Why are there changes in calorie requirements?
Following selective dorsal rhizotomy surgery or implantation of an Intrathecal Baclofen Pump to reduce spasticity, your child’s metabolic rate may change.
A child who is no longer burning energy through spasticity will use fewer calories and, subsequently, may experience significant growth, as a study in the 1990s of 28 children who had rhizotomies, demonstrated. Fifty percent of the girls grew taller and 45 percent of the boys showed improved growth.
Children who continue eating their pre-surgery amount and don’t exercise may gain weight. Some weight gain and growth is beneficial. However, if children gain too much weight, it might compromise their health and mobility.
What are the benefits of staying lean?
For a number of reasons, children with disabilities tend to fare better when they are lean. Excess weight can stress joints and add to problems with osteoarthritis. People with limited strength find it easier to move, and it’s easier for other people to help lift and transfer them if they weigh less.
Be sure to discuss weight management with your doctor after surgery or pump implantation. By about age eight, children who are inactive and overweight will find it hard to change their lifestyle and take off excess pounds.
Eat Wisely
- Make sure your child is eating healthy foods.
- Never use food as a reward.
- Switch oral eaters from whole to 1- percent or skim milk.
- Let children eat their favorite foods, but decrease portions by one-fourth.
- Cut back on fat in the diet.
- Offer healthy, balanced meals. Avoid empty foods, such as pop and chips.
- Limit juice, which is high in calories, to 4 ounces a day. If your child doesn’t like water, dilute the juice.
- If your child has a G-tube, talk to your child’s doctor about cutting back on the amount you are feeding. Your doctor can assist in reducing calories appropriately.
Exercise Regularly
- Make exercise part of your family’s daily life. Children need a 20-30 minute sports activity, walk or swim 3 to 5 times a week.
- Enroll your child is swimming, gymnastics or dance classes. At age 4 and 5, most sports are non-competitive and open to children with disabilities. They provide good exercise and a chance to socialize.
- At home, use exercise videos or appropriate exercise equipment.
- After age 13, children can begin weight training, which is a good way for children with cerebral palsy to gain flexibility and strength.
Healthy Weight Guide
These suggestions can help your child reach and stay at a healthy weight. (The consistency of the foods listed may be changed to meet your child’s needs better.)
The physical activity of children with physical disabilities may be limited because of muscle weakness or paralysis. Being overweight may be due to too little exercise or too much food for body requirements or both. Children with special physical needs may also be short for their age.
Forming good food habits early in life is important to healthy weight maintenance. Children depend on parents to provide food habits and they also start very early developing attitudes, feelings and habits about foods
The best way to lose weight and keep it off is by following a balanced low- calorie food plan. Weight loss may seem slow, but the general rule of thumb is “the faster the weight loss, the faster the weight is gained back.” Generally, children should not be on a strict, low-calorie diet. Good weight loss is usually seen by making better low-fat and low-calorie choices for meals and snacks.
Goals for overweight children should include stopping weight gain and aiming for a weight loss of 1/2 pound a week. If children slip occasionally, help them return to the low-fat, lower-calorie eating plan as soon as possible. Encourage your child to start (or increase) regular exercise. Check with their doctor for guidelines.
Record your child’s intake for three days. Please bring this record with you when your child comes back to the clinic. This information will help to assess your child’s diet and nutrition better.
A child’s daily diet should include:
- 3-4 cups of milk
- 2 servings of meat
- 4 servings of breads / starches
- 4 servings of fruits and vegetables
High-calorie, low-nutrient foods such as soft drinks, candy and chips should be eaten in small amounts. The food recommendations listed in this booklet can be given to your child pureed, if that better meets your child’s needs.
- Offer the same foods to the entire family so the overweight child won’t feel deprived or singled out.
- Serve meals “restaurant style” Dish foods in the kitchen rather than at the table to help control the serving size.
- Encourage eating slowly.
- Serve foods only at the table. Do not eat in front of the TV, directly from the refrigerator, or in any other room besides the kitchen.
- Try to eat only at planned meal and snack times.
- Do not skip breakfast. Offer breakfast cereals and other low-fat foods. Children who skip breakfast are more likely to snack on higher calorie foods later in the day.
- Serve fruit or angelfood cake for dessert.
- Use a non-stick frying pan that requires little or no fat. Cook foods over low heat.
- Low-calorie cooking spray may be used for frying foods without fat.
- Remove fat from soups, stews, and gravies by chilling them first and then skimming off the fat with a spoon.
- Use non-calorie sweeteners, available in liquid or granular form, for sweetening cereals or fruits.
- Avoid gravies or cream sauces.
- Season foods with herbs and spices rather than with fats. Lemon or lime juice is a good addition.
- If making chocolate milk, use skim milk flavored with chocolate extract, cocoa, or use sugar-free chocolate milk flavoring instead of chocolate syrup.
- Baking, broiling, boiling, roasting and grilling are the best low-fat cooking methods.
- Remove all visible fat from meat before cooking.
- Use butter flavors, available in powder or liquid form, on vegetables or starches.
- Sprinkle Parmesan cheese on potatoes, vegetables or salads to add zest but few calories.
Sit-down restaurant
- Order food broiled, roasted, poached, steamed or baked.
- Avoid casseroles and food with heavy sauces.
- The best protein choices are poultry, fish, veal or lean beef.
- Order salads without cheese, eggs, meat, bacon or croutons. Ask for salad dressing on the side so you can control the amount used.
- Order a baked potato or seasoned rice instead of mashed, au gratin or fried potatoes.
Fast-food restaurants
- A good rule to follow is to order the cheaper and smaller items to save calories. For example: Hamburger–275 calories, Whopper–640 calories, Small cone–85 calories, Small shake–291 calories
- Skip the French fries and onion rings.
- Remove excess sauce or mayonnaise from the buns or order burgers plain.
- Instead of a fruit pie for dessert (300 calories), try animal crackers.
- Select a fast-food restaurant with a salad bar. Use low-calorie dressing.
- Don’t order extra cheese on pizza.
- Order rice instead of refried beans.
A Gillette sports and leisure assessment can help you get on the road to a healthier lifestyle. For further information, contact Therapeutic Recreation at 651-229-3855 or recreation@gillettechildrens.com.
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This information is for educational purposes only. It is not intended to replace the advice of your health care providers. If you have any questions, talk with your doctor or others on your health care team.
If you are a Gillette patient with urgent questions or concerns, please contact Telehealth Nursing at 651-229-3890.