Human milk and breastfeeding during ketogenic diet therapy in infants with epilepsy: Clinical practice guideline

Author:

van der Louw Elles1ORCID,Trimmel‐Schwahofer Petra23,Devlin Anita45,Armeno Marisa6,Thompson Lindsey7,Cross J. Helen8ORCID,Auvin Stéphane391011ORCID,Dressler Anastasia23ORCID

Affiliation:

1. Department of Internal Medicine, Division of Dietetics Erasmus MC University Medical Center Rotterdam the Netherlands

2. Department of Pediatrics and Adolescent Medicine Medical University Vienna Vienna Austria

3. European Reference Network, EpiCARE

4. Paediatric Neurology Great North Children's Hospital Newcastle upon Tyne UK

5. Translational and Clinical Research Institute Newcastle University Newcastle upon Tyne UK

6. Department of Nutrition Hospital de Pediatria Prof. Dr. J.P. Garrahan Buenos Aires Argentina

7. Children's Mercy Hospital and Clinics Kansas City Missouri USA

8. UCL NIHR BRC Great Ormond Street Institute of Child Health Great Ormond Street Hospital for Children NHS Trust London UK

9. APHP, Service de Neurologie Pédiatrique Hôpital Robert Debré Paris France

10. Université Paris‐Cité INSERM Neuro Diderot Paris France

11. Institut Universitaire de France (IUF) Paris France

Abstract

AbstractKetogenic diet therapy (KDT) is a safe and effective treatment for epilepsy and glucose transporter type 1 (GLUT1) deficiency syndrome in infancy. Complete weaning from breastfeeding is not required to implement KDT; however, breastfeeding remains uncommon. Barriers include feasibility concerns and lack of referrals to expert centres. Therefore, practical strategies are needed to help mothers and professionals overcome these barriers and facilitate the inclusion of breastfeeding and human milk during KDT. A multidisciplinary expert panel met online to address clinical concerns, systematically reviewed the literature, and conducted two international surveys to develop an expert consensus of practical recommendations for including human milk and breastfeeding in KDT. The need to educate about the nutritional benefits of human milk and to increase breastfeeding rates is emphasized. Prospective real‐world registries could help to collect data on the implementation of breastfeeding and the use of human milk in KDT, while systematically including non‐seizure‐related outcomes, such as quality of life, and social and emotional well‐being, which could improve outcomes for infants and mothers.What this paper adds Human milk and breastfeeding can be incorporated safely into ketogenic diet therapy. With expert guidance, human milk and breastfeeding do not reduce diet effectiveness. We show two strategies for clinical practice to include human milk. Mothers can be encouraged to continue breastfeeding.

Publisher

Wiley

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