If a child has active inflammation and painful joints, they might not feel like eating. This can lead to weight loss. On the other hand, if they are taking corticosteroids, they may have an increased appetite. This can lead to excessive weight gain. If a child is overweight or has gained weight due to the side effects of corticosteroids, the extra weight can put stress on the knee, hip, and ankle joints. This can increase joint pain. It can even lead to joint damage. Therefore, having a healthy diet is very important.
The role of a dietitian or nutritionist
A dietitian or nutritionist is an expert in food and nutrition. Dietitians help promote good health through proper eating. A dietitian can talk to you and your child about special diet requirements.
Supplements
Children with JIA need additional calcium and vitamin D to help make bones stronger. While all young people need calcium and vitamin D, it is especially important in children with JIA.
Calcium
Calcium builds strong, healthy bones and teeth. It helps muscles and nerves work properly. If a child doesn't get enough calcium in their diet, their body will use the calcium stored in the bones to supply the rest of the body. This will make the bones weak. They may become more likely to fracture or break. Most teenagers do not have enough calcium in their daily diet.
Also, having active JIA can reduce the calcium in bones. Because of this, a teen who has JIA has a higher need for calcium than other teenagers.
Check out this calcium calculator from the BC Dairy Foundation: www.bcdairy.ca/nutritioneducation/calciumcalculator/. It will help you find out what your calcium intake really is!
Vitamin D
Vitamin D helps the body absorb calcium to help develop strong bones.
Sources of calcium and vitamin D
Dairy foods are very high in calcium, especially milk, yogurt, and cheese. Other good sources include calcium-enriched orange juice and enriched rice/soy beverages.
Milk (cow’s milk or enriched soy/rice milk) contains vitamin D. Fish, liver, and egg yolk are the only foods that naturally contain vitamin D. If your child does not eat vitamin D rich foods often, you may want to consider giving them a vitamin D supplement. Most multiple-vitamin supplements contain vitamin D.
Below is a chart outlining some different food sources of calcium and vitamin D.
Milk, whole, 2%, 1%, skim
Serving size: 1 cup
Amount of calcium pmg): 300
Amount of vitamin D (IU): 100
Yogurt, low fat, plain
Serving size: 3/4 cup
Amount of calcium pmg): 300
Amount of vitamin D (IU): Some brands of yogurt contain vitamin D — check labels
Milk, evaporated Carnation
Serving size: 1/4 cup
Amount of calcium pmg): 165
Amount of vitamin D (IU): 52
Frozen yogurt
Serving size: 1 cup
Amount of calcium pmg): 100
Swiss cheese
Serving size: 1 oz.
Amount of calcium pmg): 240
Processed cheese slices, cheddar
Serving size: 1 oz.
Amount of calcium pmg): 170
Fortified rice
Serving size: 1 cup
Amount of vitamin D (IU): 80
Fortified orange juice
Serving size: 1/2 cup
Amount of vitamin D (IU): 45
Fortified margarine
Serving size: 2 tsp.
Amount of vitamin D (IU): 51
Other tips for healthy eating
For those with a poor appetite:
- Try to eat small amounts of nutritious foods every two to three hours.
- Choose foods that your child or teen likes.
- Try to choose a variety of foods from all four food groups.
- Make sure to include high-protein foods during the day.
- Pediasure, Boost, Ensure, or Resource are high calorie drinks that can be used if your child has a poor appetite and has lost too much weight. These are supplemental drinks available in the pharmacy.
- Make fruit smoothies with full fat milk and yogurt, and add in an egg.
- Choose high calorie foods such as full fat dairy (3.25% milk, ice cream, cheese, and yogurt), meats and alternatives.
- Add extra calories to food by adding margarine, oil or cream to foods.
Some corticosteroids give a ‘false hunger.’ They tell the body that it's hungry even though the body has what it needs. In addition, fatigue and joint pain may cause your child to be less active. This combination can lead to being overweight, or in some cases, obese.
Below are some tips for healthy eating if your child taking corticosteroids:
- Avoid sweets as much as possible. Instead of juice or soft drinks, drink water. Try to save cookies and cakes for an occasional treat. Have low-calorie, healthy snacks available like raw vegetables, fresh fruits, unsalted crackers and unsweetened cereals. Microwave popcorn is another choice, but try not to add extra butter.
- Avoid fatty foods, like fried foods. Use oil, margarine and butter in small amounts. Switch to lower fat milk (1%) and low-fat yogurt. Low-fat salad dressings and dips are also available.
- Lower salt: Avoid packaged soups and sauces like soy sauce and ketchup, Stay away from preserved meats like hot dogs, sausage, bacon and luncheon meat. Try to look for low salt items.
- Multigrain bread, cereals and pasta, and brown rice contain fibre. This helps you feel fuller and provides more nutrients.
- Increase calcium for strong bones. For a healthy amount, teenagers require four servings per day of calcium. One serving is equal to one cup of milk, one large yogurt container, or one ounce of hard cheese. Make sure to choose lower fat cheese.
- It can be difficult if your child or your family want to eat out. Try to choose a place that offers low-calorie options.
- Plan ahead for special activities and events.
- Be as active as possible.
- Help your child find fun or interesting things to do when your child gets hungry.