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pancreatic enzymes

If a child (2 years old), is given his enzymes prior to a meal and refuses to eat what are the possible consequences ?

If antibiotics are given preventively, should it be given three times daily or if once a day is just as good?

Where can I get recent information on the effects of clapping twice a day?

Many thanks for your answers.
Dr. Linda Talbot
Thank you so much for your question.
In caring for a child with Cystic Fibrosis, a great deal of emphasis is placed on the importance of diet and growth. Toddlers are active curious and want to be in charge. Your child is learning to be independent but still needs security. Food refusal is common in young children and toddlers with CF are no exception. Some days your child may appear to eat everything and on other days they appear to eat little amounts. Naturally as a parent this can be worrying especially if your child has already taken his pancreatic enzyme supplements.

I am not aware of any specific research into potential consequences relating to taking pancreatic enzymes and then refusing to eat. Anecdotally it could potentially contribute to abdominal pain and constipation in the long term. However it is generally believed that pancreatic enzymes given without food occasionally will not harm your child.

If food refusal is a common problem it may be helpful to give a small dose of pancreatic enzymes at the start and if the meal is eaten, give more during the meal. Alternatively wait to see if the meal is eaten at all before giving any pancreatic enzymes.

Even if your child has refused to eat after taking pancreatic enzymes, it is advisable not to offer a second meal or snack as this may lead to bad or undesirable feeding behavior. It is best take the meal away without comment.

Young children often realize that refusing to eat gets them a lot of attention. To get your child to behave at meal times you need to praise the behaviours you like and ignore the behaviours you don’t like. Although this can be a challenging time for parents, try to be consistent in your approach to feeding and keep mealtimes a happy experience.

The Cystic Fibrosis Trust provide a useful guide for children and parents called “Eating Well with Cystic Fibrosis” (written by Carolyn Patchell). This is available from the CF Trust website . There is also a factsheet available from the Cystic Fibrosis Foundation called “Nutrition for your toddler with Cystic Fibrosis” (

We cannot give recommendations on timing of antibiotics as many require different regimes. Antibiotics that are prescribed to be taken three times a day are done so in order to maintain therapeutic levels of antibiotic in the bloodstream. If these antibiotics were to be taken once a day there is a risk that for periods of the day antibiotic levels will be sub-optimal and at other times of the day the levels may reach toxic levels. Please refer to the Cystic Fibrosis Pulmonary Guidelines (Flume et al 2009) or refer to a pharmacist.

Flume et al. Cystic Fibrosis Pulmonary Guidelines: Treatment of Pulmonary Exacerbations. American Journal of Respiratory and Critical Care Medicine 2009; 180: 802-808

Clapping is a form of airway clearance and there are many alternatives. There is currently insufficient evidence to allow us to recommend one form of airway clearance over another. Recent information on many forms of airway clearance can be found in the following references:
Flume et al. Cystic fibrosis pulmonary guidelines: airway clearance therapies. Respir Care. 2009 Apr;54(4):522-37.
Bott et al. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax 2009;64:i1-i52

These recommendations highlight that there is no evidence to support the use of one airway clearance technique over another. Choice of treatment often depends on patient preference as well as accessibility and cost of the adjunct (e.g. Vest).

Best wishes
Stuart Elborn
Dee Shimmin
Lisa Kent