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CHILDREN’S HOSPITAL DIET MANUAL

Diet Descriptions:

For general guidelines on quantities of foods for infants or toddlers please see “Suggested Feeding Schedule for Infants” or “Suggested Feeding Guide for Toddlers and Pre-schoolers.”

Regular Diet

The Pediatric Regular Diet is also known as “Diet for Age” or “General Diet.” The Pediatric Regular Diet may be ordered for children 8 months and older. Patients may select from the Regular menu according to their food preferences and age.

The Regular Diet has no specific dietary restrictions.

If proper selection of food is maintained, the Regular Diet is adequate in all nutrients.

High Calorie, High Protein, and High Fat are variants of the Regular diet. The amounts of these macronutrients is to exceed the normal RDA/DRIs per the age groups.

Blenderized Diet

The Blenderized Liquid Diet may be indicated for patients with head, neck, mouth trauma or wired jaw. Foods are pureed in a blender to a smooth liquid consistency or are thin enough to be taken with a straw.

Some foods that you need to avoid while on this diet include foods with seeds and tough fibers. Six to eight small meals are often required to achieve adequate energy intake.

If proper selection of food is maintained, the Blenderized Diet is adequate in all nutrients.

Carbohydrate Modified Diet

The Carbohydrate Modified Diet is prescribed to meet nutrient needs while controlling blood glucose levels or for caloric control. Concentrated sweets such as sugar, juice or regular desserts will not be offered on the menu. Sugar-free or low sugar content items will be available as well as a sugar substitute. A meal pattern may be used to determine the proportion of carbohydrates, protein and fat to be sent at teach meal or patients may be allowed to match the insulin dose to the grams of carbohydrate eaten at meals and snacks. Snacks can be initiated per physician order. The Carbohydrate Modified Diet order requires a selection of either a specific calorie level or “No Concentrated Sweets.” Diets too low in carbohydrate eliminate many foods that are important sources of vitamins, minerals, fiber and energy.

Foods containing carbohydrate:

• Breads, crackers and cereals
• Pasta, rice, and grains
• Starchy vegetables, such as potatoes, corn and peas
• Beans, lentils, and dried peas
• Milk, soy milk, and yogurt
• Fruits and fruit juices
• Non-starchy vegetables
• Sweets, such as cakes, candy, cookies, ice cream, jam, jelly and syrup

Free foods are foods that have less than 20 calories and less than 5 grams of carbohydrate in each serving. The carbohydrates in these foods do not need to be counted if limited to no more than 3 servings per day.

• Dill pickles
• Sugar-free gelatin
• 1 cup of non-starchy vegetables, such as carrots, lettuce, peppers, or broccoli

If proper selection of food is maintained, the carbohydrate modified diet is adequate in all nutrients.

Clear Liquid Diet

The Clear Liquid Diet is indicated for patients undergoing surgical procedures, those with acute gastrointestinal problems, and to assist with fluid and electrolyte replacement. This diet supplies fluid and energy in a form that requires minimal digestion and stimulation of the GI tract. Clear liquids such as broth, juice, gelatin, soda and popsicles are offered on the clear liquid menu.

This diet is intended for short term use or as a transition diet. The Clear Liquid Diet is nutritionally inadequate for patients of all ages.

Dysphagia Diet

The Dysphagia Diet is indicated for patients undergoing surgical procedures/treatments affecting the head or neck, those with certain neurological disorders, those undergoing anticancer treatment, those at risk for aspiration, or for patients needing a modified consistency due to poor dentition. A dysphagia type must be selected for this diet.

• Dysphagia I is based on modifications of a pureed diet, foods are homogenous and cohesive. Foods should be “pudding-like”. No coarse textures, raw fruits or vegetables, nuts, are allowed. Any foods that require bolus formation, controlled manipulation, or mastication are excluded. Close or complete supervision and alternate feeding methods may be required.
• Dysphagia II diet consists of food items that are ground consistency, with more texture and fiber. This diet is a transition from the pureed textures to more solid textures. Chewing ability is required. It is expected that some mixed textures are tolerated on this diet.
• Dysphagia II diet consists of food items that are chopped, similar to a mechanical soft diet. This diet is a transition to a regular diet. Adequate dentition and mastication are required. Patients should be assessed for tolerance of mixed textures. It is expected that mixed textures are tolerated on this diet. Foods are of nearly regular textures with the exception of very hard, sticky, or crunchy foods. Foods still need to be moist and should be “bite-size” pieces at the oral phase of the swallow.

