Ethan is an 8-month-old male who was born vaginally at 37 weeks’ gestational age. The pregnancy and delivery were uncomplicated. This was his mother’s second pregnancy. Ethan’s brother, who is now 4 years old, was born prematurely at 27 weeks’ gestational age. Ethan’s mother is concerned that Ethan is underweight and not eating enough food. Ethan was born small for gestational age and weighed less than 5 lb at birth. His weight and length percentiles have since increased: His weight has followed the 5th percentile for age and his length has followed roughly the 50th percentile for age since 2 months of age. His weight-forlength has consistently been between the 2nd and 5th percentiles. Ethan’s mother offers him Similac Advance formula mixed at standard dilution (1 scoop of powder mixed with 2 oz. water) 6 to 8 times daily. Ethan’s mother has a hard time reading Ethan’s hunger cues. She is so concerned about his growth that she offers him a bottle frequently, every 1½ to 2 hours. He consumes 26 to 30 ounces (780 to 900 ml) of formula daily. She offers him homemade purées of fruits or vegetables mixed with grains twice a day; he eats a couple of tablespoons at a time. When she feels he has not eaten enough food, she offers him a bottle.
Nutrition Diagnostic Statement
Food- and nutrition-related knowledge deficit related to age-inappropriate frequency of formula feeding as evidenced by formula offered every 1½ to 2 hours
Nutrition Care Questions
1. What additional information is needed to get an accurate assessment of this infant’s intake?
2. When you assess Ethan’s growth, what are your expectations for his growth rate? Do you have concerns about his rate of growth?
3. What is a typical eating pattern for an infant Ethan’s age? Is Ethan’s eating pattern appropriate? Comment on his food and formula intake.
4. How would you assess Ethan’s readiness for more textured foods? For self-feeding?
Other Common Nutrition Diagnostic Statements in Infants:
Inadequate energy intake related to mother diluting formula to save money as evidenced by slowed growth pattern and small head circumference Underweight related to dietary restrictions to address multiple food allergies without medical supervision as evidenced by decrease of weightfor-length from the 50th percentile to the 25th percentile over 1 month Inadequate vitamin B12 intake related to exclusively breast-fed by vegan mother without vitamin supplementation as evidenced by serum B12 levels below normal range and lethargy Excessive oral intake related to using foods to soothe baby as evidenced by weight-for-length at the 95th percentile for age