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In a saucepan, heat olive oil or butter over medium heat. Add garlic and shallot, sauté for 30–60 seconds until fragrant (don’t brown it).
Add tomato paste, red pepper flakes (if using), salt, and pepper. Simmer for 5–7 minutes to let the flavors meld.
Pour in the pastina and enough water or broth to just cover the pasta (about 1.5–2 cups). Stir well.
Cover and simmer for about 5–8 minutes, stirring occasionally, until the pastina is tender and the mixture thickens to a risotto-like consistency. Add a splash more liquid if needed.
Pour in heavy cream if using, stir in grated Parmesan until creamy and well combined.
Garnish with fresh basil or parsley and extra cheese on top.