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Nutritional Support for Children with an Inadequate Appetite 209

Table 7.3.1 Medical conditions and the main dietary modifications (Continued)

Neurological impairment, e.g. cerebral Food texture modifications or nutritional support to address feeding
palsy and Down’s syndrome difficulties resulting from impaired oral motor functions such as poor
chewing and swallowing
Decreased energy requirements if there is limited mobility
Portion control where there is a tendency towards obesity as in
Down’s syndrome
Increased energy requirements when there are frequent unwanted
movements or congenital heart defects

Poorly functioning or non-functioning Parenteral nutrition
gastrointestinal tract (intestinal failure) Minimal enteral (trophic) feeding to maintain brush border integrity

of the gastrointestinal tract may be appropriate

Phenylketonuria Controlled low intake of the amino acid phenylalanine

Physical disabilities Food texture modifications to address feeding difficulties
Decreased energy requirements if there is limited mobility

Prader–Willi syndrome Nutritional support for faltering growth in the first 2 years followed
by controlled energy intake to prevent or minimize obesity

requirements for each child. This can sometimes be ●● older children may refuse to follow the dietary
achieved using family foods and extra nutrient modifications in social settings rather than
supplementation using over-the-counter supplements appear different to their peer group
found in supermarkets and pharmacies. However, for
more complex dietary needs, specialist dietary ●● adolescents may refuse to comply with both
products are prescribable for specific conditions dietary and medical treatments to assert their
(listed in British National Formulary Appendix 7: independence
Borderline Substances).
●● children may realize that by refusing to comply
When giving individualized advice to families, they are able to manipulate their parents or carers.
the paediatric dietitian needs to consider:
Nutritional Support for Children
●● family routines and food and drink preferences with an Inadequate Appetite to
Satisfy their Energy and Nutrient
●● family budget for food, drinks and supplements Requirements

●● family’s knowledge of food and cooking skills Malnutrition develops when children are unable to
eat sufficient quantities of food and drink to satisfy
●● how well the parents and child understand the their energy and nutrient requirements in the long
dietary treatment aims term. This may begin to impact on health and
growth if it is not addressed. The main causes of an
●● the facilities available to the family for managing inadequate oral intake are:
the dietary modifications.
●● decreased appetite due to the medical conditions
The impact of dietary modifications on family and/or treatments
lifestyle and the quality of life of the child or whole
family should not be underestimated. Some ●● malabsorption increases the energy and
modifications may make it difficult or even prevent nutrition requirements above that for healthy
the child from eating at school or at friends’ homes or children
going away on holidays or school trips, for example.
●● increased nutrient requirements due to altered
Non-compliance with dietary treatment may metabolism, chronic illness, fever or a high level
occur for several reasons: of physical activity.

●● young children may refuse foods if they do not
like the taste, texture or appearance