 TBSP whole coconut milk, crushed ice

Not Latte:  1 cup organic brewed iced (decaf) coffee, 1 raw egg, 1/2 teaspoon maple syrup, 1 TBSP sesame tahini, 3 TBSP cashews, 3 ounces almond milk, 3 ounces whole unsweetened canned coconut milk, crushed ice

Power Peanut:    ½ soft ripe avocado, 1 TBSP cacao nibs, 1 TBSP hemp protein (such as Nutiva brand), 1 TBSP peanut butter, 3 ounces whole unsweetened canned coconut milk, 3 ounces almond or hemp milk, 1 teaspoon honey, crushed ice

Pineapple Smoothie: Fresh pineapple chunks ¼ cup, 1 ripe banana, 3 ounces whole coconut milk, 3 ounces unsweetened almond milk, dash vanilla, 2 teaspoons flax seed meal, 1 whole egg + 1 TBSP egg protein powder (option: try soaked hemp nuts in this one too)

These two are modified from a favorite book of mine called Raw Food Cleanse, which has several great recipes for smoothies, soups, and dips.

Soup Option, serve warm: ¼ cup raw cashews, 1 cup vegetable broth (such as Imagine brand organic), 6 stalks fresh young asparagus, 2 stalks celery with leaves, ¼ teaspoon fresh thyme leaves – blend all til smooth.

Pumpkin Navel:  ¼ cup raw pecans, 1 navel orange, ¼ teaspoon orange zest, ¼ cup pitted dates (soak these ahead of time to soften), dash vanilla, crushed ice, ½ cup almond milk, 2 TBSP cup cooked canned pumpkin puree, 1/2 teaspoon honey or dash stevia

Honeydew Lime Creamsicle: Click here for this really good smoothie – doubles as frozen pops in hot weather.

More ideas..

–       For any smoothie with fruits like kiwi, berries, papaya, peaches, pear, or mango, adding a raw egg or ground flax seed will create a creamy texture while adding healthy fats, protein, and minerals. Using egg protein powder is an option too. This will make your smoothies fluffy and creamy at the same time, but won’t add the fats you might like.

–       Raw nuts blend to a nice creamy consistency with the right tool – a powerful blender, Vitamix, or Bullet mixer. Soak raw nuts (and seeds) ahead of time if you like a more smooth, less grainy texture.

–       Hemp seeds, flax seeds, chia seeds, and cacao nibs are up and coming as alternative sources of protein, healthy fats and oils, and minerals. Add these to any smoothie to boost nutritional value along with calories.

–       Wean sugar-holics off their favorite processed calorie booster drinks by making your own without any added sugars: Instead of honey, maple syrup, or molasses, switch to an organic stevia powder, which is potently sweet at a tiny dose. One eighth teaspoon is enough to sweeten an 8 ounce blended drink. Add cinnamon in larger amounts – 1/4 to 1/2 teaspoon – to kick up the sweet and benefit from cinnamon’s blood sugar modulating effects.

–      Unconventional but healthy options for sweeteners in smoothies can create the creamy texture kids like, plus add extra fiber, vitamins, and minerals to smoothies. Try left over baked sweet potato (skins removed), cooked canned pumpkin, or leftover roasted mashed parsnips, which have a surprisingly pleasant and gentle sweetness when prepared this way (easy, fast, and good; use ghee, not butter, for extra sweetness and to avoid dairy protein).

–       Cook brown rice in whole coconut milk with honey, nutmeg, and cinnamon for an alternative to all the pudding your child may have been told to eat. Use a slow, low heat method and add almond or coconut milk to the liquid if needed during cooking. An hour or more of slow cooking may be needed.

–       Use coconut milk to make mild (but calorie laden) curry sauces that can go over favorite chicken or fish dishes.

–       A good blender or VitaMix will turn raw nut pieces into a creamy smoothie, but organic nut butters are an option if using whole raw nuts is too gritty a texture for your child.

–       Get the benefit of butter without the allergy or GMO hassle by using organic ghee (clarified butter). Pricey, but when you need it, you need it. Ghee has a sweeter taste than butter that isn’t clarified.

–       Skip the soy. Even if it isn’t genetically modified, it’s a frequent allergy offender, just like dairy protein. And there are endocrine effects from soy that are concerning enough for me to suggest that parents don’t use it as a major daily protein for a child. Translation: A serving here or there is fine, but don’t use it as your child’s protein source at every snack and meal daily. Soy protein is a common addition to bottled smoothies, energy bars, and protein powders.

