Background
Children with or at risk of faltering growth require nutritional support and are often prescribed oral nutritional supplements (ONS).

Design and Objective 
This randomised controlled trial investigated the effects of energy-dense paediatric ONS 2.4 kcal/ml, 125ml (cONS i.e Fortini Compact Multi Fibre) versus 1.5 kcal/ml, 200ml ONS (sONS) in community-based paediatric patients requiring oral nutritional support. 

Intervention
Fifty-one patients (mean age 5.8 years) with faltering growth and/or requiring ONS to meet their nutritional requirements were randomised to cONS (n=27) or sONS (n=24) for 28 days. Nutrient intake, growth, ONS compliance and acceptability, appetite and gasto-intestinal tolerance were assessed

Results

• Use of the cONS resulted in significantly greater mean total daily energy (+531 kcal/day), protein (+10.1g/day) and key micronutrient intakes compared with the sONS group at day 28 and over time, due to high ONS compliance (81% of patients ≥75%), maintained intake from diet alone and improved appetite in the cONS group, compard with the sONS group.
• Although growth increased in both intervention groups, results were significant in the cONS group (weight (p=0.007), height (p<0.001) and height z-score (p=0.006)).

Conclusions
This study shows that use of energy-dense (2.4 kcal/ml) low-volume paediatric-specific ONS leads to improved nutrient intakes, growth and appetite in paediatric patients requiring oral nutritional support compared with standard energy density ONS.