Babies First Bites: Weaning Diet for an Underweight Paediatric Patient

Gursharon Gill1, Charmaine Lavinia1
1. Division of Nutrition & Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur

Assessment: MHS, a 7-month old, male infant was referred to the outpatient diet clinic for poor weight gain. He was born full term with low-birth weight at 2.4kg, he had poor growth velocity starting from 4 months old. Current weight and height were 6.1kg (below the 5th percentile) and 67 cm (at the 25th percentile). He was fed with milk formula and solid food and had normal bowel output. Patients appetite decreased during sick days and he only drank milk and ate very little solids. Patient consumed 3 main meals, 5-6 bottle feeds/day (2 scoops in 90ml water), breast feeds on demand. His total energy intake was ≈370 kcal/day, meeting 60% of energy requirement (615kcal/d). MHSs mother had poor knowledge on the standard dilution of formula (Lactogen 2) and appropriate portion of rice for patient.

Diagnosis: Inadequate energy intake related to food and nutrition related knowledge deficit concerning appropriate diet (milk and solids) for age as evidenced by patients current intake meeting 60% of recommendation

Intervention: The goal of the intervention was to achieve adequate energy intake for optimum growth. Patient was prescribed with 615 kcal,10g of protein and 610 mL of fluid. Patients mother was educated on correct standard dilution of formula, increased scoops of follow-up formula, methods to increase energy density of food. Pamphlet on calorie dense sample recipes was given and advised to continue with current meal and milk frequency.

Monitoring and Evaluation: MHS gained 0.4kg in 1-month (6.5kg), length: 69 cmachieving growth velocity for his age. Energy intake met 100% of requirement. Mother had increased usage of oil from 1/4tsp to 2 tsp and increased rice portion from 1 tbsp to 2 tbsp for lunch and dinner. The patient will be monitored on growth, development and dietary intake.