Question:  What to do for Growth Failure in Children with Chronic Kidney Disease ?
Answer: Children with CKD may lose their appetite or lack the energy to eat. To treat growth failure in children, a health care provider may recommend dietary changes, such as
                
- adding calcium. Children with CKD should get the recommended level of calcium for their age from their diet or from calcium supplements.  - monitoring liquids. Balancing the childs liquid intake based on his or her kidney disease is important. Some children will need to increase liquid intake, while other children will need to restrict liquid intake.  - limiting phosphorus. Children with CKD may need to limit phosphorus intake if they have mineral and bone disorder.  - monitoring protein. Children with CKD should eat enough protein for growth; however, they should avoid high protein intake, which can put an extra burden on the kidneys.  - monitoring sodium. The amount of sodium children with CKD need depends on the stage of their kidney disease, their age, and sometimes other factors. The health care provider may recommend either limiting or adding sodium, often from salt, to the childs diet.  - adding vitamin D. Children who do not get enough vitamin D through diet may need to take vitamin D supplements.
                
To help ensure coordinated and safe care, parents and caregivers should discuss the use of complementary and alternative medical practices, including the use of dietary supplements, with the childs health care provider. Read more at www.nccam.nih.gov.
                
Some children will use a feeding tube to receive all their nutrition. A feeding tube is a small, soft plastic tube placed through the nose or mouth into the stomach. The child will receive supplements through the tube to provide a full supply of fluid and nutrients to help him or her grow and develop. Feeding tubes are most often used in infants; however, sometimes older children and adolescents benefit from them as well.
                
Encouraging children to develop healthy eating habits can help prevent poor nutrition and promote healthy growing. The health care team will work with parents or caretakers to develop a healthy diet tailored to meet the needs of their child.
                
More information about diet and kidney disease is provided in the NIDDK health topic, Nutrition for Chronic Kidney Disease in Children.
                
Medications
                
A health care provider may prescribe medications that can help correct the underlying problems causing growth failure.
                
- A health care provider may prescribe phosphate binders when phosphorus levels in the blood rise and interfere with bone formation and normal growth. In the intestine, the medications bind, or attach, to some of the phosphorus found in food, causing the phosphorus to move through the intestine without being absorbed and exit the body in the stool. This process can decrease blood phosphorus levels and increase blood calcium levels. Phosphate binders come as chewable tablets, liquids, capsules, and pills.  - A health care provider may prescribe alkaline agents such as sodium bicarbonate to restore the acid-base balance in a child with acidosis.  - Synthetic erythropoietin is a man-made form of erythropoietin given by injection to treat anemia.
                
Growth Hormone Therapy
                
When a health care provider diagnoses a child with CKD and the child begins to show signs of growth failure, the health care provider may prescribe daily human growth hormone injections. The injections are a man-made growth hormone that mimics the natural hormone found in the body. Researchers have shown that using growth hormone therapy is effective in helping children reach normal adult height.
                
More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure in Children.