There is a need for measures to prevent accidental ingestion at hospitals that provide food for children with food allergies. The dietetics department of our hospital attempts to prevent accidental ingestion by providing meal tags that clearly indicate the dishes prepared without allergens (“allergen-free meal”), which are attached in the designated area by a licensed cook in charge of food preparation. During the 1-year period between January and December 2014, 258 children with food allergy were treated in our hospital and received allergen-free meals. There were 3 cases in which dishes containing allergens were served by mistake, and accidental ingestion by the patient occurred in 2 cases. Regarding the cause of these serving errors, it is likely that they occurred because allergen-free dishes were served using tableware with the same color as that used for allergen-containing dishes. Accordingly, we have revised our preventive measures against accidental ingestion so that all of the tableware and trays used for allergen-free dishes are yellow in color, in order to distinguish them from other dishes. Furthermore, we have provided a dedicated shelf for allergen-free dishes, and have also made it a requirement for final confirmation to be performed by 2 responsible cooks who double-check the food before serving. We will continue to monitor and improve our measures to prevent accidental ingestion as necessary.

  The incidence of fever in children admitted to general hospitals is very high. Provision of adequate nutrition and fluid supplements to febrile children is very important, but with some children it is difficult to maintain an adequate intake. To address this problem, we devised a new ‘febrile children's menu’, utilizing preparation methods and foods to produce a palatable menu for patients with fever.
  We introduced this ‘febrile children's menu‘ on January 6, 2011, providing it to 109 patients (age range: 1 to 8 years, average age: 3.3±1.9 years) over the ensuing 3-month period. We provided a mean 4.0±2.9 meals per day to each patient during their febrile stage (≥37.5°C). To evaluate the usefulness of the ‘febrile children's menu’, we investigated eating rates during the febrile period in all patients who had been provided with the menu, and performed a questiomaire survey on their parents/guardians. The mean eating rates during the febrile period were 39±30% for main meals, and 28±22% for side dishes. No significant difference was seen in the eating rates during the febrile period recorded over the 2-month period prior to introduction of the new menu to 112 febrile children (age range: 1 to 8 years, average age: 3.3±2.1 years), 39±30% for main meals, and 29±22% for side dishes. The questionnaire survey was responded by 43 parents/guardians (a recovery rate of 39%). The ‘febrile children's menu’ was assessed as ‘good’ by 67% of respondents, representing an overall favourable impression from the parents/guardians. With reference to the survey results, we will attempt to further improve the ‘febrile children's menu’ with the aim of increasing eating rates during the febrile period.

In 2010, we at Konan Kosei Hospital introduced a menu with 8 days set as a cycle for inpatients undergoing chemotherapy. We have thus far used it for 258 patients. Over the 6-month period extending from October 2011 and March 2012, we performed a questionnaire survey on 23 patients (8 with lung cancer, 5 with acute myeloid leukemia and 3 with lymphoma) about their meals. On the basis of the findings, we have made a number of improvements in the menu.　　To the question of ease with which to eat, 96% of patients responded the meals were “easy to eat.” When it came to the volume of meals, 29% replied that breakfast was “small,” whereas 83% said lunch and dinner were “just right.” Cold chawan-mushi (custard-like egg and vegetable dish steamed in a cup) was difficult to eat for 7 patients, whereas there were indications that fish meals were also hard to eat.　　Based on this survey, we have increased the volume of breakfast, and replaced cold chawan- mushi with hot chawan-mushi. Furthermore, in order to reduce the smell peculiar to fish, we substituted kaba-yaki (spitchcocks) and ankake (food dressed with a thick, starchy sauce) fish- cooking styles for nitsuke (fish boiled and seasoned with sugar and soy sauce) and mushizakana (steamed fish) styles. Further surveys are necessary to produce a menu suitable for as many patients undergoing chemotherapy as possible.

  Patients with dysphagia suffer from various degrees of difficulty in eating or swallowing. To improve their oral intake, meals must be provided with due consideration given to individual patient's eating ability. In this study, we examined a newly developed grading system of oral nutrition, which comprised 5 grades (I-V) based on the degree of difficulty in swallowing each formula. Grades I-III are meals suitable for swallowing training, grade IV represents meals that were enough to meet nutritional requirements, and grade V meals for the preparatory stage leading up to the changeover from liquid to solid foods.
  To assess the 5-step grading system of oral nutrition, we worked out average ingestion rates in 23 patients with dysphagia. The ingestion rate was 75±21% for patients on grade IV oral nutrition, and 74±19% for those on grade V, with a combined rate of 74±20%. This was higher than the average ingestion rate in a previous study conducted before our introduction of the grading system for oral nutrition (Journal of the Japanese Association of Rural Medicine 57: 83-88, 2008). We considered the surveillance data showed tendency to support the 5-step grading system, and in a case with dysphagia, this system actually brought about a remarkable improvement in ingestion. It has been introduced in our hospital since July 2008.

  Dietary management during chemotherapy for cancer can improve a patient's nutritional status through an adequate dietary intake, and increase the therapeutic effect.  In this study, we performed a questionnaire survey of inpatients in chemotherapy about their dietary preferences and changes in their senses of taste and smell, with the aim of producing a ‘chemotherapy menu’, utilizing recipes and foodstuffs to produce a palatable menu for those patients with their appetite diminished. We received responses from 102 out of 109 in patients surveyed (94%). Of the respondents, 66% rerealed that they had a decrease in appetite during chemotherapy, of whom 85% complained of extremely poor appetite. The smell of fish dishes disturbed 29% of the respondents, of whom 62% reported a stronger aversion to hot dishes. The foods easy to eat were found to be fruits, noodles, and soups. Meat and fish dishes, white rice, and stews were difficult to eat. Seasoning with tomato sauce made food difficult to eat for 44% of the respondents, whereas soy sauce was shunned by only 6%. The survey also found that 38% liked the use of Furikake (dried seasoning sprinkles), because it could make the meals palatable.  Based on the survey results, we devised an 8-day ‘chemotherapy menu’. It includes a Japanese style breakfast, with bread as an option, and many foods easy to eat, such as flavoured rice, sushi, noodles, sandwiches, and fruits. We have offered this menu to 47 inpatients, with average eating rates of greater than 70% for both rice and dishes. We will further conduct surveys with a view to producing a ‘chemotherapy menu’ palatable for as many patients as possible.

  In recent years, changes in Japanese dietary habits have been associated with the increased incidence of obesity and lifestyle diseases even among children. Dietary education is considered essential for stemming this trend. In this study, we introduced the following initiative in dietary education for children admitted to hospital and their parents from the standpoint of health care workers providing meals to inpatients. We added a ‘Children's Lunch’ to the menu. Designed for the fussy children, it was a nutritionally balanced meal. On traditional seasonal festival days, we wrote an introduction to Japanese seasonal cuisine and showed it to the children. To the parents, we distributed a regular weekly pamphlet outlining the importance of dietary education, with an explanation of the ingredients used in the meals, and recipes.  To assess the results of this initiative, we conducted a questionnaire survey of parents on a weekly basis. The results of the surveys (n=215, recovery rate 87%) taken during the first three months showed that the majority of parents rated all four aspects of the ‘Children's Lunch’ high menu content, presentation, child's response, and the pamphlet contents. The parents displayed a deep interest in our activity, because 93% of those parents said that they were impressed with dietary education. On the other hand, some dietary problems were identified, with tendencies to use only ingredients preferred by the children, and eat out often.  This was a short term initiative, limited to hospitalization, but we were cwetain that we had been able to provide an opportunity for parents to think about their children's diets. We plan to continue this initiative, thereby making a contribution to dietary education for children.