Nutrition for toddlers and young children with Cystic Fibrosis
Nutrition needs in Cystic Fibrosis (CF)
Most young children need 1,000 – 1500 calories daily. A child with CF may need 20 – 50% more (1,200 – 2,200 calories) daily. Higher body weights are linked to better lung function so making sure children with CF eat enough to maintain a healthy weight is important for their health. Since children with CF tend to eat the same amount as other children, more calories (energy) should be added to their diet to meet their higher needs.
A healthy balanced diet is important for the whole family; including your child with CF. This includes wholegrain breads and cereals, fruits and vegetables, dairy products and foods containing protein like meat, chicken, fish, legumes, nuts and eggs. For the healthy population we talk about eating a ‘healthy food pyramid’ (as above).
For children with CF, we like to talk about a ‘healthy food cube’ instead because children with CF need to eat lots of everything! (as above).
Mealtime behaviour management for children with CF
Getting children to eat well can be a challenge but there are things parents and caregivers can do to help children eat well to stay healthy.
Keep in mind that all toddlers and young children go through phases of fussy eating behaviours, habits or likes/dislikes. While good nutrition and growth are a focus for those with CF, try to be realistic and not get too anxious about ‘normal’ toddler eating! The CF team will keep an eye on your child’s weight and growth and discuss any concerns with you as they arise. If your child is growing well, is hydrated and their vitamin levels are ok, these are good signs you are doing a great job of meeting your child’s nutrition needs!
Tips for encouraging healthy eating
Plan ahead and have structured mealtimes
Ø Aim for three meals and three snacks every day at about the same time each day. This gives your child time to get hungry between meals and snacks and increases the chance that they will eat more and try new foods.
Ø Before starting a meal or snack, do your best to have all the food ready. This will help you to be free during the meal to spend time with your child. You can then role model good eating, and give them praise for good eating.
Ø Work out the fat content of the meal or snack your child is going to eat so you can have the right number of enzymes ready.
Ø Don’t allow TV, toys, handheld games, Mp3 players or books at the table as these distract from eating.
Ø Avoid cooking different meals. Plan one menu for the whole family then add extras to your child with CF’s meal to increase the calories.
Ø Limit the length of meals to about 20 minutes. When the meal is over, clear your child’s plate (even if they have not eaten much) and do not offer other food until the next scheduled meal or snack.
Give choices
Ø Always have foods on the plate that you know your child likes and will eat. This will mean that they will at least eat something! Include new foods, or those your child has rejected in the past, on the plate as well and let your child decide which foods they want to eat.
Ø Allow your child to choose whether to prepare their enzymes or have you do it for them.
Ø Give your child two options at meal or snacks and let them choose what to eat (e.g. ‘would you like some pasta or a cheese sandwich for lunch today’) rather than ‘what would you like for lunch’.
Ø Allow your child to choose between two items to add to their food to provide extra calories (e.g. should we add cheese or butter to your vegies?’).
Ø Involve your child in choosing what to cook for meals and let them help to prepare meals. Think about your child’s safety if they are helping in the kitchen.
Emotions and attitudes
Ø Try not to worry if at the end of the meal your child has not eaten much. If you are relaxed about eating, your child is more likely to not become anxious at meal times.
Ø Have a relaxed talk with your child about healthy eating, at a time other than at meals or in clinic. Make sure you explain, in a way they can understand, the reasons for needing to eat high – calorie foods.
Ø Give your child the chance to express their feelings about having to eat a lot and about having CF. Let your child know that you understand. Children who can put their feelings into words often feel less need to rebel by not eating.
Ø Talk with your dietitian, doctors, nurses, psychologist and social worker for support and advice.
Fat is high in calories, so in order to achieve a high calorie intake, people with CF are should have a high fat intake. For the healthy population, too much fat in the diet is not advised due to its effects on cholesterol, heart health and weight. Research has found that people with CF have lower cholesterol levels despite their high fat intakes. They also have a lower rate of other risk factors for heart disease such as obesity. For these reasons, they are not likely to be at an increased risk of heart disease by having lots of fat in their diet. Healthy fats including polyunsaturated and monounsaturated fats have been shown to be best for heart health however it is okay to include some saturated fats in your child’s diet.
Fat counting resources
Use written resources, food labels, fat counters, websites and apps to work out the fat content of foods and drinks.
We suggest using ‘Allan Borushek’s Calorie, Fat and Carbohydrate Counter’ available at newsagencies and bookstores. Most foods and drinks have calorie, kilojoule and fat contents listed. This book also has a website and phone app which can be helpful to use. The website is www.calorieking.com.au, the phone app is Calorie King Australia.
