Nutrition is a very important factor in keeping children with liver disease in good shape. Clearly, these children must take in and absorb enough calories to grow. In addition to the normal calories that are required for age and weight, children with chronic liver disease need extra calories. Some children with chronic liver disease require supplemental tube feedings (or even intravenous feedings) to optimize their nutrition. Careful attention is paid by pediatric gastroenterologists and dietitians to provide adequate calories, adequate protein (excess protein can cause ammonia accumulations in children with liver disease) and fat. When formula feedings are used, we attempt to deliver fat in the form of MCT oil, which does not require bile salts for absorption. Infant formulas like Pregestimil and Alimentum or toddler formulas like Peptamen contain MCT oil. Sometimes Vital, a formula containing many carbohydrate calories but little fat, is used. In older children taking a regular diet, higher calorie goals can be established; sometimes protein or salt are restricted.
Supplementation of fat-soluble vitamins is key since patients with chronic liver disease can become deficient in vitamins A, D, E and K. Vitamin A deficiency can cause vision problems. Vitamin D deficiency can cause weak bones called rickets. Vitamin E deficiency can cause neurologic problems. Vitamin K deficiency can cause bleeding or even stroke. Attention must be paid as to whether these children have adequate levels of certain minerals. Calcium is important since, in combination with the vitamin D, it promotes good bone growth. Zinc is sometimes deficient in patients with chronic liver disease as well. The iron may be low if intestinal bleeding is going on chronically or nutrition is poor.