Many parents prepare meals in advance every night after dinner for the following day and keep them in plastic containers in the refrigerator. Some parents also prepare meals a week in advance and freeze them. Consult the bound volume of newsletters for helpful tips on storing meals and how to wash out greasy containers.

A child may cheat on the therapy because he/she is constantly hungry. If this is the case, it is important that you consult the dietitian so that the dietitian can adjust your child's meals to better alleviate the hunger problem. Another way to prevent your child from cheating while on Ketogenic Therapy is to avoid keeping non-ketogenic foods around the child. You may want to give your child the same foods that you are having whenever possible. For example, feed your child the same chicken and vegetable that you and the rest of the family are having. The only difference is that your child's meal will have added butter or oil compared to the family's meal. By doing so, your child will feel that his or her meals are not completely different from everyone else's meal at the dinner table. Caregivers should educate siblings, friends, and family members about Ketogenic Therapy so that they understand why a child is on the therapy and prevent them from giving extra sweets.

High levels of ketones are generally managed by giving the child small amounts of juice. Consult your dietitian before you do this. The dietitian may also decrease the ketogenic ratio of the diet to lower the urinary ketone level, if this becomes a chronic problem.

Ketone levels are usually low during periods when a child is undergoing stress. Stress can occur when a child has the flu or some other type of infection. The reason why this happens is still not very clear. However, it may be that during this period, the child is less likely to eat ketogenic meals. It may also be that the medications used to treat the flu or infections have some carbohydrates, which can lower the ketone levels. Consult with the dietitian and clinic staff for medications low in carbohydrate fillers to treat your child's secondary illness. If a child has low ketones as a result of having a cold or the flu, caregivers should focus on treating the illness by making sure the child is not dehydrated using sugar free liquids. If vomiting and/or diarrhea continue to persist for 24 hours, consult your physician and the dietitian. In many cases, Pedialyte is recommended to maintain hydration and electrolyte balance.

A limited amount of information is available about the length of time one should stay on Ketogenic Therapy. The time on Ketogenic Therapy varies from one child to another. Some books and publications about Ketogenic Therapy say that most children are on the therapy for approximately two years. However, it is important for the caregiver to remember that the goal is to improve seizure control, and the length of time needed to achieve this will vary among children.

When an individual goes on this therapy, one of the items needed is a scale. It is important that the person preparing the recipes do so with accuracy using a scale. Since there are many types of scales to choose from, selecting one that is right for Ketogenic Therapy may be somewhat difficult. It is important to speak to your dietitian and ask yourself the following questions when you are selecting a scale:

• What is the scale's readability? Does this scale measure to at least a tenth of a gram?
• What is the scale's weighing capacity?
• How durable are the parts? This is important because you will use it on a daily basis.
• How much can I afford to spend?
• What special features does this scale have compared to other scales?

Shands Children's Hospital uses the Ohaus Scout Balance model SC4010 during the hospital initiation because it has a weighing capacity of 400 grams, measures to a tenth of a gram, and has taring capability and auto calibration. It also comes with standard features such as a weigh hook, calibration mass, and 120VAC, 50/60Hz adapter. This model costs approximately $150.00. Please note that the scale price is subject to change. Let your Ketogenic Therapy Team know if there will be any problems getting a scale.

Ketogenic meals should be administered at specific times throughout the day. By enforcing a consistent feeding schedule, you can help control various factors such as hunger and ketone levels. If necessary the dietitian can add in snacks for your child.

Clinic visits at Shands Children's Hospital are scheduled at one month, three months, six months, nine months, and twelve months after the initiation. After being on Ketogenic Therapy for twelve months, clinic visits are then scheduled every four months.

Ketogenic meals are generally prescribed with specific calorie, fat, carbohydrate, and protein amounts and administered three times a day with or without snacks. However, the number of meals prescribed per day can vary from one individual to another. Some children have better seizure control on 3 meals and 1 or 2 snacks per day meal pattern, while others have better seizure control on a 4 meals per day meal pattern.