By Laura Quenneville, RD
Without adequate nutrition, children’s growth and development might be compromised. Growth and development are typically not a concern when a child is meeting their caloric requirements and/or does not have any food restrictions, economic or social challenges, chronic diseases or acute illnesses. But for some families, the reality can be different when it’s time to discuss an “ideal” nutritional plan. Although all children might encounter some dietary obstacles, a healthy diet can be especially challenging for a child with kidney disease.
A child living with chronic kidney disease may face dietary challenges that could be life-threatening if ignored, such as (elevated serum potassium. So, it’s really important to curate a well-rounded diet that adheres to their dietary requirements. Remember, every child is different and will need a nutritional assessment from a registered dietitian to better understand their needs based on requirements, growth trajectory, and specific needs related to their diagnosis.
What is optimal growth or optimal nutrition?
Nutrition is key when wanting to optimize growth. If a child receives adequate nutrition for their age, they should thrive as expected, you would think. Well, it may not be that easy. Chronic kidney disease affects the production of a growth hormone and can slow down linear growth in children. A child with kidney disease may be prescribed an external growth hormone injection to help gain more height, but this will work only if nutrition is optimal.
Doctors and health care professionals will use special charts to assess children’s growth. They will review their nutritional needs to ensure the child is feeding well and tolerating their feed. When the child is older, a variety of foods from all food groups, vegetable, fruit, protein, dairy, grains, and fat, should be introduced, along with regular mealtimes (breakfast, lunch, and dinner) and snacks (2-3 snacks per day). With chronic kidney disease, a child may have food restrictions depending on the primary diagnosis and stage of CKD. When a dietary restriction is required, it is important to discuss it with your nephrology team and their dietitian to make sure your child is meeting all its dietary needs, including calories, proteins, vitamins and minerals. A simple deficiency can lead to another one and eventually impact growth. It can also impact your child’s general health or even their residual kidney function.
Dietary restrictions can also impact various systems like the gastro-intestinal function. A low potassium diet, for example, can decrease fiber intake. If potassium and fluid intake is limited, constipation can become an issue or worsen if it’s already present. A low potassium and low phosphorus diet can lead to low calcium and vitamin D intake, as dairy consumption will be limited. These micronutrients are important for bone health and crucial in a growing little human! These food restrictions can be more challenging when your child has either food allergies and/or is a selective eater.
Chronic kidney disease and sodium intake in children
Salt is added to many commercial and processed food items as well as baked goods. It is easy to exceed the daily recommended intake with these foods alone, so imagine if added salt comes into the equation. Limiting sodium intake might be necessary if your child is diagnosed with hypertension, nephrotic syndrome, has fluid retention, and/or on dialysis treatment. In general, you will be asked to avoid table salt, limit processed food and meals at the restaurant. Reading nutritional labels is a great start to monitoring salt consumption. You should aim for a maximum of 10-15% of sodium per serving. The % on nutritional labels are based on adults’ requirements. Thus, this percentage would be lower for your child. For more tips on low sodium diet, please read our blog post: Health Canada’s Healthy Eating Strategy: Why Lowering Your Sodium Intake Matters. Please note that a child on peritoneal dialysis or with a certain type of kidney disease that leads to larger urine output might need additional sodium. To make sure your child is meeting their sodium requirements, reach out to your nephrology team!
Feeding a child should be simple and pleasant but can also be complex and frustrating! Don’t refrain from contacting your care team members to address any related concerns or ask questions.
Interesting websites to visit:
- https://www.myrenalnutrition.com/dietary-principles (Includes great videos to show to your kids, recipes and a game!)
- https://www.kidneycommunitykitchen.ca/kkcookbook/recipes/ (for more recipes)
References
- Desloovere, A., Renken-Terhaerdt, J., Tuokkola, J. et al. The dietary management of potassium in children with CKD stages 2–5 and on dialysis—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 36, 1331–1346 (2021). https://doi.org/10.1007/s00467-021-04923-1
- Nelms, C.L., Shaw, V., Greenbaum, L.A. et al. Assessment of nutritional status in children with kidney diseases—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 36, 995–1010 (2021). https://doi.org/10.1007/s00467-020-04852-5
- McAlister, L., Pugh, P., Greenbaum, L. et al. The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis—clinical practice recommendation from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 35, 501–518 (2020). https://doi.org/10.1007/s00467-019-04370-z
- Shaw, V., Polderman, N., Renken-Terhaerdt, J. et al. Energy and protein requirements for children with CKD stages 2-5 and on dialysis–clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 35, 519–531 (2020). https://doi.org/10.1007/s00467-019-04426-0
- Texas Children’s Hospital, Pediatric Nutrition Reference Guide, 13th edition