–       If multiple allergies are in the picture – and nuts, eggs, and seeds are out – then work with a knowledgeable nutritionist who can assist with using essential amino acids, medium chain triglycerides, and safe oils to build smoothies around tolerated carbohydrate sources like ripe peaches, pears, avocado, plums, or winter squashes and pumpkin.

These options will give your child several nutrients, healthy fats, more protein, and calories to burn that are head and shoulders above some corn syrup, vitamins, and milk from a cow raised on chemicals. Remember that poor appetite and weak growth pattern can be signs of deeper problems with the GI tract, digestion, absorption, or inflammation. For strategies to sort these out, see either of my books, or get in touch. Troubleshooting growth pattern is one of my specialties in practice.

70 Comments

  1. Dont forget quinoa.

  2. I’m surprised coconut oil nor avocado were mentioned as smoothie add-ins.

  3. Elizabeth, so true! Both avocado and coconut get a lot of mention in my books. Avocado was a big help for the boy pictured here. -Judy

  4. Do you know how many calories are in a serving of your shakes that are listed on the page? And how much would a serving be. Trying to substitute them for my 14 month old daughters 8 ounces of PEdiadure required a day
    Thanks

    • Hi Janice, Pediasure gives 240 calories and 7 grams of dairy source protein. Any of these recipes are designed to be at that level or higher, with the exception of the GI Soother. That one is intended to gently stimulate and support digestion with the celery, mint, and cucumber, and introduce minerals and vitamins in the fresh greens. If your daughter likes those flavors, it’s easy to add more coconut milk (the unsweetened canned type) and a scoop of organic whey powder, if that’s tolerated. If it’s not, move to egg protein powder or hemp powder, and use products without added sugars or flavors.

  5. What a great article. I am always hesitant when parents are giving their kids these pre-made drinks, and you have made making your own very approachable with lots of options.

    In your banana cream smoothie recipe, it calls for 1/8 cup of stevia powder, is this maybe supposed to be 1/8 tsp?
    Thanks!

  6. what would you suggest for a 21 month old that wont take anything like milk? (mainly drinks, will eat chocolate puddings and yogurt) and only eats yellow/white foods?

    • Ask your doctor for a referral to a pediatric OT (occupational therapist) who can check if there are any oral motor glitches. Is chewing developing normally? Are teeth coming in on time? Is the tongue moving food correctly to back of mouth when chewing? These sorts of things are what pedi OTs do; they can make sure your child is ready for more diverse textures. If your insurance doesn’t cover this, contact your local Early Intervention Program, which can provide this service for free or at a reduced rate. If your child won’t take milk, that’s perfectly okay – there are other even better sources for the nutrients in milk – as long as you can get your child to eat them. If you can’t, supplements can bridge the gap until appetite improves. It usually improves once the child’s gut microflora is in balance. This is a big piece that gets a lot of attention in my practice – if you’d like more help, I can do that with an appointment.

      • Thanks Judy – I will be calling your office to coordinate that.
        Thank you! Demarie

    • Would love to know if your son/ daughter’s eating improved and how. Concerns are similar for 28 month.
      Drinks milk but eating is so restricted is very worrying. Waiting referrals at this time. Looking for hope!

      • Happy to help anytime Lesley. My son is now in college and yes his eating improved. You don’t need a referral to work with me unless you are restricted to staying within your insurance network’s offerings for dietitians/nutriitonists. You can pay out of pocket for my services if that is an option also; I accept credit cards or HSA cards and can give you an insurance coded statement to submit if you like.

  7. Love this article and the work you are doing! Have you thought of this? Many times these children end up on feeding tubes and the same products you mention as being so horrible are the same ones used for enteral nutrition. This leaves parents feeling they have no choice at all than to give these products to their child if they want to “feed” them. Will you please share our product, Liquid Hope? It is the world’s first organic whole foods feeding tube meal, nutritionally dense and no added sugar! Liquid Hope can also be used orally. This product is helping many children and adults alike and we would be grateful if you would let your readers know there is a choice.

