How can I increase DD's calories healthily

[HelloCheekyCat]

DD has annual appointments due to a health condition and she is always weighed & height measured.
She is on the 25th centile for weight and 75th for height, today the doctor has suggested increasing DD's weight by increasing her calories.
Given the chance DD would want to eat loads more chocolate and crisps but clearly she would need to eat healthier food, but what would/should that be?
Also do we actually need to do anything be because she's always been similar proportions but her weight hasn't increased as much since the last appointment in the same proportion as her height

I don’t see the issue with being in the 25th centile?

Avocado. Add some full fat milk powder to any milk product taken. Sprinkle cheese on veggies. Nut butters.

In isolation being on the 25th percentile isn't a problem but when combined with their height being on the 75th percentile it means they are on the bottom end of the healthy weight range. This isn't necessarily a problem but in a 14 year old can result in delayed puberty. It's also an age where it's important to ensure you have a good balanced diet for long term health. For example ensuring adequate calcium in teenaged girls can lower risk of osteoporosis in later life

It's also an age where it's important to ensure you have a good balanced diet for long term health. For example ensuring adequate calcium in teenaged girls can lower risk of osteoporosis in later life

this is what is worrying me a bit particularly because she doesn't eat much dairy (only cheese on pasta, one or two tube yoghurt a day, the very occasional cup of milk).
She takes a teen multi vit gummy with omega three but it doesn't have calcium so I think we'll switch her to a complete A-Z once she's finished her gummies , luckily she can swallow tablets so will just have an adult one.

Like @Superscientist DD she's also quite fussy so trying the suggestions will be interesting! She loves Reeses and she's said she'll try peanut butter but doesn't know what to have it with because she doesn't like bread, haven't found GF crackers she likes (she's coeliac which is why she goes to the hospital)

You can get calcium gummies, calcium+ vitamin D helps with absorption.
I have a calcium sheet from our dietician which gives you a breakdown of how much calcium you need at different times in your life as well as different ways you can make up the necessary calcium.
I would also be looking at iron sources too, something to watch out for with iron is that calcium can impede your body absorbing iron so you would want any iron supplements or iron rich foods in isolation with calcium rich foods.

My daughter gets her calcium through oat based products - we make her porridge and white sauces with oat milk and cream and she has oat yoghurts for puddings. Fish is a good source of calcium but my daughter has a fish allergy
Iron we struggle with as she has other dietary restrictions so hers mostly comes from supplements.

At our last dietician review she calculated she needs an extra 500kcal a day which is more than we manage through foods alone so we have some fortified milkshakes on prescription at the moment to see if that can get her weight moving upwards and reduce risks of deficiencies given her already restricted diet

Ground almonds are great for this - smoothies / porridge and also added to baking. You can replace half the quantity of flour with almonds just double baking powder. Will end up denser but way more calorific.

If she’s in the middle of the healthy weight range, do you need to do anything?

That's what I am.debating to be honest. The consultant suggested increasing her calories a bit because he height has increased at a slightly greater rate than her weight but as she's 14 she has an opinion on that and doesn't really want to gain weight.

She had a blood test and the consultant asked for everything to be checked so we'll know if she is deficient in anything. She had a blood test in Jan to rule out any medical.reasons for tiredness and everything came back normal, even Vit d which the consultant was pleased with

peanut butter is nice with apple slices or on rice cakes (addition of jam optional!)

Something to watch for with the blood tests is that you can be symptomatic even though the results are in the "normal" range, they also don't always test for the right things - for example testing for iron deficiency by looking only at haemoglobin - this can miss non-anemic iron deficiency if they don't also test ferritin. "Normal" ferritin is above 10 but you can be symptomatic when your ferritin is below 100, especially if you are menstruating. It can also be the case that if several things are on the low side of normal that there is an additive effect and whilst on its own they wouldn't be low enough to cause the fatigue together they are. I'm currently going through this myself

Have you any previous height/weights to compare? My daughters has stalled over the last 18 months. When we saw the dietician in July last year it was in the well a few things have changed and she might have finding her new normal. When we saw the paediatrician in January it was hmm, maybe this is something a little more, let's try to up calories and keep an eye on things. We saw dietician again a month ago and her BMI has now dropped 3 percentiles from 91st to 25th and her weight from 50th to the 9th. She's only on the 4th percentile for height so she's not underweight and it would be quite a while before she would be underweight it's the pattern that's a concern. Our goal isn't to get her back up to the 50th percentile for weight it is to getting her eating enough to maintain the 9th percentile and a 25th percentile BMI

My daughter is a lot younger than yours but we have explained why it is we are worried about her weight and by going through the chart with her. We have explained that to grow big and strong that she needs slowly gain a little weight every year and that at the moment she's doing quite well as it's moving up but that it is more of a flat line and we don't want her to get poorly as she gets older and there would be a bigger difference between where she is and where she could be. We have done this over several little conversations and kept it ages appropriate. I wonder if approaching this from a practical point of view would be helpful?

Sometimes children respond better to honesty and facts and it puts things into context a bit better. She is fabulous as she is and you don't want to change anything as such but you want to be mindful that her body and her health is still doing well in another year, 2 years, 5 years and that means having a good balanced diet that allows her body to grow and thrive. At the moment, her diet is giving her everything that her body needs to grow and learn and be active but it is important to be ensuring that this continues to be the case.