Some babies and children with CKD struggle with feeding or eating. Even if your child’s CKD means he or she is ill for a long time, it is important that he or she still develops feeding skills.
Why does my baby or child have feeding problems?
Your child may find that food tastes different. This may affect which foods he or she prefers.
- Your child may not want to eat much because poor kidney function has an influence on appetite.
- Gastro-oesophageal reflux (also called acid reflux) – when what is eaten comes up from the stomach and back into the food pipe (oesophagus) – is very common in babies and children. It may more severe in those with CKD. Reflux can lead to regurgitating (bringing up the food into the mouth) or vomiting (being sick).
- Your child may feel nauseous (sick) or vomit. You may like to offer different foods to see which ones your child can tolerate.
- Your child may have unpleasant early experiences linked to eating. For example, if he or she repeatedly vomits, has gastro-oesophageal reflux or takes medicines that do not taste pleasant, your child may not enjoy eating.
- Your child may gag when you use feeding tubes, oral syringes or unpleasant tasting medicines. He or she may develop a fear of placing anything in their mouth.
Illness and feeding problems can mean there are fewer opportunities to offer the right types and textures of food.
What you can do
Feeding a baby or child with feeding problems can be a difficult and challenging experience. It is natural that this may cause anxiety. Providing a calm, safe and happy environment when feeding your child will allow him or her develop positive associations with food. Avoid distractions such as the phone or television, and take your time.
It is important to access the right support. You may wish to talk to someone – a family member, friend or healthcare professional. This will help you to stay calm and in control, without leaving you feeling that you will raise your voice or force feed your child.
Providing a calm, safe and happy environment when feeding your child will allow him or her to develop positive associations with food. Avoid distractions such as the phone or television, and take your time.
General tips
Keep calm and comfort your baby or child as he or she feeds or eats. This gives the message that feeding times can be happy and safe. Reassure your child if he or she is finding this difficult.
- Eat as a family as often as possible. Give your child lots of attention during feeds. If he or she is older, your child can learn by watching others.
- Praise your child, even if he or she just touches, licks or has a small taste of foods. Children respond much better to praise than they do to bribes, threats or punishments.
- Allow your child to get messy and have fun at mealtimes. Feeling and touching food is a great learning process. Try using foodstuffs such as dough, mashed potato, a coloured cornflour and water slimy mix, wet and dry pasta, chocolate finger painting. When this is mastered, your child may be ready for some basic cooking!
- Encourage older babies or toddlers to feed themselves while you supervise them – so that they grow in confidence and control.
- Give your child an amount of food that is right for him or her and that has a texture (smooth or lumpy) he or she can easily manage. For chopped or finger food, give your child pieces that are a sensible size. Speak with your doctor or renal team if you are unsure, or if a problem arises.
- If your child can manage pureed food, make this thicker. Lumpy foods of mixed texture may not be easy to start with. ‘Bite and dissolve’ foods can really help. Your dietitian can give you more ideas for your child.
- Once some food is accepted, it is important to try to move forward with new tastes and textures – even if the amount of food eaten is tiny. However, if your child really dislikes a certain food after several tries, do not force it. A toddler may need to try a food up to ten times before he or she decides whether they like it or not, so just give your child plenty of opportunity to try the same food, but with no pressure.
- Avoid hiding new foods within a food that your child will eat. Your child needs to trust you – this approach could stop him or her eating foods that he or she does like.
- Try not to worry about what your child is eating at this stage. Your dietitian will make sure that your child’s nutritional needs are met, according to their stage of development.
Gastro-oesophageal reflux and vomiting
If your child has gastro-oesophageal reflux or vomits, tell your doctor. Treatments are available and may include:
- medicines to help with gastro-oesophageal reflux – these may need to be adjusted over a few weeks, so always report back to your child’s healthcare team if things do not get better
- using a feed thickener
- smaller, more frequent feeds
- positioning changes – for example by propping up the head of the cot
- keeping your baby upright for a short time after feeding.
- giving the feed slowly through a feeding tube
Support with feeding problems
Healthcare professionals are experienced and trained to help you manage this and will support you if you have any problems.
Renal team and health visitors
The renal team can offer you support and will link in with your local team so that you have help nearer to home. It is useful to involve health visitors, nursery or school staff, and speech and language therapists.
Regularly offload any worries and discuss issues with your health visitor and/or renal team.
Teachers and nursery staff
You can speak to professionals – such as teachers or nursery staff – about your child’s eating difficulties and needs. Your renal team can also share feeding plans and recommendations with them. They may be able to encourage food experiences (like messy food play) in preschool or school settings.
Speech and language therapist
If your child has problems with chewing and swallowing foods, you may need advice from a speech and language therapist. The therapist can use techniques to encourage your child to develop eating skills, so that he or she can be given small amounts of food successfully. Some children will find it difficult to manage certain textures – chewing skills take time to develop. Toddlers need time to gain confidence with new textures. The speech and language therapist can also give advice around how to help your child with this.
If your child does not eat normally
Despite such help, some children with CKD do not eat normally until they have a kidney transplant. Keep up messy play and involvement at mealtimes, even if no food is eaten.