    • Thank you Robin! I do work with tube fed children and families who would like alternatives to the commercial formulas. In those cases I will construct a “modular” option from whole foods, with the attending MD team’s approval, that is specific to that child’s situation. It does work nicely, and needs close monitoring. The goal ultimately is to wean off the tube by correcting underlying feeding, digestion, and absorption. For sure, families working with tube feelings will want to check with their MD team on any changes.

  8. Do you have a recommendations as a substitute of the tahini if one is allergic to sesame seeds? Thanks for the recipes!

    • Two things: Some thorough testing, and, other seed and nut butters. So: Are all nuts out? I would look for any tolerated nuts by testing both IgG and IgE responses (requires a blood draw). Or, many report success checking these with non-traditional modalities when drawing blood is too much trauma for a baby or child (muscle testing with kinesiology, or biological impedance machine – both are very practitioner dependent). Under the age of about 18-22 months, the IGG testing can be less reliable, but in my experience, very helpful after that point in guiding choices for non-inflammatory foods. Elimination diets for nuts can be dicey since reactions to them can be dangerous, so testing first is my preference. Once that info is clear, then we can see if we can use stuff like almond, macadamia, cashew butter and so on. If not, consider butters from sunflower or pumpkin seeds. Choose raw not roasted if you can, to avoid any other cross contamination from roasting oils. These are more bitter than nut oils so you will need to add stevia or honey.

  9. I would love to try these with my son but he has SPD and only takes in whole milk through a bottle and only eats certain stage 2 baby foods plus Greek yogurt. His diet is full of dairy but that’s all he will take in. He is 4 and we’ve worked with OT’s and Speech therapists since he was born. Any other ideas on how to add these sorts of things to his diet?

    • NONE of the kids I meet in my practice want to eat new foods! Many if not most of them are in your son’s same boat (as was my own son when he was little). Your son’s SPD as well as his rigidity for textures can be both symptoms of and responsive to underlying nutrition and gastrointestinal deficits. Not that that is the whole story, but it is a workable and essential piece. Support the underpinnings of all this in the body and the appetite will follow – best suggestion I can offer is to pick up a copy of Special Needs Kids Eat Right or Special Needs Kids Go Pharm Free. Both are also widely available in libraries nationwide. You might especially want to check the section in the Eat Right book on milk-addicted kids, and how to break that cycle. Relying so exclusively on dairy doesn’t give kids all the nutrients they need to learn and thrive to potential.

      • Judy – I just got your book today and specifically started reading about the milk-addicted kid. I am in shock b/c this is my son! And I am frustrated no one has ever talked to us about this. We even spent a month at the STAR center in Colorado and never heard this. We live in the Seattle area, do you have any recommendations of dietitians or medical professionals that could help us here?
        My son was a 24-weeker, lost 1/3 of his small intestine, is blind from retinopathy of prematurity and has SPD. I plan to share your book with our current feeding therapist.
        Thanks,
        Demarie

        • Demarie, thank you for letting me know. I’m sorry to hear this has been so hard. It is my experience too that in most mainstream settings, milk is regarded as healthy, and indeed milk protein is relied on in many commercial formulas for children with gastrointestinal disease. While it is sometimes checked for allergy (IgE reaction), usually it is not screened for triggering sensitivity (IgG reaction), which can be particularly devastating for newborns. It is virtually never screened for triggering excess casomorphin, something you can do with a simple urine test. The casomorphin is what creates the milk “addiction”. Many children have both – immune reaction and casomorphin excess – from milk protein. I don’t know of resources in your area to recommend. I am happy to help and often do this via Skype for distance clients, as long as local MD supervision is in the loop. Many families work with me this way.

  10. THANKS!! We fight for every ounce on my son and am always looking for good, healthy ways to add the weight. Looking forward to trying some of these as he loves smoothies and milk shakes.

    • Hi Dawn, good for you guys for working so hard at it! If appetite is picky, work strategies to improve that, and he will naturally want more food. Your son’s gut microbial ecology may be working against him – those are the bacteria in the gut that help us digest food, help the immune system, and keep the pH of the digestive tract in an optimal zone for digestion and absorption. When the wrong bacteria or yeasts take over, they tilt the pH, and kids don’t feel like eating (they end up with stomach acid that is too weak to break down food or trigger hunger!). They will have weak picky appetites and reflux. Reflux meds only worsen the problem especially if used long term (more than 3-4 weeks). Check Special Needs Kids Go Pharm Free for a section on busting that cycle.

