Content of the specifications
These diet specifications give guidance about the type and quantities of foods that would be suitable for paediatric in-patients ordered a range of therapeutic diets.
Food preferences (e.g. nil beef, nil mushrooms) are not regarded as therapeutic diets and therefore not included in these specifications. The normal menu selection processes should accommodate such preferences.
As with the Adult Diet Specifications,for each diet the following information is provided:
- Aim describes the broad objective of the diet with any quantitative daily targets.
- Characteristics describes the general patterns of foods used in the diet.
- Indications lists some common medical or surgical conditions for which the diet is often prescribed.
- Nutritional adequacy provides an assessment of whether the diet is adequate alone or whether it needs supplementation to be nutritionally adequate.
- Precautions gives instructions or warnings relevant to the use of the diet in hospitals.
- Specific menu planning guidelines lists the foods that are allowed or not allowed on the diet.
- References gives a selection of authoritative sources of information supporting the diet specifications.
Use of the specifications
Any therapeutic diet or texture modification from either paediatric or adult diet specifications should be teamed with the age-appropriate diet to ensure foods are developmentally appropriate and that textures are manageable. The age-appropriate diets include: “infant”, “toddler”, “child”, and “adolescent”.
Examples:
- An 8 year old who is from a vegetarian family (including milk and eggs) would be ordered as: child 4-8 years, vegetarian including milk and eggs.
- A 14-year-old girl with wheat and milk allergies would be ordered as: adolescent 14-18 years, wheat free, milk free.
- A 2 year old for a faecal fat test would be ordered as: 1-3 years, test-faecal fat.
- A 10-year-old child would be ordered as: child 9-13 years.
- A 6-month-old infant starting solids for the first time would be ordered as: Infant first foods.
- A 3-month-old infant who is only breastfed would be ordered as: breastfed and/or infant formula fed alone.
- A 7 year old who has had oral surgery would be ordered as: child 4-8 years, smooth puree.
Precautions
Some combinations of adult and paediatric diets require caution (e.g. restrictions of electrolytes, protein, fat etc.). Some of these diets must be adjusted under the direction of clinical dietitians. Some paediatric diets require further meal planning and manipulation by a dietitian to ensure nutrient sufficiency (e.g. metabolic low protein, ketogenic, eating disorder etc.).
Diet availability
- Paediatric meals need to be provided for the next meal following patients’ admission.
- Paediatric diets may require extra meal planning and food preparation.
Diet prescription
These specifications do not attempt to define the appropriate diets to be prescribed for individual patients. Diets must not be automatically ordered for patients with the medical or surgical indications noted in the specifications because a very restrictive diet may prevent good nutritional recovery for patients, who are already undernourished or eating poorly.
Appropriate health professionals may alter the diets to meet individual patients’ needs. For example, some patients on soft diets may not tolerate bread, and this would need to be noted at the time of ordering that diet.
Foods allowed / not allowed
In the specific menu planning guidelines, it is not possible to list all foods or recipe items that might be suitable or unsuitable. Specific guidelines and some common examples are usually included, but other foods or dishes might also be suitable or unsuitable, depending on their nutritional profile, ingredients and texture.
Trade names of some common product examples have been used to clarify the intention of the guidelines, but their inclusion does not imply endorsement or recommendation of these products, nor indicate that other similar products are unsuitable.
These specifications are designed for patients in hospital; they are not intended as education material for patients prescribed therapeutic diets. For this reason they do not mention foods that would not normally be available in hospitals, for example: alcoholic beverages, take-away foods, and specialty gourmet items.
Food availability
Not all products listed as being allowed for a specific diet will be available at all sites and some foods may be reserved for use in therapeutic diets only.
Nutritional supplements
These specifications do not attempt to indicate which nutritional supplements comply with each diet, since it is assumed that a dietitian will order the type and volume of supplements according to the patient’s individual needs. In many cases other nourishing foods, such as flavoured milk or yoghurt, are suitable alternatives to commercial supplements.
Rare diets
These specifications cover diets commonly used across NSW public hospitals. They do not include special diets designed for research purposes or particular treatment situations. The local dietitian will need to specify those diets and communicate with the food service about feasibility and implementation.
Review of specifications
These specifications are initially endorsed for 3 years from the date of release. Ongoing evaluation and revisions will be managed by the ACI Nutrition Standards and Diet Specifications Reference Group.