The ketogenic diet may be a treatment option for kids with epilepsy who are not successfully treated with medication or are not candidates for surgery. This is a very high-fat diet that has been used for almost 100 years to treat epilepsy. Approximately two-thirds of children have a greater than 50% reduction in seizures, and up to 25% can become seizure free.

The Dietary Treatment Program in Children's Hospital of Philadelphia's Neuroscience Center takes a team approach to establishing a child's ketogenic diet plan, with expert input from neurologists, dietitians, skilled nursing staff and social workers. If your child is not already under the care of a CHOP neurologist and you would like to explore the possibility of the ketogenic diet for epilepsy, please contact us for a second opinion consultation.

What is a ketogenic diet?

The ketogenic diet is very high in fat (about 90% of calories come from fat), provides adequate protein, and includes very small amounts of carbohydrates. This macronutrient composition changes the metabolism of the body. Carbohydrates are no longer used to produce energy. Instead, the body breaks down fat to make ketones, which then provide energy to the brain and the rest of the body. This is a metabolic state called ketosis.

When the ketogenic diet is started, your child will be admitted to the hospital to make sure they tolerate the food and safely convert into ketosis. The ketogenic diet for epilepsy is initiated gradually over the course of four to five days as an inpatient, without the need for fasting. During this time, families learn all the details about diet management. Parents and caregivers can take cooking classes in our Keto Kitchen, where our experts can teach you how to make a high-fat meal delicious. Our team has also recently published The Ketogenic Diet Cookbook for easy access to our most popular recipes. 

Your child’s nurse may also teach you how to check your child's urine and blood for ketones and glucose. The dietitian will determine how much fat, protein, and carbohydrates your child is allowed, and how the diet will be eaten during the course of the day. All food that your child will consume will be weighed on a gram food scale to the tenth (0.1) of a gram. Vitamin and mineral supplements are required to keep your child healthy while on the diet. Our dietician will tell you what vitamins your child should use.

Medications and other products like toothpaste and mouthwash contain varying amounts of carbohydrates. It is important to choose products containing the lowest amounts of carbohydrates when your child is on the ketogenic diet. Hidden carbohydrates in these products can interfere with the positive results of the diet. The Dietary Treatment Program team will give you a list of medications and other “keto-friendly” products.

Children usually stay on the diet for about two years. They are then slowly weaned off of the diet and changed back to a regular diet. Some families can use the diet for a shorter period, while others stay on the diet for life. We currently have many children in our program who have been on the ketogenic diet for more than 15 years. Treatment will depend on your child’s unique condition.