Congenital heart disease (CHD) is one of the most common birth defects, affecting approximately 8-12 per 1,000 live births. For children with congenital heart disease, maintaining proper nutrition is essential to support growth, development, and overall health. However, these children often face unique nutritional challenges due to increased energy needs, feeding difficulties, and malabsorption. A recent consensus document from the Spanish Association of Paediatrics highlights the importance of early nutritional assessment and intervention in infants with congenital heart disease.
Why nutrition natters in congenital heart disease
Children with congenital heart disease are at a higher risk of malnutrition due to several factors, including:
- Increased Energy Needs – Their heart works harder, burning more calories.
- Poor Feeding Tolerance – Some infants experience fatigue while feeding or struggle with sucking and swallowing.
- Gastrointestinal Issues – Malabsorption and reflux can contribute to poor weight gain.
- Frequent Illnesses – Recurrent respiratory infections may impact appetite and nutrient absorption.
Proper nutrition is essential because malnutrition in CHD patients has been linked to higher surgical risks, prolonged hospital stays, and developmental delays. Studies have shown that infants with CHD who receive adequate nutrition before surgery have better recovery outcomes and lower complication rates. Addressing nutritional deficits early can make a significant difference in a child’s overall health and quality of life.
Nutritional risks and screening
The consensus document identifies cardiac conditions that carry a high nutritional risk, including:
- Complex CHD (e.g., Tetralogy of Fallot, Hypoplastic Left Heart Syndrome)
- Heart failure or pulmonary hypertension
- Cyanotic heart disease (leading to low oxygen levels and poor growth)
Infants with these conditions should undergo early referral to a paediatric nutritionist or dietitian to prevent malnutrition. Regular nutritional assessments should track weight, height, and energy intake to ensure adequate growth. Growth delays in children with congenital heart disease can be subtle, so close monitoring using weight-for-height and weight-for-age percentiles is crucial.
Healthcare professionals should also assess feeding difficulties, signs of fatigue during feeding, and inadequate weight gain. Early identification of at-risk infants allows for timely interventions such as calorie fortification, feeding support, and supplementation.
Key Nutritional Strategies for congenital heart disease
1. Energy and Protein Requirements
Children with congenital heart disease often require higher calorie intake to support growth. The recommended energy intake varies based on risk level:
- Low risk: 90–100 kcal/kg per day, 1.5 g protein/kg
- Moderate risk: 110–120 kcal/kg per day, 2.5 g protein/kg
- High risk: 120–150 kcal/kg per day, up to 4 g protein/kg
For children with severe malnutrition, energy needs may be as high as 175–180 kcal/kg per day to promote catch-up growth. Adequate protein intake is also crucial for muscle development and immune function. Insufficient protein can lead to muscle wasting and delayed recovery after surgery.
2. Nutritional Support and Feeding Approaches
- Breastfeeding: Encouraged whenever possible, with additional calorie fortification if needed.
- Formula Feeding: High-calorie formulas or semi-elemental formulas may be required for infants with malabsorption.
- Tube Feeding: If oral feeding is insufficient, nasogastric (NG) or gastrostomy tubes may be necessary to meet nutritional needs.
For infants struggling with oral intake, nighttime tube feeding can be introduced to reduce feeding fatigue during the day. Feeding therapy with a dietitian or speech pathologist may also help improve sucking and swallowing skills.
3. Pre- and Post-Surgical Nutrition
For infants undergoing heart surgery, preoperative nutritional support for at least 10 days can improve outcomes. Malnutrition before surgery is associated with higher mortality rates, slower wound healing, and increased infection risk.
Postoperatively, early enteral nutrition is preferred to support healing and recovery. If a child struggles with oral intake after surgery, healthcare teams may recommend a gradual transition from NG feeding to oral feeding to minimize stress.
Other Nutritional Considerations
- Micronutrients: Children with CHD may require supplementation of iron, vitamin D, and electrolytes. Deficiencies in these nutrients can contribute to fatigue, weakened immunity, and poor growth.
- Monitoring Growth: Regular weight and height tracking is essential to detect nutritional deficiencies early. A growth rate of at least 10g/kg/day is considered an important indicator of adequate nutrition.
- Feeding Therapy: may be needed for infants with swallowing difficulties or oral aversion. If feeding difficulties persist beyond infancy, a multidisciplinary approach may be beneficial.
- Hydration & Electrolytes: Congenital heart disease patients with fluid restrictions need careful monitoring to avoid dehydration, which can affect cardiac function.
Parental Support & Education
Parents of children with CHD often feel overwhelmed by the complex feeding challenges their child faces. Providing clear guidance on nutrition strategies, feeding schedules, and warning signs of malnutrition can empower caregivers.
Encouraging frequent, small feedings and offering nutrient-dense foods as the child transitions to solids can help maintain steady growth. Parents should also be aware of signs of feeding fatigue, prolonged mealtimes, and recurrent vomiting, which may indicate a need for intervention.
The Bottom Line
Nutrition plays a critical role in the management of congenital heart disease. Early screening, individualized nutritional plans, and proactive interventions can significantly improve growth and overall health outcomes in these children. If you have concerns about your child’s nutrition and growth, working with a paediatric naturopath or nutritionist can help tailor a plan suited to their unique needs.
For expert guidance on paediatric nutrition, including managing feeding challenges in congenital heart disease, book an appointment at with a Nutritionist or Dietitian.
