Mix the Meatball Ingredients:
In a large bowl, combine the ground chicken, pumpkin purée, breadcrumbs, egg, garlic, onion powder, salt, and pepper. Mix gently until just combined—don’t overwork the mixture.

Form the Meatballs:
With damp hands or a small scoop, form 1.5-inch meatballs and place them on a plate. You should have about 16.

Brown the Meatballs:
Heat olive oil in a nonstick skillet over medium heat. Add the meatballs in a single layer and cook for 2–3 minutes per side until golden. Work in batches if needed.

Make the Sage Cream Sauce:
In a small saucepan, melt the butter over medium heat. Add garlic and sage, stirring for 30 seconds. Pour in the heavy cream, season with salt, pepper, and nutmeg if using. Simmer for 3–4 minutes.

Simmer the Meatballs in Sauce:
Add the browned meatballs to the sauce and let them simmer for 5–7 minutes until fully cooked through and coated in the creamy sauce.

Serve:
Spoon into shallow bowls, top with extra sage if desired, and serve warm with crusty bread, mashed potatoes, or pasta.