Nutrition Interventions for Children with Special Health Care Needs

Conclusions
Appendix T
Assumptions that one tablespoon of infant formula is equal to a scoop and that each
contains 40 kcal are not true. Depending on how we prepare “20 kcal/oz” formula,
we can get anywhere from 15.2 to 22.8 kcal/oz. (Possible methods of preparation: 1
scoop added to 2 oz of water to make 2.2 oz, or 1 tablespoon plus water to make 2
oz, or 1 cup + water to make 32 oz.) This is not an issue for healthy, normally grow‑
ing infants, but it could be an issue for infants who have atypical growth and/or who
need altered formulas.
Recommendations
When accuracy in measurement is imperative, liquid concentrate formulas are the
first choice; if powders must be used, they should be weighed on a gram scale, accu‑
rate to the nearest 0.5 gram. Energy value of 1 gram of formula should be calculated
by taking the total energy value for 1 can of formula (total ounces formula made
per can x kcal/oz = total energy value for 1 can of formula) and divide by the grams
formula powder in the can.
For example: A 400 g can Similac with Iron ® Powder makes 105
oz of 20 kcal/oz formula. 105 oz x 20 kcal/oz = 2100 kcal/can;
2100 kcal/400gm = 5.25 kcal/gm formula powder.
If powders must be used, and a scale is not available, use the instructions given by
the formula producer to increase the energy density of formula. Most formula manu‑
facturers have written instructions for making altered caloric concentrations of their
formulas. Contact the formula company representatives for this information (provid‑
ed on formula containers; some contact information is provided in Appendix S).
Guidelines for increasing the energy density of liquid concentrate formulas are pro‑
vided in Table T‑1.
Nutrition Interventions for Children With Special Health Care Needs 399