  11. Do you have non-nut recipes. My guy handles nuts, but school is nut free. He eats 3 meals a day there and I find it hard to make up the calorie difference in one meal at dinner (that is if he wants to eat come dinner time).

    • My current favorite spots for recipes are PaleoPlan.com, NourishingMeals.com, and BalancedBites.com – those do have recipes with some nuts, but many without nuts too, and most of the recipes are either grain free, gluten free, or dairy free, which many kids in my practice need (based on lab findings). If your son is able to eat anything except nuts, he has a lot of options! Start by browsing the recipes at those sites for new inspiration. They emphasize ample healthy fats (which will help boost calories for your son), new ideas for presenting vegetables, and all sorts of ideas for lamb, pork, beef, and more.

  12. I have a 2.5 year old that will only eat bacon cream of wheat, orange cream yogurt and graham crackers. He drinks Pediasure and orange juice regularly but will drink most anything. He does not tolerate any textures in any food. Yogurt can’t have fruit etc. I worry about him. Nobody has been able to come up with any undead except to say he has autistic eating habits.

    • You’re right to wonder if this is adequate – it is marginal at best, for minerals, vitamins, and healthy brain fats. When a guy like your little one comes in to my office, I always ask for a food record to see if total calories and total protein are adequate too. These eating habits can and do change, with nutrition intervention, in my experience. I definitely check for food sensitivities (food allergies can be checked by a pediatric MD allergist, so I usually leave that to them), mineral status (low zinc and low iron will depress appetite), and again – that gut biome. Working corrections for these things will shift his appetite. See Special Needs Kids Eat Right for step-by-step info on how to do this, how to check if your child’s status for zinc or iron is low without blood tests, and how to find healthier new foods.

  13. Great article! My daughter was born with GI issues due to a CHD. She has GERD & eats mainly through a g-tube. My goal is work her off of the Pediatric Compleat tube formula made by Nestle. It’s first ingredients are water & corn syrup. Would you recommend these recipes for tube feeds as well? Suggestions welcome!

    • Hmmm, Compleat does have some dairy protein in it. What I have found is that when children are placed on Compleat and do not progress as hoped, the dairy is often the culprit. Persisting reflux is another sign that this might be true. You might explore ELISA IgG screening to rule out or confirm milk protein intolerance (not something most mainstream GI MDs do, except for gluten and gliadin only – not sure why this is true but that is my observation nationwide). I would do this test in your daughter’s case, and can support families via phone or Skype if travel is not an option (typical when there is a tube feeding schedule in the picture). Meanwhile, there are other dairy and soy free commercial options to replace Compleat if necessary (like Neocate or Elecare), but they do still have some corn syrup (which I don’t like because it’s genetically modified and because it usually contains traces of mercury). In those cases, if workable and permissible with a child’s care team, I will create a home made modular formula. I don’t know if these recipes here can be tolerated by your daughter without an ELISA IgG profile or other work up, but I can say they have worked for others in my practice as tube feeds.

  14. Judy- I was excited to see this article was written by you because I’ve been reading your book Special Needs Kids Eat Right. I actually stumbled upon it at the library. I’m finding it very interesting and think it can be helpful for my 5 year-old son. He has attention, behavior, and sleeping problems. He also has Aspergers tendencies. He is happy eating a ton of cheese and yogurt and raw vegetables and fruit. We’ve cut out gluten and are beginning to remove dairy. My question is which probiotics are good for his age? I can only find powdered for infants and toddlers and liquid, which is dairy. Which strains should I look for and can you recommend a brand? Thank you!

    • Whether a probiotic is going to be useful in your son’s case is something I can’t know without closer review of his case, but there are guidelines that you can start with. Which product to choose is something I fine tune with stool analysis in my practice when I can (I work in an office with an MD who authorizes testing when needed). Plus, some kids need both clearing of gut disruptive microbes (with prescription or non-prescription antibiotics, antifungals, antivirals) along with repopulating the good microbes (with probiotics) – that is, sometimes just probiotics alone won’t do the trick. Ultimately, it’s what we eat that determines the profile of bacteria we harbor in our intestines. If your son likes all that dairy, has no issues with constipation or loose irritable stool, no other signs of it triggering his immune system, and no particular functional challenges, then it may be fine if he continues to eat it as his major protein. Probiotics can help him digest it in any case. Start with a brand like Klaire Labs at a minimum of 25 billion CFUs per dose per day. Some kids in my practice go up to ten times that amount and do very well this way; others can’t. If your son has had several Strep infections, avoid blends containing Streptococcus thermophilus, as this may be less well tolerated. You can go to the Supplements section of my site and enter the on line dispensary there, and look over the products from Klaire on my list. If you order, be sure to request 10% off as you were referred by this blog, and skip the very costly chill pack shipping. Just store the probiotics in the fridge on arrival, and keep them there. There are chewables, powders, and capsules. Note: Don’t microwave or heat probiotics. If there is a history of any GI issues especially, let your doctor know you are using a new supplement.

