Nutrition and Growth Challenges

Growth and proper nutrition are important considerations for all children with chronic kidney disease (CKD). Achieving expected growth is the ultimate outcome for all children, as it not only supports physical health but also influences positive social and intellectual well-being. In children with CKD, problems that impact growth are often multifactorial. A team of healthcare professionals (e.g., renal dietitian, nurse, social worker, psychologist, physician) experienced in the care of children with kidney disorders play a pivotal role in fostering growth and well-being. The collaboration and contributions of various team members along with engagement of the family are paramount. Most importantly, family and caregivers play a vital role in addressing the numerous needs of the child, including administrating medications, ensuring adherence to dietary modifications, encouraging physical activity, supporting educational needs, and facilitating ongoing medical monitoring. Nutrition and growth are intertwined for all children, and particularly in those with CKD. For children with CKD experiencing poor growth, insufficient intake of energy and protein is the most common cause. While there may be instances when specific foods or fluid intake must be limited, the primary goal is to support growth by emphasizing nutritious food and adequate fluid intake while minimizing restrictions to usual eating patterns. However, aspects other than intake must be considered when addressing growth concerns. Growth hormone therapy may eventually be recommended for certain children with CKD to enhance growth and overall quality of life. Managing bone issues in children with CKD is complex, but essential for optimal growth and development. The multifaceted bone disorder associated with CKD, known as mineral bone disorder (MBD-CKD), demands meticulous monitoring and regular assessments, including evaluations of bone markers such as biochemical parameters, parathyroid hormone levels, and vitamin D levels. Interventions individualized to each child are crucial. Nutrition, growth, and bone health are intricately linked in children with CKD, and successful outcomes in each of these domains of medical management are pivotal for the ability of the child with CKD to thrive.