**9. Diet**

All children with cardiomyopathy should follow a healthy diet. Certain types of cardiomy‐ opathy are associated with an inability to digest certain types of food, and in these cases, a special diet is developed in consultation with metabolic specialists. In children with the dilated subtype of cardiomyopathy and heart failure, a low salt diet is recommended to avoid fluid retention. Some children with heart failure may not grow well. In these cases, a diet that increases calories is recommended. Children who are taking some medications may have low levels of magnesium or potassium and a diet that has a higher amount of one or both of these two electrolytes may be recommended. Some children with severe heart failure can retain extra body fluid, and it may be necessary to limit the amount that a child can drink to prevent fluid from accumulating in the lungs.

#### **10. Long term prognosis**

The long-term outlook of pediatric cardiomyopathy continues to be unpredictable because it occurs with such a wide spectrum of severity and outcome. Even if a child has a family history of the disease, the degree to which he or she is affected can vary considerably from his/her parents or siblings. The overall prognosis for a child also depends on the type of cardiomy‐ opathy and the stage the disease is first diagnosed. Although there is no cure for the disease, symptoms and complications can be managed and controlled with regular monitoring. Some children will stabilize with treatment and lead a relatively normal lifewith fewphysical activity restrictions. Other children with a more serious form of cardiomyopathy may face more limitations, need specialized care and encounter minor developmental delays. Occasionally children with certain types of cardiomyopathy do improve, but the majority do not show any recovery in heart function. For the most severe cases, a heart transplant may be necessary. Children diagnosed with DCM or RCM are more likely to require a transplant; it is less common with HCM. Post transplant survival continues to improve with two year survival rates at 80 percent and ten-year survival rates near 60 percent. Longer-term survival remains to be determined but is expected to improve with more medical progress and research.

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