Pancreatic enzymes help kids with cystic fibrosis (CF) digest food so their bodies can get energy and grow. Give your child the enzymes exactly as prescribed.

• Your child should take enzymes right before each meal or snack. For babies, this includes every breastfeeding or bottle-feeding.
• Follow the health care provider's directions for how much to give your child.
• If your child gets feedings through a tube, ask the health care provider when to give the enzymes.
• Your child does not need to take enzymes when snacking on foods that have no fats or proteins. These foods include:
  • fruit and fruit snacks
  • juice, soft drinks, and sports drinks
  • tea or coffee without milk or cream
  • hard candy
  • freezer pops and flavored ice that do not contain milk, nuts, or gelatin
    Note: Foods with no fats or proteins are often low in calories and nutrition. It's better for your child to eat a well-balanced diet and take enzymes than to eat too many of these foods.
• Your child should swallow the capsules whole with water or another drink.
• If your child cannot swallow the capsules whole:
  • Break the capsules open and mix the beads with a small amount of acidic, smooth food such as applesauce or puréed fruit. Never sprinkle them on other foods. Never mix enzymes into breast milk, formula, or milk.
  • After you mix the beads with the food, give it to your child right away. Do not store for later.
  • Your child should not chew the beads. After your child takes the enzymes, check his or her mouth right away. Beads that stay stuck to the inside of the mouth can cause sores. Have your child drink liquids (or nurse or bottle-feed your baby) so he or she swallows all the beads.
• Don't change the brand or dose of enzymes without asking your child's health care provider.
• Store enzymes at room temperature. Enzymes may not work well if they get very hot or cold, so never leave them in the car or anywhere the temperature changes a lot.
• For meals away from home, be sure your child has enzymes on hand and knows how to use them if you won't be there.

Your child:

• has trouble taking enzymes
• gets mouth sores
• loses weight or doesn't gain weight as expected
• has diarrhea
• has mucus or oil in poop
• has belly pain
• is more gassy than usual
• has constipation (hard, difficult-to-pass poops)
• throws up a lot

Why do kids with CF need to take pancreatic enzymes? The pancreas is a gland in the belly. It makes enzymes that help the body break down food. Enzymes move from the pancreas to the small intestine through a tiny tube called the pancreatic duct. In most kids with CF, thick mucus blocks the pancreatic duct. The enzymes made by the pancreas can't get through and break down the food in the small intestine.

When the pancreatic enzymes are taken by mouth, they go into the stomach and then directly into the small intestine where they can digest food. They don't need to pass through the pancreatic duct. 

What happens if someone doesn't have enough pancreatic enzymes? Kids with CF who don't have enough enzymes can have:

• trouble gaining weight
• belly pain
• bulky, bad-smelling bowel movements (poop) 
• bloating 
• gas

How do parents know the right dose of enzymes? Parents and health care providers work together to find the right dose of enzymes for a child. If your child still has belly pain; trouble gaining weight; bulky, bad-smelling poops; bloating; and gas, the dose of enzymes will be changed. The dose will increase often, especially in the first few years of life, as your child grows bigger.