If proper selection of food is maintained, the Dysphagia Diet is adequate in all nutrients.

Full Liquid Diet

The Full Liquid Diet is generally ordered as a transition diet once clear liquids are tolerated. Can be used after oral surgery or plastic surgery of the face or neck area, for chewing or swallowing dysfunction and for esophageal or stomach disorders when solid foods cannot be tolerated because of stricture or anatomic irregularity.

Dairy products such as milk-based soups, milkshakes, custard, pudding, and hot cereal along with pureed fruit, juice or nectars that contain pulp may be provided on the Full Liquid Diet. The diet should be advanced to provide adequate nutrition when tolerated. The Full Liquid Diet is contraindicated for patients with lactose intolerance or for patients who cannot tolerate thin liquids.

Provides more calories and protein than a Clear Liquid Diet, however may not meet vitamin, mineral and bioactive substances including fiber needs if used long term. Because it is deficient in vitamins and minerals it is contraindicated for long term use.

Low Fat Diet

The Low Fat Diet may be ordered for dyslipidemia or chylothorax. The grams of fat restriction must be specified. Lower fat food options are selected such as using low-fat or fat-free milk and dairy, using cooking methods such as baking, broiling, roasting, grilling and steaming, avoiding fried foods, choosing lean meats, and limiting fat-containing condiments.

Foods recommended and not recommended: Dyslipedmia Nutrional Therapy

If proper selection of food is maintained, the Low Fat Diet is adequate in all nutrients.

Low Microbial Diet

The Low Microbial Diet is prescribed to prevent potential food-borne illnesses or infections for immunocompromised patients.

Foods allowed include cooked meats, vegetables, grains, canned fruits and fruits with thick skin, and pasteurized dairy products.

Yogurt, raw vegetables, raw nuts, thin skinned fruit, dried fruit, and under-cooked foods of all kids should be avoided.

Low Microbial Nutrition Therapy

Depending on the food selection the Low Microbial Diet may be deficient in some nutrients such as vitamin E, vitamin K, zinc and potassium.

Low Residue and Fiber Diet

The Low Residue and Fiber Diet may be requested for diarrhea.

Foods allowed and disallowed: Diarrhea Nutrional Therapy

Depending on the food selection the Low Residue and Fiber Diet may be deficient in some nutrients such as fiber and zinc.

Low Sodium Diet

Low Sodium Diets may be ordered to help keep blood pressure normal and limit swelling from water retention. Most children need between 500 and 2000 mg sodium each day. Sodium is found in salt, baking soda and many food preservatives. Processed foods are usually high in sodium. Foods that are limited include packaged snack foods, regular canned soups and cured meats.

Recommended foods and foods not recommended: Low Sodium Nutritional Therapy

Depending on the food selection the Low Sodium Diet may be deficient in some nutrients such as vitamin E.

Maternity Diet

The Maternity Diet consists of a regular diet. Patients may select from the Maternity menu according to their food preferences.

Foods recommended and not recommended: Maternity Diet

If proper selection of food is maintained, the Maternity Diet is adequate in all nutrients.

Protein Modified or “Renal” Diet

This diet is indicated for patients requiring a protein restriction such as with some liver diseases, acute or chronic kidney disease. Nutrient amounts are adjusted depending on liver or renal function, hemodialysis or peritoneal dialysis program. A protein level must be selected for this diet. With renal disease additional restrictions may include: potassium, sodium, phosphorus and fluid.

Foods that contain protein include eggs, egg replacements, beef, fish, lamb, pork, poultry, shellfish, veal, wild game.

Because dairy foods are high in phosphate, intakes of vitamin D may be decreased, necessitating a supplement. Pediatric patients may also have a decreased intake of most water-soluble vitamins, as well as zinc and copper. IT is recommended that children on dialysis receive a water-soluble vitamin supplement. Supplements containing vitamin A are discouraged due to the vitamin A retention with chronic kidney disease. Fat-soluble vitamin deficiency is common with liver disease.

Sweet Success Diet

The Sweet Success Diet is utilized to help control blood glucose levels during pregnancy. Foods with carbohydrates are limited at all meals and snacks. Because blood glucose levels tend to be higher early in the morning, fruits and juices are restricted at the breakfast meal.

Foods recommended and limited: Sweet Success Diet

If proper selection of food is maintained, the Sweet Success Diet is adequate in all nutrients.

AND Nutrition Care Manual:

Pediatric

AND Nutrition Care Manual Approval:

Pediatric