Regarding the heart disease infant,...  It is easiest for many families and
for the doctor to switch the child to a higher calorie formula.  However,
there are many other options.  Mom can add powder to the breast milk to
increase the caloric density and bottle feed some.  The suggestions of the
high calorie foods should be encouraged.  Mom may add additional margarine
or other high calorie foods, depending on the age of the child.  Normally
after a child is one year old they can drink Pediasure, which is 30 cal/oz.
 The doctor and /or dietitian (if involved) should be able to work with this
family to add the calories within the family's wishes.  As the calorie needs
are so high, 20 cal/oz milk or formula usually is not suitable for these
children, unless the heart repair has corrected the problem.  It would be
helpful to know exactly how malnourished the child is to decide how
nutritionally proactive one needs to be or not.  Just wanted to list the
options as I work a lot with this type of patient.
Michelle Cangas, RD, LD, MS
Texas Children's Hospital