I know first hand how difficult it can be to ensure that your children are getting adequate nutrition in their daily diets. With three children of my own, and the possibility of a PKD diagnosis looming over their heads, nutrition remains on my radar as the most important weapon of defense for them.
No kid should live on a diet of junk food and soda pop, particularly with childhood obesity on the rise. But for a young one with kidney disease, or the possibility of kidney disease in their future, nutrition is even more important to protect the kidneys and maintain good health.
Children with kidney disease have special dietary needs. What’s at stake? Kidney failure has the ability to decrease growth and increase weight gain. This is especially vital during the first two years of life, when children grow the fastest. When the kidneys are not working well, they may not be able to get rid of waste products from foods in the diet. It’s that build-up of waste that often compromises a child’s growth. What can help improve growth? The right balance of nutrients and calories. I know I make it sound easy. But the reality is, it is our job as parents to offer the right food choices….over and over again. It takes numerous offerings of certain food items, before a child may “accept” it into their diets. And you may be surprised at what your children will actually eat. Many friends of mine are constantly impressed that some of my children’s favorite food items are omega-rich salmon, sushi, salads with a variety of vegetables, and whole-wheat pastas. It really is no fluke, it’s what I serve, offer and prepare. It took years of these things over and over. And now, I feel confident with their food choices. Of course, they enjoy the traditional kids items, chicken nuggets, mac-n-cheese and pizza. There is always room for those items, as long as they are balancing with nutrient-rich choices.
A renal dietician can step in to set the pace for how a child eats; making sure the diet includes or excludes a combination of sodium, potassium, phosphorus, protein, calories and fluid. The amount of calories is calculated using the child’s weight. The diet will depend on several factors: how well the child’s kidneys work, if the child requires dialysis, and if the child has had a kidney transplant. We do believe that diet may reduce the rate of kidney disease onset and progression. So developing healthy eating habits early on not only may benefit the child with kidney disease now, but also with the possibility of prolonging a kidney disease diagnosis in the future.
Children need protein for growth and repair of the body and to help fight infections. Protein is found in foods such as meat, fish, poultry, eggs and milk. When the body digests protein, a waste product called urea is produced. The kidneys normally filter urea out of the blood and into the urine. However, when the kidneys do not work properly, urea and other waste products build up in the blood. This may make your child feel unwell.
When your child is receiving pre-dialysis treatment, you may be advised to reduce the amount of protein in your child’s diet. This will help to reduce the amount of urea, which the body produces so less urea will build up in the blood. However, protein is very important for your child’s growth, so your child must have enough protein to grow, but not too much. That is why you and the dietitian must carefully monitor how much protein your child is getting. If your child is receiving dialysis treatment, the amount of protein needed in the diet will depend upon what type of dialysis treatment is chosen. After a successful kidney transplant, there is usually no need to restrict the amount of protein in the diet.
Energy is provided by foods, which contain carbohydrates (sugars and starches) and fats. Carbohydrates can be found in foods like fruits and vegetables, bread, rice, pasta and cereals. Fats are foods like oil, butter, margarine and mayonnaise. It is very important that your child eats enough of these energy-giving foods so the body does not break down muscle or use protein for energy. Sometimes dietary energy supplements may be necessary.
The kidneys control the amount of salt (sodium) the body needs. When the kidneys are not working well, salt levels may build up in the body. This build up can cause thirst, puffiness or swelling (also called edema), and possibly high blood pressure (also called hypertension). To prevent this, you may be asked to reduce the amount of salt in your child’s diet. You can do this by not adding salt to food at the table, and by minimizing salty foods, such as canned, prepackaged or “fast” foods, potato chips, ketchup, etc. There are, however, some children who actually lose too much salt or sodium in their urine. If this is the case, then there is no restriction on the amount of salt your child can have. Sometimes your child may also need to take salt or sodium supplements. Your child’s doctor and the dietitian will determine the correct amount of salt your child should have.
Potassium is a mineral that’s found in many foods. It helps the nerves and muscles to work. The kidneys control the amount of potassium in the blood. When the kidneys are not working well, the level of potassium in the blood may increase. Too much potassium in the body can be dangerous because it can harm the heart. Your child may have to limit foods, which are high in potassium. The dietitian will be able to tell you what foods contain potassium and how much potassium your child can eat.