  15. My son is 2 years old and only in the 4th percentile for weight.. His dr recommended increasing protein but it has not been easy because my son is such a picky eater! I have tried pediasure but I did not like the changes to his bowel movements so while looking for alternatives I stumbled upon this site. My son also seems to suffer from reflux, though the upper GI came back fine and allergy tests showed he was not allergic to dairy, soy, gluten, etc. we did see a GI specialist who said he could have an allergic reaction in his esophagus due to the dairy but we have not had an endoscopy to confirm. He frequently throws up in his mouth though and never seems interested in eating unless it is drinking milk or something sweet. We tried Zantac but it didn’t help.. It actually seemed to make his appetite worse. I just want to find out what to do next.. I would hate to put him through unnecessary dr visits and procedures. Not sure if this is related to his GI issues but he also gets car sick (vomits) and is extremely clumsy. Any suggestions as to what my next step should be in figuring this out? Thank you!

    • Unfortunately you are on the usual medical merry go round for these problems, but the good news is your son can get better. It sounds like there are undiagnosed food sensitivities (not allergies – that is a different immune response that is often negative when sensitivities are positive), as well as some unresolved gut dysbiosis. All of this can be treated and improved. Take a look at my book Special Needs Kids Go Pharm-Free and use the “See Inside” feature at that amazon link to check pages 111-115. Everything you’ve described here is addressed in this book, and some strategies given. You can buy the book used, new or pick it up at local libraries, many seem to have it. For more detailed help and support, I’m happy to help – your son’s scenario is my usual drill in practice 🙂 ! I love working with these kiddos because they can feel better relatively quickly. If you’d like to do that just schedule a consult any time.

  16. My 3 yr old daughter has a feeding tube and currently is getting tube feeds overnight (not during day to try to get her hungry and eating more). Can these recipes be used through a tube at a slow rate?
    We are concerned about the amount of corn syrup in her Pediasure, and lack of weight gain since she is not getting tube fed during the day. Thank you!

    • Hi Shirley, no reason why these can’t be used at night but you will want to be sure that they don’t clog the tube. Good practice is to always rinse feeding tube before and after feedings with 30-60 mL of water or whatever amount your MD has told you to use. Depending on when the pump starts at night you can observe for a time, and make sure it is working ok. Some things will tend to clog the tube more, like acidic foods/juices/sodas (which won’t be much help for your daughter anyway), and adding meds to feedings, but the “creamier” items here may be ok as long as consistency is thin enough for the tube to flow well. You can add water to the feeding to enhance the flow – this increases total volume (because you are needing to keep your calorie target and water will lower that) but if you are pumping all night at a slow pace, this can be done. Be sure to check with your care team. Also, you may want to do some work on discerning whether or not your daughter has a dairy sensitivity (IgG reaction). If she does, she will may not gain well on Pediasure, since this is a dairy protein formula.

  17. Great article! Thank you! I’ve been looking up calorie dense recipe ideas for my toddler and am kind of appalled at what I’m seeing, which is basically just recipes with tons of sugar and full fat dairy. :p My daughter has a lot of random allergies that make some of these recipes hard, but substituting or omitting some ingredients is easy enough, and you gave some great, unique ideas and touched on some important points. Thank you!!

  18. like to have more on milk allergic kids growth

  19. Thank you so much for your post, Judy. My underweight 7 year old son has a milk protein allergy and a very small appetite for anything healthy. I plan on trying your shakes to see if it will put some weight on him and who knows, he might actually like them. Here’s hoping!

  20. Judy, when pressed for time, can you recommend a non-dairy high-calorie supplement for a picky, underweight 7 year old on the go?

    • I don’t know if your son has allergies or sensitivities other than milk (common), but you can try Orgain vegan protein shakes. The protein sources are brown rice, chia, and hemp.

