What is the role of food therapy in managing health conditions in children?

Food Therapy for Children: A Comprehensive Approach

Food therapy is a specialized intervention that addresses feeding difficulties, nutritional needs, and eating behaviors in children through structured therapeutic approaches aimed at improving health outcomes, reducing morbidity, and enhancing quality of life.

Types of Food Therapy Interventions

Medical Nutrition Therapy

• Medical nutrition therapy is an essential component of treatment plans for children with specific health conditions, requiring individualized assessment by a registered dietitian 1
• For children with cardiovascular risk factors, family medical nutrition therapy is strongly recommended to address dietary patterns and nutritional needs 1
• For children with type 1 diabetes, individualized medical nutrition therapy is recommended as a core component of the overall treatment plan 1

Therapeutic Feeding Programs

• Therapeutic feeding programs are considered medical interventions specifically designed to save lives and restore nutritional health in severely malnourished children 1
• These programs require specific enrollment criteria, including children under 5 years with severe malnutrition (WFH Z-score < -3) or clinical edema 1
• Therapeutic feeding requires precise caloric requirements (150 kcal and 3g protein per kg body weight/day) and monitoring protocols 1

Behavioral Feeding Therapy

• Behavioral approaches address feeding disorders characterized by suboptimal intake and/or lack of age-appropriate eating habits, which may affect up to 45% of children 2
• Food therapy in neurotypical children with feeding difficulties can involve nutrition education, interactive games, and activities tailored to age groups with individualized treatment plans 3
• Family-based therapy approaches are considered first-line treatments for certain eating disorders in children and adolescents 4

Conditions Requiring Food Therapy

Cardiovascular Health Conditions

• For children with elevated triglycerides or non-HDL cholesterol, dietary modifications include limiting saturated fat to <7% of calories, cholesterol to 200 mg/day, and avoiding trans fats 1
• Supportive actions include decreasing sugar intake, replacing simple with complex carbohydrates, eliminating sugar-sweetened beverages, and increasing dietary fish for omega-3 fatty acids 1

Diabetes Management

• Monitoring carbohydrate intake through counting or experience-based estimation is key for optimizing glycemic management in children with diabetes 1
• Education on the impact of high-fat and high-protein meals and insulin dosing adjustments is necessary for children with diabetes 1
• For children with type 2 diabetes, low-carbohydrate eating patterns have been found to reduce A1C and the need for glucose-lowering medications 1

Food Allergies

• Children with documented IgE-mediated or non-IgE-mediated food allergies require carefully planned allergen-free diets that provide sufficient nutrients for healthy development 1
• Food allergy management includes training in label reading, recognition of allergens, and understanding precautionary labeling 1
• Nutritional counseling and regular growth monitoring are recommended for all children with food allergies to ensure adequate nutrition despite restrictions 1

Feeding Disorders

• Pediatric Feeding Disorder (PFD) is defined as impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction 5
• Children with feeding difficulties can be categorized under three principal eating behaviors: limited appetite, selective intake, and fear of feeding 6
• The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) significantly impact treatment approaches 6

Implementation of Food Therapy

Assessment and Referral

• Children presenting with a clinical history of likely food allergy should be referred to an allergist for diagnostic testing 1
• Nutritional consultation is highly recommended for children who require widespread dietary avoidance 1
• For children with diabetes, comprehensive nutrition education at diagnosis, with at least annual updates by an experienced registered dietitian nutritionist, is recommended 1

Therapeutic Approaches

• For children with overweight parents who are at increased risk of becoming overweight themselves, more intensive counseling should focus on increasing physical activity, decreasing inactivity, and encouraging healthier food choices 1
• Successful treatment components include beginning treatment before adolescence when possible, ensuring willingness of both child and family to participate, and promoting long-term permanent changes in behavior patterns 1
• For children with food allergies, avoidance diets must be carefully implemented with consideration for nutritional adequacy and quality of life 1

Monitoring and Follow-up

• Children in therapeutic feeding programs should be weighed daily at first, then twice weekly to monitor progress, with a target weight gain of 10g/kg body weight/day 1
• Regular nutrition surveys should be conducted to identify malnourished children who are not enrolled in feeding programs 1
• For children with diabetes, frequent glucose monitoring before, during, and after exercise is important to prevent hypoglycemia and hyperglycemia 1

Special Considerations

Age-Specific Approaches

• For children under 2 years, food therapy approaches must be carefully tailored to ensure adequate growth and development 1
• For exclusively breastfed infants with suspected food allergies, the trigger food can be eliminated from the mother's diet 1
• Adolescents with diabetes require specific education on strategies to prevent hypoglycemia during, after, and overnight following physical activity 1

Family Involvement

• Family involvement is critical in food therapy, with parents needing education on appropriate feeding practices and role modeling of healthful dietary habits 1
• Changes in the family environment may be necessary, such as removing high-calorie foods from the home or establishing formal exercise routines 1
• Families of children with food allergies need comprehensive counseling on food avoidance, label reading, recognition of anaphylaxis symptoms, and emergency management 1

Potential Pitfalls and Caveats

• Overreliance on serum-specific IgE testing indicating "allergy" can lead to unnecessary dietary restrictions 1
• Nearly 89% of avoidance diets in children with atopic dermatitis and food allergy diagnosed by serum specific IgE have been found to be unnecessary 1
• Very-low-carbohydrate eating plans should be used with caution in children taking SGLT2 inhibitors due to potential risk of ketoacidosis 1
• Nutritional deficits can result from widespread dietary avoidance, and quality of life diminishes as the number of food avoidances increases 1