Proper nutrition and diet are necessary for all children to grow. According to the professionals at Lurie Children’s, children who have had a liver disease are often smaller than their peers or siblings, and can have trouble eating or drinking enough to catch up. Therefore, a balanced diet and proper nutrition are vitally important both before and after your child has a liver transplant.
Nutrition Before the Transplant
Your child’s nutritional health continues to be very important while they wait for a liver transplant, as well as to be healthy for the transplant. This may be difficult due to the many jobs the liver has in regards to nutrition. These jobs include the digestion and absorption of protein, fat and carbohydrate as well as the fat-soluble vitamins (A, D, E and K).
The more severe your child’s liver disease is, the higher their nutritional requirements may be. Therefore, they may need additional nutritional support. This help can come in the form of specialized formulas (such as Pregestimil or Peptamen Junior). These formulas are higher in a type of fat that is easier for your child to digest (called MCT). The addition of fat-soluble vitamin supplements may also be beneficial. If your child is unable to eat enough or is ill, they may also need the help of supplemental tube feedings and/or intravenous nutrition support (TPN).
Liver disease can affect your child’s nutritional health in many ways. They include the liver’s inability to breakdown and use the nutrients or their poor appetite. Some of the reasons they may have a poor appetite include fatigue, nutrient deficiencies, decreased abdominal space due to ascites, reflux/nausea and diet restrictions (such as a salt restriction). Also, some of the medications your child is on may interfere with the nutrients in their diet.
Liver disease also makes monitoring your child’s nutritional health more difficult. Usually a good indicator of their nutritional status is growth and/or weight gain. As you may have noticed, weight may fluctuate based on your child’s ascites. Therefore, your liver team may ask to do additional measurements such as triceps skin fold measures to monitor his growth.
Here are some tips to help you maintain your child’s nutritional health before transplant:
Offer small, frequent feedings and/or meals/snacks. Your child will feel full faster and will be unable to eat a lot at one sitting.
Use Pregestimil baby formula if recommended by your team if your child is less than 1 year of age. This will help your baby digest the fat better.
Increase the calories per ounce in your baby’s formula as directed by your medical team.
Provide fat-soluble vitamin supplementation as directed by your team. Monitor the vitamin levels in your child’s blood on a regular basis.
Zinc, iron, calcium and magnesium may also need to be supplemented.
Your child’s nutritional health will improve greatly after a transplant. However, there are some things to keep in mind:
Maintain a healthy diet by offering a wide variety of foods to your child’s diet.
Be aware that certain medications, such as prednisone, may affect their appetite.
Prednisone may increase your child’s appetite. Monitoring his intake and discussing your concerns with your liver team are important. Be sure that they’re very active as tolerated.
Be sure your child continues to grow well.
Your child may continue to need additional mineral supplementation such as magnesium. This is due to the immunosuppressive medications. Whole grains, beans and legumes, green leafy vegetables, milk, eggs and meat are good sources of magnesium. Your child, depending on age may need 0.5-2.2 mg/day. Be aware that even with a diet rich in magnesium, an additional supplement is often needed.
Calcium can also be affected by your child’s medication. Ensuring your child consumes enough calcium is important. Good sources of calcium include milk, cheese, fortified orange juice, almonds, sardines, spinach, salmon and sunflower seeds. Supplementing diet with calcium may be needed. Supplements such as Tums and Viactiv chews can be used. The recommended daily amount of calcium based on age:
Infants (0-6 mos): 210 mg/day
Infants (7-12 mos): 270 mg/day
1-2 yrs: 500 mg/day
3-8 yrs: 800 mg/day
9-18 yrs: 1,300 mg/day
Overall, after liver transplant, your child will be able to eat a healthy, well-balanced diet. Our team has specialized pediatric dietitians who are available to you to help maintain your child’s nutritional health before and after the transplant. Please call 312.227.5067 if you need help.