  21. Are these smoothies ounce for ounce calorie equal to pediasure, or one smoothie is equal to one 8 oz pediasure? We have been searching for replacements for my sons pediasure and are so excited by your article. Encouraging and full of great information, your knowledge gives us hope!

    • These all vary somewhat for calories, but all are intended to provide high calories per ounce (20 per more) and at least 7 grams of protein and 8 or more grams of fats/oils.

      • Great, I appreciate the response! My son has been loving the GI soother. We have absolutely noticed a difference already in getting rid of the pediasure. Do you have any recommendations for a good thickening substitute? My son has oral dysphasia and we have to thicken his purees, we are currently using thick-it (which we hate) or xanthan gum. you can reply here or email me directly.

        • Great – thanks for sharing the good news! Try adding a protein to this. You could drop in a whole fresh (hopefully local, organic) egg; egg powder; whey powder (if this is not a trigger protein for your son); or collagen protein. Egg and collagen powders both tend to make things fluffy and thicker. The GI Soother is the only one here that does not have as much protein, so this is a good place to start.

  22. My 2.5 yr old daughter doesn’t take milk at all…wat should i do

    • Not sure Deepika, I can help though if you’d like to make an appointment so I can trouble shoot for you and offer concrete suggestions.

  23. My 6-year-old daughter with ASD and seizure disorder has long struggled with constipation and has a strong gag reflex when presented with foods outside her very limited repertoire. I’ve tried to manage her issues without drastic measures by including oatmeal and organic baby food pouches (fruits and vegetables) as part of her daily diet. Over the past six to eight months, her food repertoire has shrunk even further, and her gastrointestinal issues have increased; more vomiting and complaining of tummy pains. She’s also lost some weight. We’ve seen her pediatrician, started probiotics (just yesterday), and have appointments with a pediatric gastroenterologist and an OT. I want to try some of your smoothies, but I’m worried that ingredients like mint or cacao nibs might cause her to reject them or vomit upon smelling or tasting. Will the banana cream and gi soother still taste okay if I eliminate the stronger flavored elements?

    • Your daughter would, in my opinion, benefit from a comprehensive nutrition intervention, as do most kids with autism who present as she does. This is my niche in practice; your GI doctor does not do this. S/He will probably look at whether she needs steroids, reflux medicine, Miralax, or a formula like Pediasure. You can see blogs on all these topics on my site for more info. Frankly, just trying new foods won’t help much, because your daughter will likely refuse them. You’re describing a picture that indicates she may have addictive foods (these have to go – completely), texture aversions, inflammation, and a disrupted gut biome. All can be reversed with strong nutrition intervention. And, all of these impede her developmentally, behaviorally, and for growth. Pick up a copy of my book Special Needs Kids Eat Right: Strategies To Help Kids On The Autism Spectrum To Focus, Learn, and Thrive. It will explain for you a soup-to-nuts step by step program to get your daughter eating, growing, behaving, and functioning better. There is information in this book as well on the seizure connection. Dive in! There’s loads of potential for your daughter.

  24. I just started making my daughter a berry/banana with milk smoothie in the mornings, as she won’t eat anything, she is 14, is it safe to add some egg whites to her drink and if so how much

    • If your daughter has no egg allergy or sensitivity, and if you have a trusted, clean source of local organic eggs that are fresh (or from your own chickens) then many feel that adding egg whites is okay – but why just the white? Yolks are very nutritious and if your daughter has a poor diet then I’d give her the whole egg in the smoothie. If you don’t have fresh local eggs or don’t know how to confidently ascertain that they are fresh then you can buy egg protein powder and use that instead. Meanwhile consider doing some footwork to fix her picky appetite – there can be many causes underneath this that are reversible. Contact me for an appointment if you’d like more help.

