Low LCT Diet for Chylothorax Infants and toddlers: 6 months - 2 years

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1 Low LCT Diet for Chylothorax Infants and toddlers: 6 months - 2 years Nutrition and Dietetics Information for Patients, Parents and Carers Paediatric Cardiology Dietitian Nutrition and Dietetics Glenfield Hospital Groby Road LE3 9QP Tel:

2 Chylothorax What is it? Lymph vessels carry fats around the body in a liquid called chyle. Sometimes the lymph vessels are damaged which causes chyle to leak into the chest cavity. This is called chylothorax. Treatment: A chest drain is inserted to drain away some of the chyle. For the vessel to heal it needs to be rested. This can be done by changing the type of fat in the diet. The fats carried in the lymph vessels are called long chain triglycerides (LCT) and this is the type of fat that needs to be reduced. Medium chain triglycerides (MCT) are carried in the blood, not the lymph, so can be used instead. Specialist Products on Prescription: Monogen: this formula is very important for your child, as this helps your baby get the nutrients they need whilst following the restricted diet. This formula replaces their usual standard formula or milk. MCT oil: should be used instead of other cooking oils / fats. This needs to be used at a low heat as burns easier than other oils. Liquigen: this should be added into fat free yoghurts, custard, skimmed milk, scrambled egg whites and sauces that you give to your child. Your Dietitian can advise on quantities, but a typical starting dose is 1-2 teaspoons per 100g fat free yoghurt. Liquigen needs to be introduced gradually over the first week of diet otherwise your child may develop tummy ache. 2

3 Weaning 6-8 months old Foods to include: All fruit and vegetables permitted (except olives and avocado) Potato and sweet potato Boiled rice Baby rice mixed with Monogen formula Hard boiled egg white (no yolk) - whisk 2x egg whites with 1 teaspoon of liquigen, fry gently in MCT oil and slice / mash to an appropriate texture Skimmed milk / skimmed milk powder Fat-free yoghurt add 1-2 teaspoons of liquigen per 100g Quark Custard powder (not instant) - make up with Monogen formula Jars or pouches containing <0.3g fat per 100g: typically fruit and vegetable mixes (see overleaf for examples) Finger foods / snacks containing <0.2g fat per portion: typically fruit 3

4 Example Jars / Pouches Please note that formulations change, so these are for guidance only. We suggest you check the label before giving to your baby. Cow and Gate: Taste of apple Taste of apple and blueberry Taste of apple and mango Orchard fruits Fruit cocktail and baby rice Ella s Kitchen: Carrots, apples and parsnips Butternut, carrot, apple and prune Broccoli, pears and peas Sweet potato, apple, pumpkin and blueberries Spinach, apple and swede Red peppers, sweet potato and apple Peaches, pears and rice Carrots, carrots, carrots Sweet potatoes, sweet potatoes Hipp Organic: Simply squash Simply carrots Carrots and potatoes 4

5 Example Finger Foods Please note that fat contents vary, so please check the label of specific products. All fresh, frozen and tinned fruits or vegetables (except avocado and olives) Any plain rice cakes Puffed rice cereal, cornflakes, frosted flakes or puffed wheat Organix rice cakes: various flavours available apple, banana, cherry, raspberry and blueberry Organix goodies raspberry moo fruit Bear fruit paws: various flavours available Organix goodies apple and strawberry gummies Organix goodies banana and date bars Depending on your child s stage of weaning, some of these foods may not be suitable. Discuss with your Health Visitor and Dietitian if you are unsure. 5

6 Older Infants age 8 months to 2 years Free Foods : these can be eaten without restriction: All fruit: fresh or tinned are acceptable All vegetables (except olives and avocado): tinned, frozen, and fresh all acceptable Potato and sweet potato Hard boiled egg white (no yolk) - whisk with liquigen and fry gently in MCT oil Skimmed milk / skimmed milk powder Fat-free / 0% fat yoghurt (not low-fat) 0% fat cottage cheese Quark Jelly Ice lollies Most fruit sorbet check label for fat content Custard powder (not instant) - make up with Monogen Jam / marmalade / golden syrup Fruit juice (dilute well) Jelly sweets e.g. jelly babies (in moderation take care with dental hygiene and choking risk) Packaged foods or jars with <0.2g fat per portion or <0.3g per 100g 6

