Some babies with CKD need a special diet as well as special formula milk. This is usually only needed for babies who are eating a significant amount of food (more than a few tastes or spoonfuls). If your baby needs a special diet, the dietitian will give you advice on which foods to choose or avoid.

It is very important not to add salt to any baby’s food. Ready-made or convenience meals often have a lot of salt. Speak with your dietitian before giving these foods to your child.

Coping with feeding problems

Some babies and children with CKD struggle with feeding or eating. Even if your child’s CKD means that they are ill for a long time, it is important that they still develop feeding skills.

Why does my baby or child have feeding problems?

• Your child may find that food tastes different because of their CKD. This may affect which foods they like.
• Your child may not want to eat very much because poor kidney function affects appetite.
• Gastro-oesophageal reflux (also called acid reflux) occurs when what is eaten comes back up from the stomach and into the food pipe (oesophagus). It is very common in babies and children and may be 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 after eating. 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 they repeatedly vomit, have gastro-oesophageal reflux or take unpleasant-tasting medicines they may not enjoy eating.
• Your child may gag when you use feeding tubes, oral syringes or unpleasant tasting medicines. They 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 for babies and children with CKD.

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 them to develop positive associations with food. Avoid distractions such as the phone or television and take your time over meals.

It is important to access the right support. You may wish to talk to someone – a family member, friend or healthcare professional.

General tips

• Keep calm and comfort your baby or child as they feed or eat. This gives the message that feeding times can be happy and safe. Reassure your child if they are finding things difficult.
• Eat as a family as often as possible. Give your child lots of attention during feeds. If they are older, your child can learn by watching others.
• Praise your child, even if they just touch, lick or have 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 them and that has a texture (smooth or lumpy) they can easily manage. For chopped or finger food, give them pieces that are a sensible size. Speak with your doctor or renal team if you are unsure, or if a problem occurs.
• 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 they decide whether they like it or not, so 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 and this approach could stop them eating foods that they do 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

Tell your doctor if your child has gastro-oesophageal reflux or vomits. Treatments may include:

• positioning changes, for example by propping up the head of the cot
• keeping your baby upright for a short time after feeding
• smaller, more frequent feeds
• giving the feed slowly through a feeding tube
• using a feed thickener
• medicines. 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

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