Seeing Food as Medicine

What a child eats or doesn’t eat can have a significant impact on their growth, overall health and well-being. For children with gastrointestinal (GI) issues such as abdominal pain, constipation, gastro-esophageal reflux and inflammatory bowel disease (IBD), food choices can determine if the child is healthy and active or sickly and sluggish.

As you know, many children with GI issues are prescribed elimination or restrictive diets that are designed to improve their symptoms by avoiding certain “trigger” foods. For many children, these diets are not as appealing as the foods they are used to. (Plus, no one likes change!) This can cause challenges with compliance – and ultimately affect patient outcomes.

The Clinical Nutrition Department at Children’s Hospital of Philadelphia (CHOP) has compiled methods we’ve found effective in improving patient compliance with elimination diets. These methods ensure adequate nutrition and empower patients to engage in the process.

Quick tips to improve patient compliance

Here are a few tips that we’ve found can help patients become more compliant with their food restrictions:

• Focus on “how to eat” instead of “whether to eat.” Caregivers should keep in mind flavor and texture preferences and include favorite ingredients if possible.
• Many cookbooks now cater to specific eating patterns, offering caregivers several appropriate options without having to experiment.
• Encourage families to allow their child to participate in meal and snack preparation. Offer a variety of foods that the child can safely eat.
• Caregivers can prepare and freeze large batches of preferred foods so they are always on hand.
• Caregivers should never force a child to eat. Mealtimes should be happy and relaxed; the meal itself should never be the center of attention.
• Pair healthy eating with preferred activities, such as reading together or visiting the playground, rather than enticing with dessert.
• Caregivers should plan to start an elimination diet when they have time for the planning, shopping and preparing the diet will require. Vacations and special occasions are particularly challenging times to start a restrictive diet.

Our goal for patients is the same as yours: to nurture them nutritionally, physically and emotionally, and support their families in their journey. At CHOP, our registered dietitians provide customized dietary counseling to meet the medical and cultural needs of patients. Our team provides in-depth nutritional assessments and counseling; management of enteral nutrition therapy (tube feedings); and evaluation of special or restrictive diets (such as an anti-inflammatory diet).

We can also help you address issues such as obesity, difficulty gaining weight and nutritional replacements with your patients.

How we can help

We offer several specialized programs to support you and your patients, including:

• Integrative Health Nutrition Program, which harnesses the power of whole foods to improve the health of children with chronic medical conditions.
• Integrative Health Gastroenterology Clinic, which helps children with GI symptoms use mind/body modalities — such as yoga, guided imagery and mindfulness, massage, osteopathic manual manipulation and nutrition — to better manage symptoms associated with their conditions.
• Food Reactions Clinic, where children are evaluated by an allergist, gastroenterologist and registered dietitian. The team helps determine the cause of the food reactions, which foods the child reacts negatively to and which foods can be safely introduced to make sure that the child is getting a balanced diet.

There are an array of treatment options available today for children with gastrointestinal symptoms. Let us work with you to determine how best to help each patient and family in your care.

— Maria R. Mascarenhas, MBBS, is a pediatric gastroenterologist, Medical Director of the Clinical Nutrition Department and Director of the Integrative Health Program at Children’s Hospital of Philadelphia.