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nutrition in infant with cf

Dear doctors,

my 4 months old daughter had been recently diagnosed with cf.

Sheis pancreatic insufficient, as diagnosed by her doctor.

Kindly advise on the following:
1. her stools are still very loose, fatty and smelly regardless she takes pancreatic enzymes with every meal. Since enzymes intake, she started to gain weight and is constantly growing every week. Will she always have fatty stools, is this normal while she takes pancreatic enzymes?
2. when can I start to diversify her food, is this recommended for infants with cf?

Thank you,
Ana Toma
Dear Ana Toma

Thank you for your question relating to your 4 month old daughter and pancreatic enzymes. It is very reassuring that your baby is growing steadily and gaining weight. However, you describe her stools as still being ‘very loose, fatty and smelly’ even though she is taking pancreatic enzymes with every meal. With adequate pancreatic enzymes, a babys’ stools should no longer be fatty and loose.

Her symptoms would suggest that she is not taking enough enzymes to fully digest the amount of breast milk or formula milk she is having at each feed.
The first thing to check is how are the enzymes being taken? Usually it is recommended that the prescribed dose of enzymes (usually small ‘microspheres’ or granules) are mixed with a small amount of breast/formula milk when your baby is very young or in fruit puree when she is a little older. They should be given from a spoon at the beginning of a feed. Usually fruit puree holds the granules into a gel and this is easier for your baby to swallow. It is NOT recommended that the dry granules are placed into your babys’ mouth as this may cause your baby to choke or cause the gums to become red and sore.

If you are satisfied that your daughter is swallowing all of the enzyme dose that your CF doctor has recommended before each feed, but is still having loose, fatty stools, then the dose of the enzymes may need to be increased.

The dose of pancreatic enzymes is usually based on the volume of breast milk/formula milk taken at each feed. As your daughter grows, you may have noticed that she is hungry and is drinking more at each feed. In which case, the amount of pancreatic enzymes required may need to be increased. Your CF Doctor (or dietitian) at your local CF centre will advise you on the appropriate dose of pancreatic enzymes to be taken with each feed.

You also asked when you should start to diversify her food in other words I presume when to start weaning? There is no need to start your baby on solid foods before 6 months of age. However some parents find that their baby is ready to start solids sooner. The earliest recommended age to introduce solids is from 17 weeks of age.

The Cystic Fibrosis Trust ( produce a very comprehensive factsheet called ‘Nutrition: a guide for feeding infants with cystic fibrosis (April 2013). This should provide with more detailed guidance on weaning. Please click on the following link to download a copy of this fact sheet.

In summary, the fact that your baby daughter is growing steadily is very encouraging. However as she is still having foul, fatty, stools, it is worth checking that she is taking all of the recommended dose of pancreatic enzymes with each feed mixed either with breast milk or formula feed or with fruit puree and given from a spoon at the start of the feed. If your daughter is taking more feed, then the dose of pancreatic enzymes may need to be increased. Please contact your dietitian or doctor at your CF centre for more specific advice. Generally speaking weaning usually begins at age 6 months of age. However solids may be introduced from 17 weeks of age. The recommended factsheet will provide you with clear guidance on how when and how to start weaning. Finally cow’s milk should not be given as a drink before one year of age.

I hope this information has been useful and that your daughter continues to grow steadily and keep well.

Kind regards

Dee Shimmin
The answer is edited by: Dee Shimmin