A Q&A with Paige Vondran, BS, Supported by Natalie L. Stoner, RD, CSP, LDN
Published on in CHOP News
Published on in CHOP News
Children’s Hospital of Philadelphia (CHOP) is one of the only hospitals in the nation with a dedicated medical chef educator to work with families to ensure patients have the best quality of life while maintaining therapeutic diets. The medical chef educator works closely with registered dietitians to create nutritional, kid-friendly recipes to meet the needs and tastes of patients who must use prescribed, restrictive diets such as the ketogenic diet, blenderized tube feeds, anti-inflammatory diets, specific carbohydrate diets and others.
Families of patients on very restrictive diets may benefit from a consultation with a medical chef educator. I help families manage the everyday challenges of therapeutic diets for children and address issues like pickiness, food “ruts” (repeatedly eating the same foods), carving out time for cooking and making restrictive diets more palatable.
When a patient is prescribed a restrictive diet, it impacts the entire family — not just the patient. Birthday parties, school lunches, day care and feeding therapy are just a few challenges a family may experience when a restrictive diet is implemented. I work closely with registered dietitians to help families better manage and maintain their child’s diet — ultimately helping them become more compliant with the diet plan.
I work with registered dietitians to provide the best care possible for CHOP patients — whether they are in the hospital or living at home. The collaboration between the dietitians and myself provides both nutritional and culinary expertise to create a meal plan suited to each individual patient. At this time, I only consult with CHOP patients and families.
I have a patient on the ketogenic diet who is refusing to eat the high-quality proteins necessary for proper growth. What recommendations do you have to meet their nutritional needs, yet keep the food desirable?
The ketogenic diet can be limiting when choosing ingredients, and picky eaters can pose an even greater challenge. Luckily, animal proteins and other high-quality proteins can be secretly added to recipes with hardly any change to taste or texture. The best proteins to use when secretly hiding them in recipes are neutral-tasting: tofu, plain unsweetened yogurt, mild cheeses, cooked ground chicken, white flaky fish and nuts. For a savory meal idea, consider a ketogenic pizza crust — which can be made using egg, mashed cauliflower, mozzarella cheese and cooked ground chicken — topped with marinara sauce, olive oil and more mozzarella cheese. No one would ever know the secret ingredient is the crust!
The best way to avoid highly processed foods that contain sugar and additives is to prepare homemade foods whenever possible. Of course, this is easier said than done! A few pro tips:
It has become quite common for families to choose to become dairy-free — whether by choice or tolerability. To ensure children receive enough calcium in their diet, consider adding calcium-rich foods such as collard greens, navy beans, tempeh, quinoa, tofu and almonds to their diets. Other good choices are homemade yogurt or nut milk without addititives. When following a restricted diet, it is important to work with a registered dietitian to ensure the diet is being followed correctly and nutrition requirements are being met. To help with meal ideas, we’ve created recipes that are dairy-free and delicious, including coconut milk ice cream and blueberry pancakes. Learn more at chop.edu/nutrition-recipes.
Blenderizing whole foods for tube feeding has become quite popular. However, it is important to use the correct equipment to ensure the blend is smooth enough to flow. We recommend using a high-quality or commercial-grade blender. It’s important to use a combination of liquid, wet and thick ingredients in the recipe. If a recipe contains too many thickening ingredients (i.e. potato, carrot or pumpkin), the blend will likely be too thick and potentially lumpy, which can result in a clogged tube. Pro tip: Blend the ingredients while hot. Hot ingredients always blend better due to the steam and higher moisture content, yielding a smoother blend.
Soluble fiber slows stomach emptying so sugar is released and absorbed into the body more slowly. Insoluble fiber helps keep bowel movements regular and prevents constipation. Choosing a variety of fruits and vegetables may assist with digestion. Consult with a registered dietitian for individualized recommendations that will ensure your patient receives adequate fiber. One easy way to incorporate fruits and leafy greens into a child’s diet is with a smoothie (try spinach and mango which taste delicious together). We’ve also developed a recipe for Mighty Bars — made with figs and dates — that is loaded with fiber and perfect for when your patients are on-the-go. Get more details at chop.edu/nutrition-recipes.
This Q&A is intended to provide general information and may need to be adapted for each specific patient based on the professional judgment of the patient’s healthcare practitioner, consideration of any unique circumstances, the needs of each patient and their family and other factors. It is not intended to constitute medical advice or treatment, nor should it be relied upon as such.