Nutrition and hydration for children and young people with complex care needs

Eileen Lock outlines the key principles for providing a balanced nutritional regime

The food and drink we consume plays a vital role in our health and wellbeing, including how we function and feel. This is especially true for children and young people with complex care needs as they are growing and developing.

Generally, this should include a carefully balanced diet that encompasses all the nutrients children and young people need for energy, strength and immune support. Without it, they are vulnerable to a variety of complications that can be detrimental to their health.

What does good nutrition and hydration look like?

Good nutrition and hydration goes beyond eating an apple and drinking a glass of water. To ensure children and young people remain healthy, they need a varied diet with a healthy balance of: 

Carbohydrates

This provides energy for basic human functions such as breathing, circulation, producing hormones and new tissue. Examples of foods in this group include pasta, bread, rice and potatoes.

Protein

Found in dairy products like milk, eggs and cheese, as well as meats and fish, protein is important in assisting the body to replenish or repair cells and tissue.

Vitamins

Vital in supporting the absorption of energy from foods, blood clotting, and developing a strong immune system. The best way to get vitamins is from a wide variety of fruit and vegetables.

Minerals

Minerals like calcium and iron support us to maintain healthy bones, teeth and transport good levels of oxygen through blood cells. Milk products provide calcium and leafy spinach is full of iron.

Fibre

What goes in, must come out. Fibre is the body’s key to removing waste products via the bowel. Nuts, seeds, wholemeal foods, fruit and vegetables are typically high in fibre!

Water

Water is the main chemical component of the human body, accountable for between 50% to 80% of us, depending on our age. Without it, our bodies can’t complete the functions we need to live.

This includes digesting food, absorbing nutrients, maintaining brain function, controlling our temperature, removing waste products, avoiding infection and blood circulation.

Why is it important?

Nutrition and hydration plays a vital role as children and young people grow and develop. If neglected, it can lead to malnutrition and dehydration, both of which can have serious implications on quality of life and medical outcomes, by increasing susceptibility to illness and infection.

Malnutrition

This term is often used if someone’s diet contains an imbalance of nutrients required to function properly. This could include lack of protein, vitamins and minerals, all of which can cause adverse effects on body functioning, health and wellbeing.

People lacking essential nourishment suffer from:

• extreme tiredness
• increased infections 
• constipation 
• lack of energy 
• gaining or losing weight 
• changes in behaviour 
• poor wound healing
• muscle weakness

Dehydration

Children and young people typically have more water in their bodies than adults. This makes them more vulnerable to dehydration. If there’s a lack of fluid in the body, they’re unlikely to maintain good health, reducing functionality and increasing their risk of clinical implications.

Signs of dehydration can include:

• tiredness
• headaches
• lack of concentration
• feeling thirsty
• dry mouth, lips and eyes
• dark and strong-smelling urine
• lightheaded and dizziness

It’s important to remember our bodies lose water throughout the day; when we go to the toilet, when we sweat, and even when we breathe. Ensuring children and young people drink plenty and often, is the best way to avoid accidental dehydration.

Children and young people with complex care needs

Children and young people with complex care needs sometimes have poor nutrition or are at risk of dehydration due to health conditions, medications or illness. There are several factors to consider when developing a tailored nutrition and hydration plan for these children and young people.

For example, they may be unable to suck and swallow, meaning food can enter the lungs rather than the stomach, typically known as aspiration. In these cases, nutritional support might be required in a liquid form via a tube to ensure they receive the right nutrients.

Similarly, certain medications can influence appetite, food intake, nutrient absorption and bowel functions. This has a direct impact on children and young people’s ability to sustain the right levels of nutrition and hydration, and adjustments to intake will be required to counteract side effects.

Children and young people with complex care needs can also develop food aversions, which is an intolerance to certain textures, flavours and food groups. This can limit the variety of foods consumed and cause a deficiency in nutrients, vitamins and minerals.

In addition to this, children and young people might require a specialist diet to manage their symptoms for certain medical conditions. For example, a ketogenic diet may be used to control epilepsy. This requires high fat and low carbohydrate intake, and supplementation is needed to support nutrient intake. 

Finally, some children with mobility problems can also become severely constipated. This will dictate the food and drink they need to consume to overcome this, for example, eating more fibre than a typical daily intake. 

Support and interventions

Often, children and young people with complex care needs will need additional support to eat or drink. This is sometimes done through a tube and a liquid feed, but other simple steps can also ensure vulnerable people get enough nutrients and fluids to function and remain healthy. 

Fortified Foods

Fortified foods add nutrients, vitamins and minerals to foods that don’t typically contain them. This increases nutritional content and provides additional health benefits. These foods are important for children with complex needs who struggle to gain nutritional value from food.

Texture modification

Texture modification is a simple way of making food and drink safer to consume. There are four key categories; liquidised, pureed, minced and moist or soft and bitesize. The texture chosen is dependent on the needs of the individual and is usually advised by a dietician. This technique is ideal for children and young people with swallowing difficulties, and for those with food aversions. 

Portion size

Portion sizes are a good way of controlling the nutritional value children and young people receive.  For example, those with mobility issues may need smaller portions to reduce the risk of obesity.

Most of these interventions are short-term fixes, but others can be permanent, long-term solutions, depending on the child or young person’s needs. Either way, they help to remove nutrition and hydration barriers, ensuring those that struggle to eat and drink, receive vital nutrients and fluids to keep them as healthy as possible.

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