Nutrition Assessment Client History
Colin is a 21-month-old boy with Down’s syndrome. He was born prematurely (30 weeks of gestation) and was started on gastrostomy tube feeding at 10 days of age because of his poor weight gain and severe gastroesophageal reflux. The poor weight gain was caused by a poor suck, although swallowing was not a problem. He was first seen by a nutritionist in an early intervention program at 4 months of age when he was 22.5 in long and weighed 10 lb 7 oz.
Food/Nutrition-Related History
At 16 months Colin was tube fed Pediasure and started eating table foods. His usual intake is 1 jar of baby food a day along with the tube-feeding formula.
Anthropometric Measurement
s At 4 months of age he was 22.5 in long and weighed 10 lb. 7 oz. At 21 months, height was 28,” weight was 18.5 lb and he was in the 5% for length and weight.
Physical Findings
He is crawling but not yet walking, and he has very limited self-feeding skills. Now at age 21 months his mother’s highest priority is to stop the tube feeding and have Colin continue to grow well. She is concerned about his rate of weight gain. She also is concerned that constipation has become a problem requiring use of the medication lactulose. He also has respiratory problems and extreme hypotonia. Feeding problems identified: Weak suck, and swallow
Hyperactive gag reflex Refusal to drink formula from a bottle or cup due to g-tube Poor appetite Not self-feeding
Nutrition Diagnostic Statements
Tube-fed toddler with caloric intake estimated at 100 kcal per kg. NI-1.4 Self-feeding difficulty related to developmental delays as evidenced by inability to feed himself most foods offered. NB-2.6 Inadequate
Nutrition Intervention
1. Introduction of drinking from a cup with a straw using formula and water.
2. Introduction of soft table foods before gastrostomy feedings.
3. Reduction of size of servings of food offered.
4. Work with occupational therapy in promoting eating of finger foods.
Nutrition Care Questions
1. What would be your approach in working with this mother and the other team members?
2. What do you think would be his nutritional needs, starting with energy?
3. How many ounces of a 30 cal/oz tube-feeding formula would you recommend for Colin to promote weight gain?
4. What steps should be taken to increase his oral intake and decrease the tube feeding?
5. What would you recommend for management of his constipation?intake of baby food and table food. NI-2.1 Refusal to drink his formula or other beverages from a cup. NC-1.1