Cystic fibrosis (CF) is a genetic condition that primarily affects the lungs and digestive system. One of the significant challenges for ...

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Nutrition in Children with Cystic Fibrosis | Ms. Roshan Kore

I'm Dr indu kosla I'm the pediatric pulmonologist here at the NH srcc hospital for children in Mumbai which is managed by Nar Health today I'm going to touch upon a topic on nutrition in children with cystic fibrosis and and Dr Roshan Kore who is our chief dietician here at the NH srcc Children's Hospital will join me shortly why is nutrition important in children with cystic fibrosis in fact this is the pillar on which their health depends we know that the reason why these children are malnourished or they do not grow is because they lose fat and protein in their stools this occurs because of lack of enzyme called the pancreatic enzymes predominantly the lipase the proteas which uh are not secreted into the intestine as the thick mucus blocks the duct of the pancreas hence whatever these children eat either is malabsorbed and it's thrown into the stoo it's just not completely absorbed because of this they do not gain weight and hence when they do not gain weight they are more prone to infections they're as it is prone to infections because their lungs are blocked because of thick mucus and when they are malnourished they are further immuno deficient or they're poorer in immunity and therefore they get more and more infections so these children require High protein almost two to three times the recommended dietary allowance of proteins calories fat uh vitamins fat soluble vitamins which also don't get uh which also don't get digested because of the because of the problem of the deficiency of enzymes in their intestine all this has to be supplemented from outside apart from this they need enzymes to digest whatever we are giving so we need to give pancreatic enzyme which is called as pan pancreatic enzyme replace ment therapy which has to be given in younger babies who are breastfed we need to give approximately around 2,000 international units of this pancreatic enzyme per 120 ml of milk as they grow older the calculation is done based on the fat content of their food so approximately you need 10,000 international units of pancreatic enzymes per 3 to 5 gam of fat in their meals approximately if one has to calculate the upper limit of dose age is 10,000 international units uh per kilogram of body weight but that's the upper limit it needs to be monitored based on the child's uh weight gain based on the child's frequency of stool or presence of oil in stool so each child may have a different requirement of the pancreatic enzymes what is important that these enzymes are available in a capsule form and inside the capsule are there are there are microspheres which are coated and these have to be delivered in into the intestine since small children cannot take them as a capsule form these capsules are opened and they have to be uh given to children in such a form that it goes unscathed into the intestine so these enzymes have to be qued uh so that the child uh it can reach and not be destroyed by the acid in the stomach uh has to be given mixed with either say apple py a little bit of honey and it should be given as the child starts consuming a meal so once the child has consumed three to four scoops of any meal that the child is consuming this dose of pancreatic enzyme which is qued in either honey or an apple py should be given so that it acts on the food that the child is eating once you do this and along with the diet which Dr Dr Roshan Kore will suggest to us uh these children will do can do very well and they they can lead a better quality of life uh considering the fact that they have cystic fibrosis thank you hello I'm Roshan Kore Pediatric ditian at srcc Children's Hospital managed by Nar Health today we are discussing about the topic nutrition for Cystic Fibrosis we all know that children with cystic fibrosis have increased requirements for calories and proteins along with other nutritions because as Dr indu has explained they are not able to absorb whatever is getting provided to them so let's see how how we can improve the nutrition content of the food first is the calories to increase the calories in the diet fats which are a major source of calories giving 7 kilo calories per gram are our first thing that we go to fats can be included in the form of butter ghee oil MC oil and coconut oil for cooking as well as drizzling over different preparations second is including nuts and oil seeds like ground nuts coconut casew pistachios Etc in preparations like porridges salads fruit salads and thereby increasing the calorie and protein content we can also have we can also ensure that the child gets enough calories by making preparations with more than one food ingredient so that there will be all the other nutrients along with calories and proteins good example for that is something like a parata which can be made using a wheat flour as well as a cheese or paneer and vegetable mixture so you get a balanced diet in one meal it is important that the child with cystic fibrosis gets concentrated meals because their appetite is very poor so you need to give foods which are prepared in concentrated which are concentrated in nutrients like calories proteins fats fibers everything together together you have to understand that a child when a baby is born with cystic fibrosis the baby would be on breastfeeding at the age of around 4 to 6 months weaning or compliment feeding needs to be started If the child is going well weight gain is proper the introduction of complimentary feedings can be delayed up to 7 month but if the child is lacking in weight gain we need to introduce concentrated Foods before that we have to remember that a baby is ready to eat soft foods at 7 month of age and we start with soft foods like soft opma Hala Ki rather than giving liquidy gruels and uh thin kji when we are making this soft kites we have to start with one food at a time introducing just a rice or a moong at one time and then slowly progressing to other food grains and other vegetables and fruits give time for 4 to 5 days to digest and tolerate one food and slowly and steadily you will have a whole range of foods which the child can start eating then start by combining these Foods together to make a complete balanced meal in one bowl for the baby porridges like which have uh satu ATA or wheat ATA and other millets can be prepared in milk instead instead of preparing in water they can be concentrated by adding a teaspoon of ghee or a dollop of butter adding sugar jaggery dry dates powder can further increase its calories that way a small bowl of porridge is having all the goodness of the nutrients that a child is requiring then you can also move on to introducing non-vegetarian foods like egg and chicken by the time the baby is 8 to 9 month old introduce one small thing at a time check for intolerance Don't Panic if there is a little bit of change in the stool structure the baby will take a little while to get adjusted to the new foods adding eggs and chicken to different meals will further enhance the protein content the child also needs multiple vitamins and minerals especially the fat soluble vitamins which are available in Dairy and non-vegetarian Foods so introducing uh Dairy and non which is a must for children with cystic fibrosis when the child is ready to eat soft foods and has all the different flavors and different foods introduced you move on to solid foods by the time the baby is teething that way you will achieve a goal of providing the child a full meal at age one year so that he can have a thali of food where all the different foods that an adult would be eating are introduced but remember remember that you need to keep the portion size small and concentrated when older children are having Cesc fibrosis and that is when you have to think about the growth so to ensure that the child is growing well make sure you are introducing all the different foods we can add fats in form of snacks snacks like chips and Wafers may not be advisable for generally for children but small portions of this can give a load of uh calories and salt to a child who has a increased demand for these things also things like uh cheese and paneer have high calorie and protein value and a thing like a pizza which is modified to add some Sprouts more cheese more paneer and a lot of vegetables in the gravy can be a good source of snack for this children introduce sweet preparations like porridges Hala lados chickies because they not only have sugar in it but also have fats in the form of ghee nuts also provideed proteins and the grains will provide with the fiber and the calories so traditional Indian preparations can be a good source of nutrition for our children with cystic fibrosis as the child Goes to School make sure the tiffen preparations are easy to eat something like a rrap is stuffed with protein rich foods like uh nonvegetarian and paneer and dairy and sprout house can be easy for a child to hold and eat and one bite will give all the wholesome of nutrition that is required so a balanced diet is the key to provide concentrated energy protein and nutrients to the child with cystic fibrosis

Dr.

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