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Common Medical Conditions Requiring Dietary Modifications 213
●● casein and gluten-free diet high-fat and ●● Increasing energy intake using extra oil, butter
and cream may not be suitable when a child is
●● ketogenic diet – very feeling nauseous. It may be better to try
low-carbohydrate. the prescribable high-calorie/high-nutrient
drinks.
To assess the effectiveness of any dietary
intervention for a particular child, an objective ●● Overnight tube feeding is often recommended
record of symptoms must be kept during a baseline as it can help to maintain growth, boost the
period of the regular diet, the intervention period immune system and prevent weight loss.
and then a return to the regular diet as described for
open food challenges (see Chapter 7.1, page 190). Coeliac disease
Before embarking on an exclusion diet with a In children with this autoimmune disease, the
child who eats very selectively it is advisable to assess protein gluten causes the production of destructive
whether excluding any key foods they normally eat antibodies which damage the tissue of the small
will compromise their energy or nutrient intake, as intestine, causing malabsorption of food.
once foods have been excluded for a while the child
may refuse to begin eating them again. Gluten is found in the three cereals: wheat, rye
and barley. All food and drinks made from these
Cancer cereals need to be eliminated from the diet of a
child with coeliac disease. Some children may
Children with cancer may have a reduced appetite need to avoid oats as well as they may be sensitive
due to: to a similar protein, avenin, in oats. Sometimes
oats are contaminated with traces of wheat, rye
●● pain or barley.
●● repeated infections when the immune system is Children with undiagnosed coeliac disease or
compromised due to chemotherapy and who are not following their diet may have any of
radiotherapy the following symptoms:
●● nausea and vomiting caused by chemotherapy ●● weight loss
and radiotherapy
●● poor growth
●● diarrhoea because of antibiotic treatments or
because of cancer treatments ●● diarrhoea
●● changes to their taste buds making food less ●● nausea
enjoyable.
●● wind
Children eating poorly can become malnourished
quite quickly, which will further lower their ●● tiredness
immune system and they may begin to lose
weight. ●● constipation
Considerations for nutritional support ●● anaemia
●● Small frequent snack-style meals about 5 or 6
●● mouth ulcers
times each day may be preferable to 3 big meals
and 2–3 small snacks. ●● headaches
●● If the child has a sore mouth, very soft foods ●● hair loss
may be preferable.
●● skin problems.
●● If nausea occurs, cold food may be preferred to
hot food. Foods that should be included or eliminated in a
gluten-free diet are listed in Table 7.3.2.
Parents and children need to check the labels on
food packaging of all commercial foods for their
