Nutritional advice for children on dialysis The kidneys remove waste products such as phosphate, potassium, urea and extra fluid from the body. These waste and fluids come from the foods you eat and fluids you drink. Dialysis is used to help remove these waste products but unlike normal kidneys, they cannot be removed completely.
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Nutritional advice for children on dialysis
Diet is important in the management of children undergoing dialysis. The diet will help control the levels of phosphate, potassium and urea in the blood while making sure your child gets enough energy and protein to grow and gain weight properly.
Nutritional advice may change over time and will depend on your child’s growth, body weight, blood results and appetite.
You may be asked to record the food your child eats over the course of two to four days to provide the dietitian with enough information to advise on any needed changes.
Nutritional advice is no less important than dialysis and the medications your child may prescribe.
Diet goals during dialysis
- Provides enough: Energy & Protein/Vitamins & Minerals/Dietary Fiber
- Reduce intake: salt (sodium) phosphate/potassium
- Drinks may need to be reduced in children who produce little urine. Nutritional advice is just as important as dialysis and the medications your child may prescribe.
If you are advised to eat more sugary foods and drinks, try to protect your teeth by eating them at mealtimes rather than as a snack.
Remember to brush your teeth at least twice a day and avoid sugary drinks after brushing your teeth at night
Foods that are high in fat and provide more energy may be encouraged when your child’s appetite is low.
Try to find a balance between polyunsaturated and monounsaturated fats.
At mealtimes, try to replace foods rich in saturated fats with healthy foods containing mono/unsaturated fats.
A diet rich in saturated fat tends to raise the level of cholesterol in the blood, which increases the risk of heart disease in the future.
- Forbidden: butter / ghee / lard / fatty cuts of meat
- Allowed: olive/vegetable or sunflower oil
The importance of protein for dialysis patients and ways to increase it in the diet
Why does a child need more protein?
Protein is essential for growth, muscle building, and tissue repair. Urea is a waste product of protein metabolism, which is normally excreted in the urine by the kidneys.
A buildup of urea in the blood can cause poor appetite or feeling sick.
Hemodialysis helps remove some of the urea from the body, but not as effectively as a normal kidney
It is important that the child gets enough protein to help him grow properly and to replace the protein lost during dialysis.
- Animal protein sources: Meat/poultry such as chicken and turkey/fish/milk, yogurt, cheese and eggs.
- Remember: dairy products are rich in phosphates.
- Recommended daily intake: one portion of animal protein
- Plant protein sources: peas, beans, lentils (legumes)/soybeans
- Recommended daily intake: 1-2 servings of vegetable protein
Salty foods to avoid or reduce:
- Salted Potato Chips, Nuts & Snacks
- Canned and preserved foods with added salt
- Smoked meat and fish
- Most types of cheese, for example, cheddar, processed cheese
- Do not use a salt substitute as it is usually high in potassium
Less salt substitutes:
Salted tortilla chips or corn snacks
Sweet snacks instead of salty
Unsmoked meat and fish
Low-salt canned products, such as baked beans
Fresh fish, poultry and meat
Cottage cheese, full-fat soft cheese
Important tip: herbs and spices can be used in cooking rather than selling to add flavor
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Fluid requirements depend on how much urine the kidneys produce and how much is removed by dialysis.
- Divide fluids between meals and snacks throughout the day
- Frozen fruit is low in potassium, for example. grapes
- Chew sugar-free gum or mint
- Take medicines with fluids at mealtime
- Use a smaller cup
- Measure the cups so you know how much to drink
- Measure a glass of water every morning, in a limited amount for the day
- Use water from the jug throughout the day
- Chilled drinks last longer and quench thirst more effectively
Vitamins and supplements
Vitamins and minerals are essential for growth and good general health. Usually this is in tablet form.
Children undergoing dialysis may have poor appetite and may need a special daily multivitamin supplement.
Certain fruits and vegetables are restricted when trying to reduce potassium levels, and this will reduce your vitamin C intake.
Water-soluble vitamins (mostly B and C) are lost in the dialysis fluid.
Vitamin A can build up to toxic levels when kidney function is impaired.
Fish oil supplements often contain high doses of vitamin A. All vitamin supplements containing high doses of vitamin A should be avoided.
Your child may develop anemia because the hormone that stimulates the body to produce red blood cells and store iron is made by the kidneys.
You should try to introduce foods that are as high in iron as possible but you may also need to prescribe an iron supplement.
Beef / Lamb / Pork
Meat Dishes – Shepherd’s Pie and Curry
Poultry – has less iron but is still a good source
Fish – Oily fish, for example. Sardines and fish
Egg – scrambled or omelette
Pulses (peas and beans such as cooked beans,
Beans, lentils) tofu, dahl, chickpeas
Green vegetables, such as green beans and cabbage
Broccoli, spinach, leeks
Iron-fortified breakfast cereals
Barley loaf, digestive biscuits
Fruit – fig rolls, apricots and plums
Useful Tips :
- Iron from grain products is better absorbed in the presence of vitamin C
- Fresh fruit juices are high in potassium, while diluted fruit juices have much less and are a good source of vitamin C.
- Give iron and vitamin supplements together, not ideally with food
- Drinking tea with food reduces the amount of iron absorbed. Therefore, if your child likes to drink tea, it is best to take it between meals
- If your child is eating all night, do not add iron to the feed but give it as a bolus beforehand
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At times when your child’s appetite is poor, nutritional supplements may be needed to keep his weight back and grow.
There are a range of nutritional supplements available that can be prescribed to your child. Sometimes equal nutrition cannot be achieved with oral supplements alone.
Source: dietary advice for children on diagnosis