Background and objectives: Adequate nutrition is a key determinant of growth in children, and Oral Nutritional Supplement (ONS) represents an important strategy to improve growth and nutritional adequacy in nutritionally at-risk children. We aimed to assess the effect of ONS combined with dietary counselling (DC) on the growth and nutritional adequacy in 1–3-year-old children ≤ 25th weight-for-length percentile. Methods: In this prospective single-arm, open-label intervention study (N = 108), children received 2 servings/day of ONS plus DC for 16 weeks. The ONS was energy and nutrient dense, with increased levels of vitamin A, iron, and zinc (growth-limiting micronutrients), as well as DHA and phospholipids, including sphingomyelin. Anthropometric assessments were performed at baseline and weeks 3, 6, 9, 12, and 16. Change scores from baseline to week 16 were analyzed by a mixed model adjusted for age, sex, and baseline, and was corrected for regression to mean. Nutrient intake was assessed using three-day food intake diaries at baseline, week 6, and week 16. Nutritional adequacy was estimated by comparing against the Estimated Average Requirements, based on the Philippines Dietary Reference Intakes. Acceptance of the ONS was assessed using a toddler milk satisfaction questionnaire. Results: The children´s mean age at baseline was 21.3 ± 6.6 months and 44.4% were male. Weight (0.740 kg) and height (3.02 cm) significantly increased (p < 0.001) from baseline to week 16 including at weeks 3, 6, 9, and 12. There was a significant increase in change score for weight-for-height (0.188 SD), weight-for-age (0.146 SD), height-for-age (0.062 SD), and BMI-for-age (0.163 SD) Z scores, and intakes of energy, protein, and critical micronutrients, such as zinc, iron, selenium, and vitamins A, B1, B3, B6, B9, B12, C, and D, all significantly increased from baseline to week 16 (p < 0.05 for all). The percentage of children achieving nutrient adequacy increased (p < 0.05) and reached close to 100% for iron, zinc, calcium, and vitamins A, B1, B3, B6, B9, B12, and C. Compliance to the ONS intake was high (86%) and 99% reported their overall opinion on the product to be good, very good, or excellent. Conclusion: ONS combined with DC promotes growth and nutritional adequacy, and is well accepted in toddlers with growth concerns.

Background and objectives: Oral Nutritional Supplements (ONS) is shown to impact growth in nutritionally at-risk children, however, effects on developmental progress and behavior are not well elucidated. We aimed to assess the effect of ONS combined with dietary counselling (DC) on the achievement of developmental skills, temperament traits, and parent-reported toddler quality of life in 1–3-year-old children in the ≤25th weight-for-length percentile. Methods: In this prospective single-arm, open-label intervention study (N = 108), Filipino children received 2 servings/day of ONS, plus DC for 16 weeks. The ONS was energy and nutrient dense with increased levels of vitamin A, iron, and zinc (growth-limiting micronutrients), as well as DHA and phospholipids, including sphingomyelin. Developmental milestone achievement, temperament traits, and toddler health-related quality of life scores were assessed using the Ages and Stages Questionnaire (ASQ-3), Early Childhood Behavior Questionnaire (ECBQ-SF), and Infant and Toddler Quality of Life Questionnaire Short Form (ITQOL-SF47), respectively, at both baseline and week 16. Change scores were analyzed by ANCOVA, correcting for baseline measure, age, and sex. Results: The children´s mean age at baseline was 21.3 ± 6.6 months and 44.4% were male. There was a significant increase (p < 0.01 for all) in scores for language, motor, cognitive, and social developmental domains from baseline to week 16. Temperament scores related to social skills and behavioral regulation including cuddliness, high intensity pleasure, low intensity pleasure, perceptual sensitivity, positive anticipation, sociability, surgency, and effortful control all increased significantly (p < 0.05 for all) from baseline to week 16. The scores on several parent-reported aspects of child well-being such as satisfaction with their child’s growth and development (including physical growth, motor and language development, responsiveness to others, and learning abilities), their child’s overall behavior (including the ease of managing it), their child getting along with others (including less tantrums, responding positively to affection, and listening and following directions), and their child’s health increased significantly (p < 0.05 for all) from baseline to week 16. Conclusion: ONS combined with DC in toddlers experiencing growth concerns supports developmental skills and temperament traits essential for learning, as well as parent-perceived toddler quality of life.