Paediatric Cystic Fibrosis (CF) – Helping your child to eat well

Eating well and mealtimes

Eating well is important for everyone, and is especially important for children with cystic fibrosis. Having a healthy diet will help you child get the energy and nutrients they need to gain weight and grow, fight infections and stay well.

When young children are not eating well, meal times can be stressful. If your child has CF, this can be particularly challenging, especially if your child is struggling to gain weight or if your child needs to take enzymes or medication with their food.

Top tips for meal times

Offer meals and snacks at regular times, this way your child learns to expect when they are going to eat.

Always offer breakfast. This gives your child the energy they need for the day ahead and it can help to improve their concentration.

Offer small portions at first, these are less daunting and you can always offer seconds afterwards.

Offer a savoury and a sweet course at lunch and dinner to encourage variety.

Eat together as a family as often as possible, aim to make mealtimes a pleasant and social experience.

Children eat best when there are no distractions. Turn off the television and put tablets away until the end of the meal.

Keep mealtimes short; set a time limit of 20 – 30 minutes. Then remove uneaten food without comment.

Make the food look attractive, offer colourful foods, choose colourful plates and cups with your child’s favourite ‘characters’ on, use pastry cutters to cut sandwiches, arrange food in patterns.

Involve your child in preparing food, talk about food you both like and which meals you enjoy. Take your child shopping, talk about what you are planning to buy, allow them to help you choose. Let your child help with cooking, they may even want to taste the results! Try growing fruit and vegetables in the garden.

How you can help

Your child will copy your behaviour; if you eat well and enjoy your food, your child has an excellent role model.

Praise your child when they eat well, even if it is just a spoonful. This helps your child learn that good behaviour gets attention, whilst unwanted behaviour does not.

If your child refuses to eat, resist the temptation to offer an alternative meal. Offer a normal portion of dessert at the end of the meal, so your child has a second opportunity to eat, or wait until the next usual meal or snack time.

It is not easy, but try to avoid getting cross or showing your frustration, as this shows your child you are anxious, and reinforces the behaviour you are trying to avoid.

Never force your child to eat.

Try not to offer only those foods that you know your child will eat.

Try serving food you know your child will eat at the same time as you offer them a new foods or a food they have previously rejected. This way your child has something they like to eat, you feel less anxious as your child has eaten something.

If possible, only introduce one new food at a time.

The new food may need to be offered a number of times before your child accepts it.

If your child tries to get your attention by screaming or throwing food, gently remind them this is not acceptable; remove the food without any further comment.

Be careful if you give instructions such as ‘stop throwing the food’, your child might not stop. If you threaten a consequence for a particular behaviour, carry this out as soon as possible so the child learns the connection.

Avoid bribery or empty threats that can’t be carried out (for example ‘you won’t come on holiday unless you eat your dinner’) your child will learn these are meaningless.

Ask other caregivers such as grandparents or child-minders to do the same, this way your child knows what to expect.

What if my child needs to gain weight?

If your child needs to gain weight this can be a particular concern when they are not eating well.

If this continues, your dietitian can give you advice on helping your child gain weight.

Your dietitian may suggest you include high-energy foods into your child’s diet as snacks, or by adding extra energy to their meals. Balance high-energy foods with other food, so that your child continues to have a varied diet. Offer small portions of high-energy foods, either with or after meals. Try not to offer high-energy foods just before a meal as your child may then refuse to eat the meal.

What if my child is unwell?

Children often eat less when they are unwell. If your child is unwell, you may find they start to refuse food they previously enjoyed and this can cause added concern.

Try offering smaller portions of food more frequently. Offer foods that your child enjoys and food that they find easy to eat. Offer milky drinks in between meals as a way of boosting their energy intake.

If your child has been unwell, it can take 1 - 2 weeks for your child’s appetite to fully recover. Contact your dietitian if you are concerned.

What if my child needs to take enzymes (Creon)?

If your child is not eating well it can make giving your child the correct dose of enzymes difficult to manage, this is especially so if they are grazing and eating constantly through the day, or if they are not finishing their meals.

Offering meals and snacks at regular times will help your child learn when they are going to eat, and allow them to develop a sense of hunger between meals. This means they will be more likely to finish their meal.

Tips for enzymes (Creon)

Enzymes work best when given at the same time as food.

If you have already given your child their enzymes and your child subsequently does not finish their meal try not to show them you are concerned. After 20 minutes if your child still hasn’t finished their meal offer a dessert in the usual way, try to choose a dessert that needs enzymes, for example yogurt or cake, or offer a cup of full fat milk.

Try not to worry that your child may not have had the full amount of food for the amount of enzymes they have taken. This is not harmful if it happens occasionally. Contact your dietitian for advice if this happens frequently.

Avoid the temptation of offering your child their favourite food, such as chocolate or crisps to ‘mop up’ the enzymes, your child will soon learn to manipulate this situation.

You can try splitting the enzyme dose, for example, you can give some of the enzymes at the start of the meal, and give the remainder of the enzymes in the middle or at the end of the meal. Extra enzymes can be given if your child has second helpings or dessert.

If your child refuses to take their enzymes please contact your dietitian.

If you require any further information, please contact your dietitian.

Dietitian: ……………………………………………………

Tel: 01223 216655