Dietary Adherence By Children On Dialysis

01-03-2007 | Categories:

Patient Education

Solving the Diet Dilemma for Children Written for the American Association of Kidney Patients web site by Donna L. Morton de Souza, MPH, RD

This page at the American Association of Kidney Patients web site suggests methods by which parents of children on dialysis can encourage adherence to the dietary restrictions necessitated by that treatment.

Most of the advice is standard, as evidenced by the main headings:

Reason With Your Child
Offer Rewards for Positive Efforts
Provide an Appropriate Environment to Promote Success
Elicit the Support of Others
Encourage Independence
Encourage Daily Exercise as Approved by the Physician
Educational Games and Activities

One section, however, seems counterintuitive although it is a relatively common strategy in the management of diets for weight loss, diabetes, dialysis, and other health problems: Allow For “Cheat Treats”
[Excerpt from article follows:]

As teens struggle for independence from their parents, they may “rebel” by being non-compliant with diet and medications. A “small amount” of careful noncompliance may help promote increased compliance with the more important aspects of their treatment. Ask your child what food or beverage he would like to choose as a “cheat treat.” Consuming the cheat treat on a dialysis day, two to three hours before their treatment is probably the best time to “cheat” and can be treated as a reward for having to receive dialysis treatments three times per week. However, avoid cheat treats on the dialysis days that follow two or more days without dialysis. Consult your clinic’s registered dietitian for more information on the appropriate timing and amounts of specific cheat treats.

Commentary

This parental advisory is well written and could be helpful because it collects in one document the most significant topics dealing with dietary compliance for children in dialysis.

The notion of promoting limited episodes of noncompliant compliant behavior in the service of long term adherence is intriguing.

Allowing patients on dietary restrictions controlled, planned “cheats,” the oxymoronic phrasing notwithstanding, appeals to common sense and is advocated by many professionals. In my quick and dirty searches this morning, however, I am experiencing difficulty finding well contracted studies that support this notion.¹ I plan to pursue followup on the research and publish a post re the impact that “permission to cheat” may have on dietary compliance.

Of course, cheating, sanctioned or not, takes place in treatment adherence situations other than diet. I suspect, however, that therapist-approved cheating on diets is the most common form, and the abundance of cases as well as its relatively stigma-free status may make it easiest to examine, and principles thus derived for dieting may have implications in other fields as well.

Footnotes

The difficulty may have more to do with finding the correct combination of search terms for this somewhat ambiguous topic than the lack of studies. [back]

« Factors In Lifestyle Change
Cash For Compliance & Other Ethical Dilemmas »

Related Posts: