Children with heart conditions may have trouble feeding or swallowing, or they may need a special diet. A multidisciplinary team, made up of a variety of health care professionals will help you decide how to safely feed your child. These health care professionals can include dietitians, lactation consultants, and occupational therapists. Dietitians are experts in healthy eating and nutrition. Lactation consultants are experts in breastfeeding and infant feeding. Occupational therapists assess difficulties in everyday living and help children and parents develop skills and make a plan to overcome these difficulties.
Dietitian
What is a dietitian?
A dietitian is a registered health professional with expertise in healthy eating and nutrition. Dietitians have special training in food science, nutrition, and eating for special diets. Their work is focused on preventing and treating illness through dietary modification. The dietitians who work in hospitals are usually referred to as clinical dietitians.
Children with heart conditions often need the support of a dietitian who can help ensure the best nutritional intake possible for children by helping to plan a well-balanced diet and educating parents so that they can take the necessary steps to do the same.
How can dietitians help children with heart conditions?
Dietitians assess children in the cardiac ward to see if their nutrition and feeding are adequate. They focus in particular on those children who are failing to thrive. The high-risk patients - those at risk of poor growth and development - tend to be under the age of 2. Dietitians see children in the pre-operative and post-operative clinics, as well as in cardiac nutrition clinics.
Dietitians sometimes work with occupational therapists if there are physical challenges to food or fluid intake. Specifically, dietitians can address feeding or hydration issues that come up due to heart conditions or problems that may result after surgery. This is supervised by the cardiologist.
Dietitians also help treat children with inherited high cholesterol levels (hyperlipidemia) and those who are obese as a result of lifestyle or treatment for a heart condition that has caused weight gain.
How would your child see a dietitian?
A doctor or nurse would refer your child to a dietitian if there were concerns about your child's feeding ability or nutritional intake.
What are some of the common questions parents of children with heart conditions ask dietitians?
Many parents want information on basic feeding strategies, specifically about:
- when and how to start a baby on solid foods
- how long to spend on feeding
- how much children should be eating and drinking
- evaluating and changing a feeding plan
- how to breastfeed a baby with a heart condition
- how to supplement breastfeeding
- when and how to wean from breastfeeding
- how to know if a breastfed infant is getting enough nourishment
- how much weight a child should be gaining
- planning meals after discharge from hospital.
Some of these issues may seem straightforward, but they become more complicated when a child is sick and the family is under stress. Some parents might have had experience raising other, healthy children, but find the issues are different with their ill child and are unsure how to cope.
What do the dietitians look for?
When evaluating your child, the dietitian will check your child's weight, height, food intake, and fluid status. Growth charts help identify how your child is growing compared to children of the same age and sex. For example, a child who is in the 90th percentile for height but the 50th percentile for weight would be considered underweight. A child who is growing slowly or a child that stops growing or starts losing weight is also cause for concern.
How will the dietitian help your child?
Depending on your child's condition, the dietitian may recommend energy-boosting formula or food with extra calories. They may help organize a feeding tube to help your child get the appropriate nutrients they need if they are not able to take in enough food by mouth or needs supplemental feeding. They can also arrange for special diets or special nutritional products if your child is taking certain drugs that affect nutritional intake; for example, potassium supplements or drinks with electrolytes can help replace potassium lost due to diuretic use. The dietitian can also give advice if the child has a surgical complication, such as chylothorax.
The dietitian will provide guidance on how to feed your child appropriately at home and, later, how to ensure they eat well at school.
Lactation consultants and occupational therapists help parents carry out the dietitian's recommendations.
Lactation consultant
What is a lactation consultant?
A lactation consultant is someone with expertise in breastfeeding and feeding newborns and young babies. They are part of the health-care team. These health-care professionals provide services to mothers who wish to breastfeed their newborn or young baby, or who wish to express and store breast milk for their hospitalized baby.
Why would you and your baby need to see a lactation consultant?
A lactation consultant can help if you, your baby’s physician, or any other member of the health-care team has concerns about your baby’s breastfeeding, or if you need help and support with expressing breast milk (breast pumping).
Occupational therapist
What is an occupational therapist?
An occupational therapist (OT) is a registered health-care professional who provides assessment of oral feeding function and swallowing safety to recommend feeding interventions. A feeding assessment often occurs in the hospital room. If medically necessary, a videofluoroscopic feeding study can be conducted in conjunction with radiology.
How can an occupational therapist help with feeding children with heart conditions?
In some cases, infants and children with a heart condition may experience feeding and swallowing problems. An OT can help by providing a thorough assessment of the child’s oral motor and swallowing function and offer recommendations to make feeding safe, efficient and comfortable.
How would your child see an occupational therapist?
When problems with oral feeding and/or swallowing are identified by the parent, caregiver or health-care team member, a referral for occupational therapy would be provided by your child's doctor.