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Salt substitution in case of babies

Question
Dear experts,
in how far the loss of salt in case of babies or toddler with CF should be covered by increased salt intake and how can the additional salt be given to babies?
Many thanks....
Answer
Hello,
Loss of salt is a problem for CF patients especially on hot summer days with a high humidity and additional physical exercise (sport), as the patients lose high salt amounts via the sweat.
In the first year of life, the right behaviour is important. Babies should stay in the cooler house, if temperatures outside are high. The clothes should be light and airy and enough fluid intake is important. If increased sweating cannot be avoided, it has to be distinguished between breast-feeded and bottle-feeded children.
Breast-feeded children should get besides the breast milk 2-3 mmol/kg body weight and day sodium chloride. This can be prescribe in form of NaCl solution that is given in a certain amount over the day.
In case of bottle-feeded children, the milk should be switched to a special CF milk (Cystilac) that has an increased sodium chloride content.
Babies, who get already complementary feeding, need an additional amoung of NaCl of 1-2 mmol/kg body weight per day.
Toddlers, who are usually very active, should get enough fluid, with mineral waters with a high NaCl content or so-called isotonic drinks. Furthermore savory snacks should be in the household of CF children, so they can fight their salt hunger immediately.
Warn symptoms in case of a beginning salt loss syndrome are loss of appetite, reduced physical activity, apathy and vomiting. Vomiting is already a threatening symptom of in imbalance of the NaCl household.
Best regards,
Dr. H.-G. Posselt
11.05.2018