OA/TOF - Extra nutrition support for children 6 months and older factsheet


Infants born with tracheoesophageal fistula (TOF) and oesophageal atresia (OA) can have challenges with growth. Some infants may have feeding difficulties, which may affect their intake of food and drink. Others might have increased nutrient requirements.

If growth is a concern, your child's dietitian or doctor may suggest:

  • giving extra nutrition support, such as specialised infant formula or fortifying food with extra fat or protein, and/or
  • feeding a smaller amount of food more often.

Some babies need to be fed through a tube that goes from their nose to their stomach (nasogastric tube). The tube is to give nutrition from formula, breast milk or a combination of both. If this is needed, it will be decided by you and your child's health care team.

 Things to consider

  • Never give your baby extra food without checking with a doctor or dietitian first.
  • Your baby needs regular check-ups with their GP, dietitian and/or clinic nurse to track growth and to review the need for ongoing nutrition support.


Tips for gaining weight

You may be able to add extra ingredients to your child’s food that are high in energy and protein.

Speak to your child’s doctor or dietitian to check if these suggestions are appropriate for your child.


Oils and margarine (high energy)

  • use for frying meats/vegetables
  • add into pureed vegetables or mix into commercial baby foods
  • drizzle over the top of rice, noodles, pasta, and vegetables
  • spread margarine thickly on bread, sandwiches, and biscuits.

Breast milk or formula (energy + protein)

  • your child’s dietitian may give you a special recipe for adding energy and protein to formula or breast milk.

Avocado (high energy)

  • use as a spread on bread, sandwiches and biscuits
  • mash with sour cream, cream cheese and use as a dip with vegetables or biscuits

Cream (high energy)

  • add to fruit or vegetable purees, or mashed potato
  • add to soups, sauces or casseroles
  • mix into cereals e.g. baby cereals, Weet-bix, porridge

Egg (high protein)

  • make high energy scrambled eggs with cream, oil, cheese or meat
  • add mayonnaise to boiled mashed egg.

Dairy products (high-protein)

  • full fat dairy foods are suggested for children under 2 years of age, including milk, yoghurt, cheese, cream cheese, ice cream and sour cream
  • include a variety of dairy-based snacks in your child’s diet, e.g. yoghurt with fruits, cream cheese dip on bread or biscuits, cheese sticks, cheese sandwiches.

Meat and alternatives (high protein)

  • this includes pureed meats, such as beef, lamb, chicken, pork and fish, and meat alternatives (e.g. baked beans, lentils, chickpeas, etc)
  • be careful with legumes as the 'skin' of legumes may need extra processing to make smooth purees.

Nut spreads (high protein + high energy)

  • add margarine, oil, cream or grated cheese to increase energy
  • whole nuts are a choking hazard for children under 3 years of age
  • use smooth peanut butter or other nut spreads on bread biscuits, etc
  • use hommus or other bean spread as a dip or spread.

How much to use

The following examples are a guide only. Please talk to a dietitian if you are not sure how much is suitable for your child.

Pureed foods
  • add 1 teaspoon margarine/oil into 2 tablespoons of puree/mashed vegetables
Soft foods
  • add 1-2 tablespoons grated cheese into 1/2 cup baked beans/spaghetti
  • add 2 tablespoons cream into 1/2 cup cereal
  • add 1 tablespoon margarine/oil into 1/2 cup cooked pasta/noodles/vegetables
Finger foods
  • dip cooked vegetable pieces in cream cheese/avocado/hommus/plain yoghurt
  • add melted cheese on the top of vegetables, meats or bread
  • use thickly spread margarine on sandwich/bread and add cheese/avocado/spreads
  • cook meat with oil and add cheese/creamy sauce/crumb coating
Last updated Friday 9th February 2024


This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.

© Sydney Children’s Hospitals Network 2024