Diet

Many parents think that children with cardiomyopathy need special low-fat diets similar to what is recommended for adults with heart disease. On the contrary, children with heart disease usually have poor appetites and need high calorie foods and snacks to increase their weight. A good article to read is "Nutrition in Pediatric Cardiomyopathy" published in Progress in Pediatric Cardiology.

It can be a challenge for parents to increase the amount of calories their child eats in a healthy and positive way. Ensuring adequate nutrition often requires both dietary and behavioral modifications. The National Food Service Management Institute’s Handbook for Children with Special Food and Nutrition Needs states, “It is not effective to increase the calories for these children with large or double portions. The key is to increase calories by adding fats, oils, sugars, or thickeners such as cereal or commercial supplements to the food without increasing the serving size.” In addition, slow introductions to foods generally help children feel less overwhelmed and more relaxed about trying something new.

Oral Feeding Recommendations

Establish a regular meal and snack routine for your child: plan for three meals and two to three snacks, spaced at least 1 to 2 hours apart. Do not offer anything to eat or drink between set meal and snack times except for water.

For children who take food in by mouth, calories can be increased in a variety of ways. The following high calorie foods can be added to the child’s usual diet to maximize calorie intake:

  • All fruits – serve with cream on top or dip into yogurt, chocolate or nut butters
  • All vegetables – serve with butter, margarine or cheese on top
  • Butter or margarine – add to meats, hot cereal, vegetables or bread products
  • Cheese – add to creamy foods
  • Commercial nutrition supplements – serve as beverage
  • Eggs – add to baked goods, meat loaf and puddings
  • Fats and oils – use in sautéing or frying, add to soups, casseroles, vegetables, gravies or oatmeal and in incorporate oil, mayonnaise and salad dressing to other dishes
  • Infant cereal – add to pureed fruits, soups, cereal
  • High protein foods – increase portions of beef, pork, chicken, turkey, and fish; eggs, nuts and nut butters, dried beans and peas
  • Starchy foods – increase intake of breads, pasta and rice, along with certain types of fruits and vegetables
  • High fat dairy products – use whole milk or flavored milk, cream, half-and-half, cream cheese, whole milk yogurt, pudding, powdered dry milk, cheese, sour cream, ice cream
  • Evaporated Milk – add to beverages, soups, cereals and puddings
  • Instant breakfast packets – mix into milk or other foods
  • Powdered Milk – add to soups, mashed potatoes, cream sauces, puddings
  • Peanut Butter and Nut Butters – spread on crackers or bread
  • Rice cereal – add to other pureed foods
  • Offer higher calorie beverages like Ensure, Sustacal or Nutrament more often
  • Sauces and condiments – add or use chocolate syrup or caramel sauce, barbecue, tartar, or sweet-and-sour sauce, ketchup, maple syrup, cheese spread, honey (for children older than 1 year), hummus, jams

A good book to consult is Bowes & Church's Food Values of Portions Commonly Used, a sourcebook that provides nutritional data (calories, fat, and sodium) on common foods and brands.

Vitamins

It is not always easy to make sure children get all the vitamins, minerals, and nutrients they need through the food they eat. Your doctor or nutritionist may recommend supplements for your child to help support healthy growth. Some vitamins and minerals can be harmful if taken incorrectly, so it is important to talk with your child’s health care team to find out which supplements and doses are right for your child.

Supplements

High calorie liquid supplements designed for children such as Pediasure, Boost and Ensure should be offered in place of usual beverages. There are also a variety of powdered nutritional supplements that can be added to drinks or prepared food. These include Carnation Instant Breakfast, Duocal and Scandishake.

Fluids

Children with heart conditions like cardiomyopathy are at a higher risk for heat exhaustion or heat stroke because they have low cardiac reserve. The heart cannot quickly adjust to changes in the body during extreme heat. Adequate fluid intake is important during hot weather or while engaging in exercise to prevent dehydration. If your child is taking a diuretic that rids the body of excess water and salt, your doctor may recommend a potassium supplement or electrolyte solution like Pedialyte.

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