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220 7.3 Nutrition for Children with Chronic Diseases and Syndromes
inject insulin after meals and snacks, rather than disease, often these children have a reduced
before, calculated on how much carbohydrate has appetite and may have already lost weight. Growth
been consumed. faltering may also be present.
Adolescents may also refuse to follow their usual The feeds are usually drunk orally but can be
routine, refusing both insulin treatment and/or taken via a tube if children do not like the taste or
dietary routines for a period – just to test out the cannot manage the required volume orally. Once
necessity of it. Some may be tempted to reduce the inflammation has resolved – usually after
insulin intake as a means of losing weight. about 6–8 weeks – normal foods are introduced
one by one. Any food that causes symptoms is
Type 2 diabetes stopped and introduction of other foods continues.
Dietary treatment in children with type 2 diabetes The final diet is then made up of foods that do not
is also a nutritious, balanced, low glycaemic index cause symptoms. If there are any nutritional
diet with carbohydrate spread out evenly deficits then a dietitian can advise on a suitable
throughout the day. Obese children should also supplement to correct the deficiency.
aim for a negative energy balance so that they lose
weight because the progression of their disease will Neurological disabilities – cerebral
be slower in the absence of obesity. palsy, Down’s syndrome, muscular
dystrophy and degenerative
Inflammatory bowel diseases – disorders
Crohn’s disease
When motor function is affected in children with a
The intestinal inflammation in Crohn’s disease is neurological disability poor nutritional intake can
believed to be caused by an immune reaction result. The more severe the disability, the more
against the bacteria living in the bowel. The normal limited the oral intake and the more likely
food residues passing through the gastrointestinal malnutrition will arise.
tract are thought to be the energy source for these
bacteria. Hence, to induce remission from the Impairment of oral motor function can limit the
inflammation some centres change patients to a ability to suck, drink, bite, chew, seal the lips, use the
synthetic liquid diet free of all food residues for 6–8 tongue effectively and swallow. Symptoms include:
weeks. Other centres use steroid treatment instead
of a change in diet, and evidence for which is the ●● weak sucking in infants
preferable treatment is debatable (Zachos et al.
2007, Critch et al. 2012). ●● poor progression through food textures during
weaning
The synthetic liquid diet has one of the following
as a protein source: ●● coughing, choking and gagging on foods
●● single amino acids – an elemental feed ●● vomiting
●● short chains of amino acids – an oligopeptide or ●● frequent respiratory infections from aspiration
hydrolysed protein feed of food into the lungs.
●● whole protein from a single source (e.g. casein). Gastrointestinal muscle tone may also be impaired,
resulting in limited absorption of nutrients and/or
The choice of feed is made by the medical team and gastro-oesophageal reflux.
at present evidence does not favour one over the
others (Critch et al. 2012). A paediatric dietitian Feeding takes longer and usually requires
must ensure that the quantity of whichever feed is a parent or carer’s dedicated time as well.
consumed will provide adequate energy and A multidisciplinary assessment is important:
nutrients for the child. With the onset of the
●● Speech and language therapist can assess
biting and chewing skills and safety of swallow.
