1. Rona Cookson
Paediatric Dietitian

2. Content Quality protein rich diets
Probiotics and the gut flora of tube fed children
Getting the best out of your dietitian

3. Quality Protein Rich Diets
How to make high calorie diets ‘healthier’?
Include the 5 food groups
? Equal proportions
Monounsaturated and Polyunsaturated fats
Protein
Perspective
Growth and weight gain is current priority

5. Four Main Food Groups Bread, cereal, potatoes, pasta, rice…
Get the balance right with fibre – may be too filling
Increase calories with spreads, oils, sauces
Fruit and vegetables
Higher calorie – fruit juice, dried fruit, avacado
Milk and dairy foods
Sat fat but good source protein, vitamins & minerals
Meat, fish, eggs, beans, nuts….
Best source of protein
Increase calories with oils and sauces; try nut butters, humous
Oils and spreads and foods to eat less often
Bigger proportion than for healthy population
Add spread, oils, cream, cheese, mayonnaise etc to foods

6. Fats Mono & Polyunsaturated fats Saturated fats
Vegetable oils – fry vegetables, meat, eggs, chips…
Spreads – use generously on bread, potatoes, veg…
Mayonnaise – as a dip or on sandwiches, potatoes…
Nut butters
Saturated fats
Cream – add to full fat milk, puddings, sauces, fruit…
Cheese – grate or make cheese sauce for veg, pasta…
Butter – as above with spreads
Coconut milk and cream – add to soup, curry, puddings

7. Protein Aim to include main protein sources twice a day
Meat
Fish
Eggs
Soya, Quorn
Beans, pulses
Nuts
Milk, cheese, yoghurt also good sources

8. Meal Ideas Pasta Scrambled eggs with frozen spinach, cheese & cream
salmon, cream, smoked cheese & brocolli
Tuna, sweetcorn and mayonnaise
Scrambled eggs with frozen spinach, cheese & cream
Fried fish fingers, croquettes & frozen peas
Cheese sauce (made with double cream & full fat milk)
Cauliflower cheese, fish pie, macaroni cheese
Rissotto
Roasted butter nut squash (roast with lots of oil)
Chicken, leek and double cream
Chicken Korma
curry powder, coconut milk or cream, sultanas, onions and peas/butternut squash

9. Snack Ideas
Breadsticks or vegetable sticks with dips/cheese spread
Dried fruit
Breakfast cereal
Rice cakes/toast with spread, nut butter, jam…
Cheese strings/purple babybel (cheddar)
Puddings
Custard, rice pudding, delight/whip deserts
Add fresh/frozen berries or banana and double cream
Fruit puree & double cream/mascarpone cheese

10. Probiotics Any children already taking these?
Evidence of benefits for diarrhoea, constipation, bowel conditions, atopic conditions
No current recommendations for tube fed children
Literature search
Specific patient groups (preterm, critically ill)
Inconsistent methods to report dose
Increased risk via tube as increased probiotic survival - more research needed for tube fed children
Generally safe to take orally, esp. in foods
Discuss supplements with pharmacist, dr, dietitian
Caution with newborns (not known how affects developing immune system)

11. Get the best out of your dietitian
Ask questions
Evidence based practice (don’t believe everything you read!)
If we don’t know, we can look up the evidence and get back to you (eg probiotics)
Phone/ between appointments
Let us know if practical problems with our advice
Texture modification
Cooking skills/time
Fussy eating/food refusal
? Pyschology referral – what is available locally

12. Rona Cookson, Paediatric Dietitian
Thank you
Any Questions?
Rona Cookson, Paediatric Dietitian
September 2016