Melanie Cole (Host): This is Pediatric Specialty Care Spotlight with Shriners Hospitals for Children in Chicago. I'm Melanie Cole and today, I invite you to listen, as we share nutrition advice for recovery, health, and healing in our children. Joining me is Pamela Patt. She's a clinical dietician and the director of nutrition services at Shriners Hospitals for Children in Chicago. Pamela, I'm so glad to have you with us today and what a great title, director of nutrition services at Shriners. That's really impressive. And because of what you all do there at Shriners and such an amazing institution, can you tell us the importance of nutrition for children before and after surgery, for children with injuries or complex medical conditions? How can nutrition after injury or these things really help our kids to heal?

Pamela Patt, MS, RDN, CSP, LDN, CNSC (Guest): Wow, that's a big question. I think one of the most important things, and, I'll start with kids with complex medical conditions, is these children have a lot of surgeries throughout their lives and a lot of medical interventions. So, I think that one of the most important things is trying to keep their nutrition as optimized as we can throughout their life span. It's important to make sure that they're growing. Most of the kids that I see, no matter what their medical conditions are, we want to make sure that their height and their weight are proportional. A lot of times you'll see kids with specialty medical needs that kind of fall through the cracks. And everybody's so focused on their seizure disorder or their scoliosis or their contractures that they don't think about the basics of just general health and wellbeing. Are they eating their fruits and vegetables? Is their vitamin D good? Are they getting enough calcium? We see a lot of orthopedic patients and unfortunately, iron, which is important for having good hemoglobin and hematocrit and recovering from surgery, having energy, not being anemic and calcium are two of the biggest deficiencies that we see in young teens and adolescents.

Host: So, you've mentioned calcium and iron. If you were to give parents of these children a definition of good nutrition in this situation, what would that look like Pamela?

Pamela: Well, you start out with your basics, okay. Well-balanced diet. All of us need to have foods from every food group, whether you're a vegetarian, vegan, pescatarian, you need to have some sort of a protein source. That could be beans and lentils, tofu. It could be fish, eggs, cheese, peanut butter is a great source of protein, or you can eat beef and pork and those types of foods as well. We all need to have some dairy products or dairy alternatives. I know a lot of people don't do dairy, can't tolerate dairy, but you still have a calcium requirement. Children between the ages of 9 and 18 actually require somewhere between 1200 and 1300 milligrams of calcium per day. That is the equivalent of four, eight ounce glasses of milk. And, milk gets replaced by sweet tea, less and less nowadays with soda. More and more kids are drinking more water, which is great. But, from a calcium standpoint, I still need them to get some sort of dairy or dairy alternative. And then we all need fruits and veggies. Right? There's so much fiber in them. They have a lots of vitamins in them. And then you look at your phytonutrients. We're finding out more and more about all of the minor chemicals that are in fruits and vegetables that actually play a huge role in helping our cells stay healthy and recover from injury and damage. And then of course we need carbohydrates. Carbohydrates are our main fuel source, so whole grain breads and cereals, pasta. Those things are all really important too. And like I said water, I can't emphasize enough how important it is to get your kids to drink water. Every cell in our body is mostly water. And so it helps to flush our system out when we drink plenty of water, it helps to keep us hydrated. It helps to keep us awake, alert, and energized.

Host: Well said, that was an excellent comprehensive list. Is there anything different? You work with families on this a lot and as children are going in pre-surgery and even post-surgery, what do you want parents to know about that pre-surgical food? Do you want them to feed children, less spicy, scrambled eggs and pasta, you know, easier to digest foods? Is there a difference between what they get in the hospital and what they're going to do at home? Tell us a little bit about what you want them to do pre-surgery and then we'll get into post.

Pamela: To be honest with you, one of my biggest concerns pre-surgery is that the kids are well-hydrated. So, they're getting plenty of fluids, and that they're actually having good bowel movements and constipation is also a huge problem in American society. And the more constipated you are, the more nauseated you're going to be after anesthesia and surgery. So, if your kids are not regular, give them some prune juice, make sure they eat some prunes, whether they'd be the dried little sweet ones, stewed prunes, maybe give them a stool softener before they come in for surgery so that they do have a good bowel movement. It doesn't really matter pre-op, spicy, not spicy, greasy, not greasy. That's more of a postoperative type of a food concern. So, I think the biggest thing is to have them be eating healthfully, and then, making sure that they are well hydrated and have a functioning GI tract before they come in for surgery. When they're in the hospital, most kids don't stay a really long time in the hospital nowadays. When I started this job many, many years ago, my kids used to stay here an average of five days, four or five days. Now, a lot of our kids are in and out in one or two. So they primarily will get, liquids immediately after surgery. So, things like apple juice, broth, ice chips, but that doesn't last very long. Kids are much more resilient than adults when it comes to progressing their diet. And usually by the end of the first day after surgery, whether you get out at 10 o'clock at night and that's the next day, or you get out at 10 in the morning and you're eating by later that evening, they are able to progress to kind of a more bland, regular diet.

Host: That's important information, especially about constipation. And even if they do have to be on pain medication, and as you say, anesthesia, all those things add to that constipation. Are there any differences for children with complex medical conditions? You spoke just briefly about it at the beginning, that have special needs or are difficult to feed? What would you like some general nutrition advice for parents about that?

