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Common Medical Conditions Requiring Dietary Modifications 221
Video-fluoroscopy of swallowed liquid and solids
may be used to ascertain whether food/drink is
spilling into the air passages and lungs causing
coughing, wheezing and chest infections.
●● Occupational therapist can advise on the most
appropriate seating for mealtimes and on any
eating aids that will help.
●● Physiotherapist can advise on an ideal position
for oral feeding.
●● Dietitian can assess their nutritional intake with
the current regimen and suggest improvements.
●● Paediatrician can treat any gastro-oesophageal
reflux, oesophagitis, slow gastric emptying or
constipation.
Thickening liquids may help with control of
swallowing liquids. However, if oral feeding is not
considered safe then tube feeding directly into the
stomach must be commenced. Most children will
require nutritional support and tube feeding to
provide partial or total nutritional intake.
Ideally, all children with neurological disabilities
should have regular assessments of their:
●● energy and nutrient requirements – both
increase as children grow and care needs to be
taken during the adolescent growth spurt when
nutritional needs increase markedly to support
this rapid growth rate. Overall energy
requirements may be lower than the norm in
children with limited mobility or higher than
the norm in children who make frequent
involuntary movements
●● actual nutritional intake and challenges to
achieving their nutritional needs – this may
change with time
●● weight and growth – this may require the use of
specialist anthropological measuring equipment
depending on the child’s posture and muscle
tone. It may be necessary to track growth
through limb measurements or sitting height
rather than standing height.
Cerebral palsy
Most children with cerebral palsy have feeding
difficulties and many of these children need to be
tube fed to support their limited oral intake.
Down’s syndrome
Children with Down’s syndrome often have:
●● reduced muscle tone leading to minor feeding
difficulties
●● congenital heart defects which may increase
their energy requirement
●● gastrointestinal problems such as constipation
and gastro-oesophageal reflux.
When assessing their needs, growth must be plotted
on specialist Down’s syndrome charts because short
stature is a component of the syndrome.
Activity 1
Plan a one-day menu for a diabetic diet for a
12-year-old girl, with 50 per cent of her energy
requirements as carbohydrate spread evenly
over three meals and two snacks. Add in an
extra 20 g of rapidly absorbed carbohydrate for
volley ball practice after school.
Activity 2
Write a letter to a school outlining the needs
and menu suggestions for a newly diagnosed
7-year-old boy with coeliac disease who wishes
to continue eating school meals with his friends
rather than take in a packed lunch and have to
sit in another room.
Activity 3
Design a feeding regimen using a feed that
provides 1 kcal/mL for a 5-year-old girl with
cancer. She has lost weight and now weighs
14 kg and needs 40 per cent of her energy and
nutrient requirements as an overnight feed. She
is in bed from 7 pm to 6.30 am. Her parents go
to bed at 11 pm.
Acknowledgements
With thanks to Vanessa Shaw, Head of Dietetics,
Great Ormond Street Hospital for Children NHS
Trust, London.