Enzymes
Don’t forget to have enzymes before having any foods or drinks containing fat.
Use the following guide to work out how much Creon to have:
Ø Creon Micro: 1 scoop per 2-3g fat
Ø Creon 10,000: 1 capsule per 4-6g fat
For example the iced coffee above would require 4 scoops of Creon Micro or 2 Creon 10,000 capsules.
High calorie additions & enzyme dosing
This fact sheet provides examples of how many enzymes to give with food and drink. The number of enzymes required is based on:
· 1 Creon Micro per 2-3g fat
· 1 Creon 10,000 per 4-6g fat
Addition / Fat (g) / Creon Micro / Creon 10,000Olive/Canola/Coconut Oil (1 tablespoon) / 20g / 7-10 / 3-4
Avocado (1/4 medium) / 7g / 2-3 / 1-2
Chia seeds (1 tablespoon) / 5g / 2 / 1
LSA Mix (1 tablespoon) / 5g / 2 / 1
30g cheese / 10g / 3 / 2
Cream cheese (1 tablespoon) / 7g / 3 / 2
Peanut Butter (1 tablespoon) / 10g / 3-4 / 2
Butter/margarine (1 teaspoon) / 4g / 2 / 1
Mayonnaise (1 tablespoon) / 15g / 5-6 / 3
Nutella (1 tablespoon) / 6g / 2 / 1
Cream thickened or sour cream (1 tablespoon) / 7g / 3 / 2
Cream double thick (1 tablespoon) / 10g / 3 / 2
Ideas for adding extra calories:
Ø Add cheese, margarine/butter or oil to vegetables, scrambled eggs or pasta.
Ø Add olive oil or an oil based dressing to salads.
Ø Spread butter or margarine plus mayonnaise, avocado, peanut butter or cheese spread on sandwiches, crackers, muffins or crumpets.
Ø Add cream, sour cream or margarine/butter to soups, casseroles, pasta sauces, scrambled eggs or potatoes.
Ø Cook meats in plenty of oil or margarine/butter.
Ø Add LSA Mix to cereals, yoghurts and smoothies
Ø Add cream to cereal, milk drinks, yoghurt or custard. Try whipped cream as a topping on hot chocolate.
Ø Dip fruit pieces, vegetable sticks or crackers in cream cheese, cheese spread, peanut butter or full fat dips. Avocado with oil is a great dip!
Ø Use full cream milk plus cream, ice cream, full cream yoghurt & chia seeds to make shakes or smoothies.
Ø Try adding chia seeds, frozen yoghurt & coconut oil to juice to make a juice based smoothie.
Ø Add powdered milk to milk and milk drinks or use in casseroles, soups and pasta sauces.
Are those extra high calorie additions and snacks really making a difference?
The table below shows how many calories & fat are added when you use additions or change to high calorie snacks.
Breakfast1 piece toast
with margarine (1 tsp)
and honey
135 calories (567kJ) 3g fat / 1 piece toast
with thick margarine (2 tsp)
and peanut butter
203 calories (853kJ) 11g fat
Morning Snack
Piece of fruit + packet of chips
172 calories (722kJ) 7g fat / Piece of fruit + bliss ball
302 calories (1268kJ) 25g fat
Lunch
Sandwich with margarine and vegemite
212 calories (890kJ) 3g fat / Sandwich with chicken, cheese, lettuce, mayonnaise
364 calories (1528kJ) 16g fat
Afternoon snack
Muesli bar
116 calories (487kJ) 4g fat / Berry coconut smoothie
492 calories (2066kJ) 20g fat
Dinner
Spaghetti Bolognese
220 calories (924kJ) 7g fat / Spaghetti Bolognese + 1 tsp olive oil + 1/8 cup grated cheese
320 calories (1344kJ) 22g fat
Dessert
1 scoop vanilla ice-cream
85 calories (360kJ) 4g fat / 1 scoop vanilla ice-cream + strawberries + thickened cream (1 tbspn)
165 calories (693kJ) 11g fat
Keep in mind that your child’s eating habits, behaviours and preferences, as well as their nutrition needs and goals will change as they grow. The CF dietitian is always at clinic if you need to chat about any food or nutrition issues. Why not ask the dietitian where your child currently is on the growth charts. They can also answer questions about your child’s eating, weight, or nutrition goals. You can ask to speak with the CF dietitian at any clinic visit – you do not have to wait for your doctor to suggest a dietitian review!