Pamela: So, for kids that have special healthcare needs. So, let's start with kids with spinal cord injuries. We do follow a large group of children with spinal cord injuries, and their nutritional needs from a basic standpoint, really aren't any different than another child's. However, they do have a slower metabolism most of the time. Because when you lose muscle mass, which happens when you can't use a body part, the muscles atrophy, you lose muscle mass, muscle is our metabolically active tissue. It's the tissue that burns all of the calories. Not all, most of the calories. So, when you lose muscle mass, depending upon how severe your spinal cord injury is, your calorie needs, no matter how old you are, are going to decrease. Doesn't mean that you still won't have teenage increases and slowing down when you get in your mid to late twenties, just like everybody else, but their baseline energy needs are going to be less. Same thing with children with spinal bifida because of the muscle atrophy in their lower extremities. And it's dependent. It varies dependent upon how much function they have in their lower extremities. They're going to burn less calories, which means weight gain is going to be a lot easier and they're going to be more prone to obesity. They're also more prone to putting on abdominal fat. And so therefore at a higher risk of developing things like high cholesterol, high triglycerides, potentially down the road, diabetes and heart disease. So, these are things that we as dietitians, try to talk to these families about, as these kids come into our system for their future. When your kid has a spinal cord injury, you are not worried about their weight gain and their heart disease when they're 50. You're worried about getting them to walk now. But the idea is, if you don't take care of your body and you don't help it to be as healthy as it can be, when those future miraculous treatments come along, whatever that may be, whether it's stem cells or something else, nerve regeneration; you're not going to be a candidate for that if your body is in horrible shape, if you have a bunch of comorbidities, if you are 200 pounds overweight. So taking care of your body and keeping it as healthy as you can, so, number one, you can enjoy the things that you're able to do right now. And two, so that you are at the best you can be should a new treatment come along that you would be a candidate for. When you look in general at kids that have a disability, maybe they're not able to walk, maybe they're in a wheelchair. What do they need that other kids maybe don't need or what don't they need that other kids are able to do. So, they have more of a possibility of gaining weight. And to the extent of becoming obese, kids with muscular dystrophy, kids with cerebral palsy who are in wheelchairs. The flip side of that, however, is that some of the kids with these diseases also have extreme spasticity or disorganized discoordinated movement, and they burn a ton of calories. Kids with acidotic cerebral palsy, they can be burning three to 6,000 calories a day. And trying to keep up with their energy needs is a huge problem. Nobody eats like that, right? Michael Phelps, he's the one that can eat that many calories. That's what we always think of. So, how do you get enough calories into these kids? And sometimes the answer to that is that they need supplemental nutrition, whether that be things like Pediasure, nutritional supplements, Carnation breakfast essentials, et cetera. Or is it a tube feeding? Some of our kids have difficulty chewing and swallow. Whether it's because they have a cleft lip and palate, whether it's because they have discoordinated movements because they have cerebral palsy, maybe it's because they have a disease where they don't really have good control over the muscles in their mouth. And we are lucky enough here at the Chicago Hospitals to be able to do gastrostomy tube placements and help these families out with these kids who just can't get enough nutrition by mouth.

Host: What great information. You are just a wealth of information, and I can hear the passion in your voice, Pamela, as well for working with these children. As we wrap up, I'd like you to offer parents your best nutritional advice, whether their children are disabled or going to have surgery, or just coming to Shriners Hospitals for Children in Chicago with any type of condition, what you want us to know about feeding our kids healthy and so that they are able to heal? And certainly with things like orthopedic injuries so that we can help our body really to heal at its best.

Pamela: I would start with the basics. The basics being, eat with your child. Family meals are important. We need to sit at a table at least once a day with the family. Show them. Be a role model. Kids are not always good about listening to what you say. But they are really good at repeating what you do, seeing what you do. And I have seen this in my own family. I've seen this with my patients, parents that are reluctant to walk the walk. Right? They tell their kids, they need to eat vegetables, but yet dad doesn't do it. So, be a good role model. Provide healthy, nutritious foods. You don't have to go to Whole Foods and buy the most expensive organic food. Go to Trader Joe's, go to Aldi's, go to your local market, go to your farmer's market. Include your kids in cooking whenever you can, no matter what their level of function, they need to be a part of the family and they need to be a part of the eating environment. Be a good role model, drink water. Yes. Are you going to do things that maybe aren't the healthiest, are you going to have too many cups of coffee or a soda pop here and there, but, in general show your kids that all foods can fit, that they need to have fresh and healthy foods. Try to cook, not eat at fast food restaurants all the time and variety, variety, variety. Make sure that you have a colorful plate. Eat the rainbow. I know it's kind of a cliche, but it's there for a reason. And again, protein, calcium, iron really, really important. And if you have questions about any of those things, please reach out, talk to a dietician. If you're a patient at Shriner's Hospital, you can always ask to see the dieticians when you come in to clinic.

Host: Wow. What an informative episode this was, Pamela. Thank you so much for joining us today and really sharing your passion and incredible expertise with us today. To make an appointment, please call 773-385-KIDS, that's 773-385-5437. Or you can always visit our website at shrinerschicago.org for more information, and to get connected with one of our providers, just like Pamela Patt. Thank you so much for listening. That concludes this episode of Pediatric Specialty Care Spotlight with Shriners Hospitals for Children in Chicago. For more health tips and updates on the latest medical advancements and breakthroughs, follow us on your social channels. I'm Melanie Cole.