Which dietary modification is most appropriate to promote growth in a toddler with cystic fibrosis who is small for age?

• A. Low-protein, low-calorie diet
• B. High-protein, low-calorie meals
• C. High-protein, high-calorie meal with skim milk shakes between meals
• D. Gluten-free, lactose-free diet

Answer: (C)

In cystic fibrosis, growth is promoted by giving plenty of calories and adequate protein because the child often has higher energy needs and fat malabsorption. The most effective approach is a diet that is high in both protein and calories, with extra calorie-dense supplements between meals to boost total daily intake. A high-protein, high-calorie meal plan plus skim milk shakes between meals provides these nutrients—protein to support tissue growth and repair, and extra calories to meet the increased energy demands, helping the toddler gain weight and grow toward expected trajectories. This approach works best when pancreatic enzyme therapy is used with meals to improve fat and overall nutrient absorption.

Unnecessary restrictions like a gluten-free or lactose-free diet, unless there is a diagnosed intolerance, can limit calorie and nutrient intake and hinder growth. Simply reducing calories or protein would not support growth in a toddler who is small for age, and removing common tolerated foods without indication is not beneficial. A plan that emphasizes higher protein and calories with between-meal supplements addresses the specific growth needs in CF.