Helping your child to eat. Nurse specialist Sarah Regan from Great Ormond Street Hospital in London gives advice to parents and carers on the best approach
When children have a heart disease such as cardiomyopathy, they may not gain weight as rapidly as other children their age.
The reasons include:
♥ inability to eat and absorb sufficient calories and nutrients to meet the heart’s needs
♥ difficulty in suckling and eating because they have to breathe faster
♥ tiredness
♥ poor appetite, particularly after being in hospital or put on a new medication
♥ frequent infections (such as bronchitis, chest infections and pneumonia)
♥ vomiting
The challenge
The challenge in feeding children with cardiomyopathy is to provide more calories than the average child requires for growth in an appropriate and feasible way.
Breastfeeding and bottle-feeding
Babies with cardiomyopathy can be breastfed or bottle-fed but they may not be able to tolerate a large volume of milk. Instead of having feeds every four hours, babies with heart failure often feed every two to three hours or have “on demand” feeding. 
Some breastfed babies consistently gain weight but others may find feeding more challenging. Then supplementary feeds by bottle containing high calorie formula can be given.
New mums need good support from health care professionals to encourage them during a very tiring and stressful time. Your midwife and health visitor can help monitor your baby’s feeding patterns and growth, and provide information about different types of bottles and teats.
If your baby does not gain sufficient weight, you may be referred to a dietician who can help with more nutrient-dense formulas or recommend high calorie brands. Supplements such as Maxijul or Duocal can be added to milk feeds.
Common questions What are safe, healthy ways to increase a child’s calorie intake once he is eating regular foods? While toddlers grow at a slower rate than infants, toddlers need enough energy to fuel their activities and the next stages of growth. So try to include in their diets a variety of foods including whole milk; soft cheese, yogurt (low-fat dairy products are not recommended for children under five years of age), chicken, fish, eggs, chopped fruits, cereal, bread, pasta and vegetables.
Should I feed my baby more often or start them on solids early?
If your baby is struggling to gain weight, you can increase calories in the formula milk without increasing volume. Starting a baby on solid foods early will not help as solid foods contain fewer calories per ounce than breast milk or formula.
Will my child develop bad eating habits?
Children learn about food by watching parents’ eating habits. So eat healthy foods with your child and give them freedom to taste different foods in a relaxed and fun setting. Get them involved in meal preparation and food shopping. Even fussy eaters may eat foods they helped prepare. Try not to force your child to eat. Some children develop poor eating habits due to negative associations with eating or being in hospital and need to be seen by a feeding specialist.
Tube feeding
Some babies with severe heart failure may for short periods require a feeding tube (naso-gastric tube) that is inserted into the nose. Babies can still breastfeed but can be given high calorie tube feeds, including breast milk containing extra calories, as a supplement.
While the tube may look uncomfortable, children usually adjust quickly without problems. Feeding pumps can also be used that allow continuous feeding (often used overnight). It is important to continue to offer feeds/food orally while the feeding tube is in.
Older children may sometimes require a feeding tube that passes directly into the stomach.
If children have persistent problems with vomiting, anti-sickness treatments may be prescribed or they may be referred to a paediatric gastroenterologist.
Feeding as they get older
Children with cardiomyopathy do not need low fat diets like adults with heart disease. They have poor appetites and need high calorie foods and snacks. They often prefer to be offered smaller, more frequent meals.
When your child is eating solid foods, you can buy or prepare foods that are higher in calories. Easy ways to boost calories include adding powdered milk or grated cheese to meals.
Try to include in their diets a variety of foods including whole milk; soft cheese, yogurt (low-fat dairy products are not recommended for children under five years of age), chicken, fish, eggs, chopped fruits, cereal, bread, pasta and vegetables.
The general rule is they can eat everything in moderation but should try to maintain a normal body weight.
If your child is taking a diuretic (water tablets), your doctor may also recommend a potassium supplement to replace the amount of potassium lost with body fluid. Foods such as bananas, orange juice, potatoes and dried fruits are good additional sources of potassium.
With older children, it is important to prevent dehydration during hot weather or while playing sports.
There are high calorie drinks such as Ensure that are recommended. Juice and water contain minimal calories and nutrition.
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Dedicated to Damian McLoughlin, who died age 20 of cardiomyopathy. This site is supported by Damian's family and friends.
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