The quest for a healthy diet isn't an easy one. Talk to almost any parent and you’ll likely hear long lists of foods their child eats or doesn’t eat. Throw arthritis into the mix and navigating toward sound nutrition can become much more difficult.
“It’s critically important that kids with juvenile idiopathic arthritis (JIA) get proper nutrition, but it can be more challenging because the kids’ appetites may be suppressed by the disease itself or by the medication they take,” says Daniel Lovell, MD, director, Division of Rheumatology at the Cincinnati Children's Hospital Medical Center.
Joint pain, fatigue, nausea and stomach pain all can take their toll on normal hunger cues. Kids with jaw pain or temporomandibular joint disorder (TMJ) may have difficulty chewing or swallowing food.
Mechanical problems may come into play too, since cutting up and handling food may be hard for those with arthritis in the hands, fingers and wrists.
“One example is that children in school may not be able to open their milk cartons,” says Barbara Warady, RD, senior clinical nutritional specialist at Children’s Mercy Hospital in Kansas City, Mo. “They may not want to tell anyone that they can’t open them so as a result they just don’t drink the milk.”
When kids with arthritis don’t eat enough to meet their nutritional needs they can become more vulnerable to other problems. Poor growth can certainly be caused by the disease or exacerbated by medications like long-term steroid use. But growth can also be impaired if children don’t get the necessary amounts of protein, carbohydrates and other nutrients required to build bone and muscle. Malnutrition, anemia, nutrient deficiencies and osteoporosis may also result.
Fortunately these conditions occur far less frequently than they did even a decade ago due to advances in drugs. “Now we have treatments that are more effective and we can control the disease in the vast majority of children,” says Dr. Lovell. “If you can control the disease, then kids’ appetites improve, their energy is better, their joint pain lessens and they can be more active.”
Conversely, echoing the general rise in obesity among the U.S. population, some kids with arthritis are too heavy. Low activity due to the disease may be partly to blame. Regular steroid treatment causes a dose dependent increase in appetite as well as fluid retention that can also be associated with increased blood pressure. “So if a child has steroids as a chronic part of their treatment then I think those children benefit from early and ongoing involvement with a nutritionist who can find creative ways to limit sodium and calories in the kid’s diet,” says Dr. Lovell. These children must get adequate calcium and vitamin D since steroid use can cause re-absorption of calcium from the bones.
Registered dieticians can also offer ideas about how to deal with behavioral issues that sometimes arise. Having a chronic disease puts many stresses on children that are out of their control. “Food can be one of the few things that children can control when they have active disease. So sometimes food becomes a control issue for families,” says Warady. She suggests parents don’t push food on kids with low appetites because eating should remain a pleasant experience. But also avoid a situation where parents let kids eat whatever they want because they need to gain weight.
Another behavioral problem that more often affects teens rather than children is depression. When depressed, some kids will not eat enough while others will overeat.
Both Warady and Dr. Lovell have seen families who seek nutritional treatment approaches to their children’s JIA. Dr. Lovell says studies show about 20 percent to 30 percent of patients try alternative therapies, most commonly nutritional therapy.
“While very few reviews of these therapies have shown any ill benefits from trying these approaches, there’s no nutritional treatment approach that’s been proven effective for arthritis,” says Dr. Lovell. “The only time that I’ve run into real problems is when the parents are so focused on the nutritional approaches that they’re not willing to incorporate more standard type therapy and children end up losing time getting the disease under control.”
Warady stresses the need for families to tell their health care providers about any supplements, herbs or the like that their child is taking. “There may be possible interactions or side effects they are unaware of with some of the things that they could be taking,” says Warady. Also with a product like omega-3 supplements parents want to make sure their child is taking the right dose and not ingesting too much.
All in all, giving children the most nutritionally balanced diet possible combined with medical treatment that keeps their arthritis in check will go the farthest toward producing happy, healthy kids.