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Children with seizures who are not successfully treated with medication, and who are not candidates for epilepsy surgery, can be considered for the ketogenic diet. This is a very high-fat diet that has been used for almost 100 years to treat epilepsy. Approximately two-thirds of children have a greater than 50 percent reduction in seizures, and up to 25 percent can become seizure free.
The Children’s Hospital of Philadelphia’s Dietary Treatment Program takes a team approach to establishing ketogenic diet plan, with expert input from neurologists, dietitians, skilled nursing staff and social workers. If your child is not already under the care of a CHOP neurologist, and you would like to explore the possibility of the ketogenic diet, then contact the Pediatric Regional Epilepsy Program for a second opinion consultation.
The ketogenic diet is very high in fat (about 90 percent of the calories come from fat), provides adequate protein, and includes very small amounts of carbohydrates. This macronutrient composition changes the metabolism of the body. Carbohydrates are no longer used to produce energy. Instead, the body breaks down fat to make ketones, which then provide energy to the brain and the rest of the body. This is a metabolic state called ketosis.
When the ketogenic diet is started, your child will be admitted to the hospital to make sure she tolerates the food and safely converts into ketosis. The diet is initiated gradually, without a fast, over the course of 4-5 days as an inpatient. During this time, families learn all the details about diet management. Parents and caregivers can also take cooking classes in our Keto Kitchen, where our experts can teach you how to make a high-fat meal delicious.
Your child’s nurse may also teach you how to check your child's urine and blood for ketones and glucose. The dietitian will determine how much fat, protein, and carbohydrate your child is allowed, and how the diet will be eaten during the course of the day. All food that your child will consume will be weighed on a gram food scale to the tenth (0.1) of a gram. Vitamin and mineral supplements are required to keep your child healthy while on the diet. Our dietician will tell you what vitamins your child should use.
Medications and other products like toothpaste and mouthwash contain varying amounts of carbohydrates. It is important to choose products containing the lowest amounts of carbohydrates when your child is on the ketogenic diet. Hidden carbohydrates in these products can interfere with the positive results of the diet. The Dietary Treatment Program team will give you a list of medications and other “keto-friendly” products.
Children usually stay on the diet for about two years. The diet is then slowly weaned off and changed back to a regular diet. Some families can use the diet for a shorter period, while others stay on the diet for life. We currently have many children in our program who have been on the diet for more than 15 years. Treatment will depend on your child’s unique condition.
Follow these steps to prepare for treatment in our Dietary Treatment Program.
Our teaching kitchen is a place to learn creative cooking techniques and practice preparing recipes for your child’s prescribed diet plan.