Diet and JIA
Children and food can be a source of stress for any parent. However diet can provoke even more anxiety when you have a child who is affected by a health condition such as JIA. Managing the side effects of medication can be an additional challenge as can encouraging a healthy diet in the middle of a flare up.
At present there is no specific evidence-based dietary recommendation for children with rheumatic diseases. However we do know that there are some things that can make a difference to either symptoms or disease activity such as eating a healthy, balanced diet, maintaining a healthy weight and satisfactory Vitamin D and calcium levels:-
- oily fish may be helpful in reducing inflammation and studies indicate fish oils may support some symptoms of arthritis. Oily fish includes salmon, trout, mackerel, sardines and fresh tuna. Good ways to get children to eat oily fish include making fishcakes, fish pie, kedgeree, pate or as fillings to wraps and baked potatoes
- studies of the Mediterranean diet have found it to be rich in plant nutrients, complex carbohydrates, fibre, vitamins and minerals This diet emphasises fruit and vegetables, fibre from nuts, olive oil, pulses and whole grains, fish and poultry as part of a healthy diet
- increasing the types of food found in the Mediterranean diet and reducing refined foods such as white bread, pasta, sugar and refined cereals may not just be of benefit to a child with JIA but the family as a whole
- vitamin D is an essential nutrient needed for healthy bones and to control the amount of calcium in our blood. It occurs naturally in a few foods such as oily fish and eggs. Your child’s health care team may suggest your child takes a daily supplement of vitamin D drops. The recommended daily dose of vitamin D drops for children aged six months to five years is 7-8.5 micrograms per day but with all medications and supplements it is important you discuss this with your child’s health- care team first. Eating regular meals will help support your child’s energy levels but some medications may mean your child can often feel hungry. Here are some ways you can help your child with this:
- make sure your child has breakfast. This doesn’t mean just cereals as your child will feel fuller for longer if you also include protein as part of the breakfast. Try eggs – poached, boiled or scrambled – sardines, avocados, nut butters, humous, home-made beans on toast
- when children are hungry it can be tempting to give them high carbohydrate snacks like toast, crackers or fruit. Make sure snacks like this also have protein and good fats with them – like nuts, seeds, olive oil, coconut oil, butter, avocado - which will satisfy them for longer
- if you’re giving your child fruit add a handful of nuts and seeds, try vegetables dipped in nut butters, humous, avocado, sweet potato wedges, boiled eggs, cheese and natural yoghurt
- whole nuts, including peanuts, shouldn't be given to children under five due to the risk of choking. However as long as there is no history of allergies in your family you can give your child crushed nuts or nut butters once they're six months old (NB lots of schools have a completely nut free policy so ask before adding to lunch boxes or snacks for school!)
- stay away from packaged/bottled fruit juices, processed sugary drinks, and snacks. Foods containing high levels of sugar often have little nutritional benefit and may mean your child feels more hungry afterwards
- if you want juice - squeeze or juice your own and remember lots of children love vegetable juices like carrot and cucumber too! Although these are healthier options for your child remember, fruit contains natural sugars so fresh juices, including vegetable juices, should only be drunk in moderation. Also remember, one average portion only counts as one portion of fruit or vegetables.
Enticing children who feel unwell or are experiencing side effects from medication to eat can also be tricky:
- keep the meal sizes small, offer them frequently and don’t worry if your child takes a little longer over their meals. If food is refused take it away and try again another time
- try to keep meals as simple as possible and include one thing you know your child likes at each meal
- home-made soups such as chicken broths or simple vegetable stews are easy on the digestion and full of nutrients to support repair in the body. You can make this in bulk and freeze for when it’s needed
- smoothies made at home with a blender are usually loved and easy to drink by a child who feels unwell. Start with a glass of milk (you can use nut, oat or coconut milks if you prefer to not use dairy) and add oats, berries or fruit (fresh or frozen). Add a teaspoon of coconut oil, nut butter or seeds such as pumpkin and sunflower to increase the protein. It’s also easy to hide a small amount of greens such as spinach or kale in a smoothie!
- if your child is taking methotrexate he/she may require additional supplementation of folate. Good sources of folate in food include – broccoli, brussels sprouts, spinach, asparagus, peas, chickpeas, brown rice
- constipation and/or diarrhoea can be common side effects of medication. Increasing the fibre in your child’s diet through five portions of fruit and vegetables each day and swapping to wholegrain rice, wholegrain pasta, wholemeal bread, seeds, nuts and oats will keep bowel movements regular and make your child feel fuller for longer
- children with constipation or diarrhoea also need lots to drink. Frequent sips of water are best. Try to avoid giving too much milk or squash as these can cause constipation.
Nut butters can be found in all the large supermarkets with the peanut butters. They usually have cashew, almond, brazil. They also sell them at most health food stores.
Coconut oil can be bought at large supermarkets such as Tesco and Sainsburys as well as health food shops. You can usually find it in a jar with the olive oils etc.
References available on request