7 Staple foods at mealtimes: Your child s meals can include the following foods, in the portions specified: 35g tinned tuna (in spring water NOT oil) 40g cooked white fish (e.g cod, pollock, haddock) 25g well cooked prawns 10g cooked (20g raw weight) skinless chicken or turkey 40g baked beans / butterbeans 45g cooked red lentils (15g dried weight) 20g Quorn mince or 15g Quorn chicken style pieces 1 teaspoon reduced fat soft cheese (e.g. Philadelphia light) 40g cooked pasta or rice or cous cous (plain versions only) 100g tinned spaghetti 20g puffed rice cereal, cornflakes, frosted flakes, puffed wheat 1/2x weetabix 1/2 medium sliced bread or 1/2 crumpet or 1/2 regular pitta (~30g) 1/2 breadstick or 1 plain rice cake 1/4 weight watchers wrap or Tesco light choices tortilla Include free foods (from previous page) to provide your child with a complete meal. 7

8 Recipes Fish Fingers: 40g boneless white fish slice into appropriate sized pieces 1x beaten egg white 10g breadcrumbs 1 tablespoon MCT oil for frying 1. Dip the fish in egg white 2. Coat with breadcrumbs 3. Fry gently in MCT oil until golden brown and cooked through Chicken nuggets: 15g cooked skinless chicken breast, sliced thinly 1x beaten egg white 5g breadcrumbs 1 tablespoon MCT oil for frying 1. Dip the chicken in egg white 2. Coat with breadcrumbs 3. Fry gently in MCT oil until golden brown 8

9 Recipes Kedgeree: 40g cooked boneless white fish (e.g. cod or haddock or pollack) 40g plain boiled rice 1 hard boiled egg white chopped 2 teaspoons MCT oil Mix then fry in MCT oil over a low heat until heated through. Tuna fish cakes: 35g tinned tuna in water 50g cooked potatoes Chopped parsley Skimmed milk to bind 1x beaten egg white 10g breadcrumbs 1 teaspoon MCT oil plus additional for frying 1. Mash the potatoes with 1 teaspoon MCT oil 2. Add the fish and parsley, bind with a small quantity of skimmed milk 3. Shape into flattened circles, dip in egg white, then coat with breadcrumbs. 4. Fry in MCT oil over a low heat until golden brown 9

10 Recipes Pasta sauce Makes a large batch can be frozen in individual portions 1 tablespoon MCT oil 1 large onion, chopped finely 1 pepper, seeded and sliced thinly 1 courgette, chopped into small pieces 200g tinned tomatoes or passata Mixed herbs: basil and oregano 1. Fry onion in MCT oil over a low heat 2. Add sliced pepper and cook for a further 10 minutes 3. Add tomatoes, courgette and herbs, cover and simmer for 30 minutes 4. Remove lid and cook for further 10 minutes White sauce for fish, chicken and rice dishes 1 tablespoon MCT oil 1 teaspoon plain flour 100ml skimmed milk or Monogen formula 1. Heat MCT oil gently 2. Add flour gradually and beat well with wooden spoon 3. Add milk gradually, stirring continually and cook for 5 minutes 10

11 If you have any questions, write them down here to remind you what to ask when you speak to your child s Dietitian. 11

12 Developed and produced by Leicestershire Nutrition and Dietetic Services October 2016 LNDS 028 University Hospitals of Leicester NHS Trust Access our website on Today s research is tomorrow s care We all benefit from research. Leicester s Hospitals is a research active Trust so you may find that research is happening when you visit the hospital or your clinic. If you are interested in finding out how you can become involved in a clinical trial or to find out more about taking part in research, please speak to your clinician or GP. If you would like this information in another language or format, please contact the service equality manager on