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Food and food supplements

Good food is part of the answer!
Look to nutrition with a new enthusiasm because there has been decades of research proving that a good diet will boost children's health, increase resistance to infection, and enhance quality of life.

It is more agreeable to offer your child a more varied diet, particularly fresh fruit, vegetables, nuts and pulses rather than even more oral tablets containing food supplements.

Some children lose their interest in food and may become lethargic or nauseous as a consequence of their illness, isolation from friends or disturbed taste in their mouth from the medication. Some children with arthritis do become medically malnourished and it is both distressing and frustrating to daily try to encourage a frail child to swallow meagre mouthfuls.

Principles to boost your child's health and enjoyment of food are:

• Use fresh fruit and vegetables, and don't overcook them!
• Prepare small bits of carrots, broccoli and cheese pieces and dips that are usually loved by kids of all ages.
• Try to convey an enjoyment of food rather than make mealtimes an unpleasant ordeal
• Try to use nuts and pulses where possible and try exotic fruits occasionally just to keep an interest in new taste experiences.
• Encouragement for the parents is as important as encouraging the child.
• Consistent back up from the whole family is essential.
• Listen to your child in her description of what things taste like to her. Children taste things differently to adults, and medication can also alter their sense of taste.
• It may fluctuate according to when they have medication so work out what time of day they are most likely to enjoy food rather than insisting they fit in with you.
• Seek out a clinical dietician's help if you have concerns about your child's diet and nutrition. Ask the rheumatologist or GP to refer your child if necessary.
• Buy as good quality of basic foods as you can afford.
• Avoid unpasteurised milk, cheese or other products from unpasteurised milk.
• Use bottled water if abroad.

If your child is eating tiny quantities of food...

• It is far more nutritious and flavoursome if they have a few ounces of good quality mild cheddar cheese rather than an equivalent portion of processed cheese and the additives it may contain.
• Use a smaller plate and small portions and loads of encouragement.
• Focus on what is consumed rather than on what is left on the plate. A dietician can prescribe a calorie rich powder to add to foods you prepare.
• Crisps (with as few additives or flavourings as possible) are discouraged for well children but become a useful calorie rich food when helping a non-eating child to eat something. Most children enjoy making small sandwiches with crisps especially if you make a great game of squashing the sandwich as flat as possible before eating!

Food Supplements

Every year upwards of £300m is spent on food supplements. Arthritis is such a common condition for older adults across the world and there is a huge market for supplements that relieve pain, stiffness, and reduce dependence on medication. The search for greater relief is understandable but as with other issues, seeking knowledge is the first step forward. There are many claims about a huge range of products, and with each year come new claims for cures.

The three main concerns about regular use of food supplements are: -

1. The vast majority of food supplements have not undergone rigorous testing and therefore variations in potency, content and ' beneficial' effect claimed by manufacturers.
2. The lack of research into how these food supplements interact with a range of medicines.
3. Supplements that may prove popular with adult arthritis sufferers are not necessarily suitable for children - the lack of background research means that there is no evidence about how the supplements are absorbed by juvenile organs and body systems, and therefore there seems to be a potential for unknown risk to children. Most supplements are regulated under food law, which means that they cannot claim to treat, cure or prevent disease. Many of them get round this by more subtle claims and labelling that specifically targets 'sufferers'. A tiny minority of food supplements are licensed which entitles manufacturers to make medical claims. Licensed products will have reliable, consistent potency and content and will have undergone stringent laboratory testing for safety and side effects like other pharmaceutical medicines. Look for a tiny PL number on the back of the product, but these products are often alongside those without any license.

Essential fatty acids

Researchers at Cardiff University have confirmed that essential Omega 3 fatty acids in cod liver oil may reduce the action of enzymes that cause pain, inflammation and cartilage damage. No specific research investigated how children should best use it. Beneficial effects were reported on joint mobility, pain and skin after several months' usage. No harmful effects were noted.

Specific plant oils (particularly from SAM-e = S-adenoysyl methionine = extracts of devils claw) have some beneficial effect in people who have osteoarthritis. Some research with a preparation of avocado and soya bean, called ASU, looks promising but again did not focus on the specific challenges for children with arthritis, nor was it used in combination with conventional medicine.