  25. My son with Down syndrome was primarily NG tube-fed for the first 16 months and has significant oral feeding difficulties. He is now 5-year old and still struggling with weight gain (only 29 lb.) and oral feeding difficulties/dysphagia. He is still struggling to make progress due to a significant hyper-gag reflex and hypersensitivity in the oral cavity. He tends to vomit on a regular/almost-daily basis, largely due to his gag reflex combined with a likely weak lower esophageal sphincter, reflux, and poor gastric emptying. His feedings are time intensive of every 1 to 1-1/2 hour interval given the significant volume he is required to consume in order to maintain his growth and hydration. Due to small tolerate amount, he can only tolerate small volume of 2.5-3.5 oz. with each feedings. His 3-course diet for breakfast, lunch, and dinner included one of his favorite foods (cheese puffs) and a soup puree. The soups are either homemade or purchased from Whole Foods, blend it down to a puree and then through a strainer to remove all remnants of the soup for a smoother consistency. Safflower oil, coconut oil or avocado oil is added to the soup to increase calories. PediaSure is supplement for extra calories in between each meal and Duocal is also added to his diluted coconut water for extra calories. Due to the risk of aspiration on thin liquid, Thick-It thickener is added to his liquid for nectar thick consistency. I am looking for a smoothie recipe to replace his high calories PediaSure (1.5 cal per ml). Do you have a plain vanilla favor smoothie recipe as an alternative to his high calories PediaSure? Have you heard of PediaSmart? What are your thoughts on the product?

    • The recipes here are high calorie and can be made plain vanilla easily with coconut milk as primary liquid; avocado is a keeper here as it’s neutral in flavor though it will make the smoothie pale green. These are thicker, so that may work in tube. I would definitely suggest you run an ELISA IgG food antibody screening to see what proteins are best tolerated, as well as a zinc status level, iron status, and a gut biome screen with stool test, either culture or DNA probe, for fungal and commensal strains as well as beneficial strains. Many kids without Downs have strong gag reflex, delayed gastric emptying, and oral hypersensitivities. This may not be just about Down’s but possibly due to backstory of a big fungal or unhelpful commensal bacteria load in GI tract, and/or low zinc status. All worth investigating because it may help him leave the tube behind. Pediasure and PediaSmart are both dairy based. Great to go organic, not great if the casein or whey are trigger proteins for your son.

      • Thank you, Judy! My son has been off of the tube since he was 16-months old. About 3 months ago, T&A procedure was done and we are hoping that eating will improved. Since surgery his gag reflex has improved and vomiting is less but have not gone away. We hope that in time, it will get better. I will be inquiring about these work-ups with his GI doctor at his next follow up appointment. Do you still recommend investigating and doing all these work-ups even though tube was removed 3½ years ago?

        • Absolutely, for any child with Down’s, I would. Your GI doctor is likely to disagree, as they don’t specialize in nutrition. If not he would have offered it already. Wonderful that he is off the tube!

  26. Are raw eggs safe?

  27. What do you think about blood group diet? Is it true that we have to carefully choose food that we eat according to our A,B, AB, or O blood group?

    • This is one approach I have not used in my practice, and have not met any who have done this for their kids in my nearly 20 years in practice – but know it has devotees!

  28. Judy, my daughter is 2 years old, she has been under 5th percentile in her weight for the last six month, and not eating well since about 11 months old. We just recently stopped breastfeeding, but I’ve been offering her whole milk since one year old and she has been rejecting it, along with practically all diary products – just won’t eat or drink it, even home made whipped cream. She is IgA deficient, but IgG, IgE, and IgM came back normal (I know because of low IgA, the rest are not reliable). Her Celiac panel was negative, but we just saw a GI and she ordered DGP-IgA IgG since she still suspects celiac disease (mentioned nothing about milk proteins) and prescribed Omeprazole meanwhile, but my daughter never had any symptoms of reflux (GI said even without symptoms she can have it , plus it’s needed in case she will need a “scope”). And of course she recommended Pediasure- (doing my research lead me to your site). I don’t want to give her pediasure as I believe in whole foods, and very hesitant to give her omeprazole. I am so torn to follow recommendations of GI doctor? And my pediatrician thinks there is nothing wrong at all. What other tests can be done to rule out milk protein allergy/sensitivity? Thank you!

    • Hi Vita, IgA is the key immunoglobulin for mucosal lining of gut, ear, nose, and throat. If low your daughter will be more susceptible to infections. Low nutrition status can cause this; any IgG reaction to a food she relies on will exacerbate this. I’d suggest a functional nutrition approach, this would certainly include ruling out milk protein sensitivity with testing (ELISA IgG food antibody profile) as well as a functional comprehensive digestive stool test. I offer both of these in my practice. Schedule an appointment anytime to get started.

  29. Thank you so much Judy. I am going to order your books today as I didn’t know what to do withis my daughter. However, once she is in daycare or a school setting what do you suggest?