Calcium and phosphorus
Calcium and phosphorus are important for the growth of strong, healthy bones. In chronic kidney disease (CKD), the kidneys cannot remove enough phosphorus from the blood and the levels can build up. This can cause itchy skin, joint pain and weakened bones. Your child may have to limit the amount of high phosphorous foods. These include milk and dairy products, peanut butter, nuts and seeds, dried peas and beans. Medication is sometimes given with meals to prevent the absorption of the phosphorus from the digestive tract and so reduce the build up of too much phosphate in the body.
Healthy kidneys produce a special form of Vitamin D that helps the body absorb calcium. Your child’s doctor may prescribe a Vitamin D supplement that will help keep your child’s calcium levels normal and prevent the bones from becoming weak.
The kidneys control fluid balance in the body. When the kidneys do not work well, it may be difficult for them to get rid of excess water. The amount of urine they make may decrease.
The excess water stays in the body causing weight gain, puffiness or swelling, and a rise in blood pressure. If this happens, it may be necessary to reduce the amount of fluid that your child drinks. It is helpful to reduce the intake of salty foods because salt will make your child thirstier. With some types of kidney disease however, the kidneys produce a large amount of dilute urine. This means that although there is a lot of urine, it does not contain the waste products, which should normally be found in the urine. If this is the case, your child might need to drink lots of fluid. Check with your child’s doctor and dietitian about how much liquid your child needs to drink.
Vitamins and minerals
A well-balanced diet normally provides enough vitamins and minerals to keep your child healthy. If your child is not eating well, your child’s doctor and dietitian may prescribe a daily vitamin supplement. A supplement is necessary if your child is on dialysis because some vitamins and minerals are lost during the dialysis treatment.
Many children with CKD have decreased appetites and they may develop a dislike for foods they used to love. They may feel tired, nauseous and generally unwell. They may not be able to eat enough food to meet their special needs to grow and be healthy. If this is the case, your child’s doctor and dietitian may prescribe a special formula or milk shake. This will provide the extra nutrition your child needs. Be sure your child takes these formulas and milk shakes as prescribed, because they must be treated with the same importance as medications.
Points to Remember
• Diet can play an extremely important role in managing symptoms, preventing symptoms and supporting overall health.
• In children, CKD can cause problems such as weak bones, lack of appetite, lack of energy, and slowed growth.
• Health problems from CKD can be prevented or delayed by eating the right foods.
• Children with CKD may, at times, avoid eating because they have poor appetites. Taking in too little energy can lead to decreased activity, poor growth, and decreased resistance to infection.
• Caretakers should talk with the health care team about the amount of protein and the sources of protein in their child’s diet. Protein helps build and maintain muscle, bone, skin, organs, and blood. But proteins break down into waste products that must be removed from the blood by the kidneys.
• Doctors sometimes recommend that people with CKD eat moderate or reduced amounts of protein to relieve the burden on the kidneys.
• In some children with CKD, too little sodium can lead to dehydration and poor weight gain. Too much sodium can increase thirst, raise blood pressure, and cause water retention that may lead to excess weight gain or fluid buildup in the lungs.
• People with CKD should avoid salt substitutes that use potassium.
• Potassium keeps the heart beating regularly and muscles working right. Too little or too much potassium can cause heart and muscle problems.
• When blood phosphorus levels are high, healthy kidneys remove the extra phosphorus from the blood and move it to the urine. In children with CKD, the kidneys do a poor job of removing phosphorus and blood phosphorus levels can become too high.
• If a child’s kidneys fail and the child begins dialysis, caretakers may need to limit how much their child drinks because one dialysis session removes only a limited amount of fluid.
• Many caretakers find that keeping track of test results helps them see how well their child is doing.
• Encourage the child to be physically active and eat a well-balanced, nutritious diet. Note: Always consult your doctor or dietician before changing a kidney disease diet and adding exercise into your lifestyle.
Information or materials posted on this blog are intended for general informational purposes only, and should not be construed as medical advice, medical opinion, diagnosis or treatment. Any information posted on this blog is not a substitute for patient specific medical information or dietary advice. Please consult with your healthcare team or dietitian for a more complete dietary plan and recommendations.