  30. Is raw egg (non cooked egg) and added to these smoothie recipes blender without being cooked first safe for a toddler to consume? I always thought it wasn’t.

    Please explain.
    Thanks Nat

    Btw, i just discovered your website and absolutely love it:)

    • This is your decision. I am comfortable with raw egg for my family when the eggs come from a trusted local source that uses hygienic, organic techniques. I have visited local egg producers to observe what they do and ask questions; you might do the same. Salmonella poisoning from eggs is rare. It can occur from other foods too, including tomatoes, beef, greens, or processed foods like peanut butter or protein powders. In animal foods, salmonella poisoning tends to occur in factory farmed or processed foods where animals are crowded into dirty conditions and relying on a steady diet of antibiotics to control infection. The CDC reports significant drops in illness from eating raw eggs in recent years, while illness from foods like leafy vegetables increased dramatically. In backyard flocks, the CDC gives conflicting information. It has reported illnesses this year with home-owned chickens as the source, but then states that no deaths were attributed to Salmonella infection. In any case, you can wash your hands, and eggs in the shell, thoroughly with soapy water before using them, as well as carefully wash other raw foods first. Illnesses from backyard flocks can come from handling chickens, not eating the eggs – even healthy chickens may carry Salmonella on their feet and feathers. Tips on keeping backyard chickens can be found here.

  31. Just made the Banana Cream for my “underweight”, 23 pound 2 year old and she LOVED it! Drank every last sip! My ped told me to give her pediasure twice a day but I don’t like the ingredients (and it is SOOOO expensive!!!!!!) soooo this is the route I am taking. The goal is to gain weight and how I go about doing that is up to me so I am going to try to do it the healthy way. Thank you for the information!!

  32. I am so grateful to have found this! You are truly heaven sent. I have a 7 month old who suffered a brain injury at birth and is currently suffering from low tone in his neck & core. He gets extremely constipated. I’m currently breastfeeding & introducing solids. Are the above recipes infant friendly? He often breaks out from first stage baby food(the organic foods I blend as well) so he’s scheduled for an allergy test Tuesday. Things like pears, apples & berries causes him to have red rings around his eyes as soon as he eats them. He was gaining weight nicely until he turned four months. Now at seven months he’s only gained two lbs but grew a total of 7 inches since birth. He is extremely long & very skinny. I’m not sure what to do. His doctor is no help. Can you suggest something please?

    • Of course Kami! Plenty of ideas and suggestions. Make an appointment and we can get started. Unless your baby is my patient, I can’t advise on his treatment plan. You can click on the “appointment” tab to place a slot on my calendar.

      • Okay great! I will make an apt!!

  33. UPDATE: My daughter, who was 23 pounds in August, is now up to 27/28 pounds, depending on when I weigh her!!!!!!!!!!!!!!! That’s a HUGE gain. (Last year, within one years time she only gained 5 pounds…I wasn’t giving her anything supplemental because I didn’t realize she was “underweight”) I make her the banana cream shake daily, and she drinks it entirely. I am THRILLED! Weight check at the doctors in a week and I hope that they will be pleased as well. 🙂

    • Great news Sally! Thanks for sharing it! Hope she is also feeling and functioning better too. Kids need to play and be happy!

  34. Hi Judy,

    Thanks for sharing, great & informational article!

    I’ve had similar problem too, my son would often refuse to eat and he was very underweight. Although he’s quite a picky eater, somehow he loves Pediasure. I’ve seen great improvements after 1-2 months, he’s started to eat more regularly and properly now.

  35. I love these ideas for alternatives to Pediasure, however they are are too thick to work with a bottle nipple. My daughter is 11 months old and doesn’t yet drink well enough from a cup or straw. Would there be anything similar to the thin consistency of Pediasure? Thanks!

    • Yes you’re right, these recipes are not intended for use in a bottle or for kids under one year old. Pediasure isn’t for infants either. If your child is needing hypoallergenic alternatives that work in a bottle, you can look at commercial options for infants like Alimentum, Neocate, Elecare, or an organic goat milk infant formula like Holle. There are recipes available for homemade infant formula as well, from Loma Linda University, Weston Price, and elsewhere. I would suggest getting professional guidance on using any alternative formulas for your daughter. I do work with infants in my practice, so if you don’t find the answers you need at your pediatric visits, set up an appointment and we can find the right option for her.

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