Nurul ‘Aqilah binti Hasan Ashaari1, Jazlina binti Syahrul1, Zalina Abu Zaid1, Hanim binti Mamat2
1Department Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia
2Hospital Melaka, KKM
A, Boy, Malay, 2 years old, first child and born as full-term baby. Was referred for optimization feeding as he has inability to eat and has poor weight gain. Patient did corrective cleft palate procedure a month ago. Using GMFCS V, feeds orally graph, patient was at <5th percentile on the first visit (5.8kg). In two months, patient’s weight increased 200g and no weight gain reported for another two months. Approximately, five months later, patient’s weight increased 600g. Currently patient is 6.4kg and the graph increased at 10th percentile. Despite multiple visits, patient’s weight increment is not significant as the rate weight gain is approximately 150g per month due to inconsistent intake from solid/milk as it was only given upon patient’s request. Patient had difficulty to eat as his oral and poor motor conditions. Energy intake ranged of 50-70% energy adequacy with 0.6g/kg/BW protein.
Inadequate oral intake related to decreased ability to consume sufficient nutrients as evidenced by diet history (50-70% energy adequacy, 0.6g/kg/bw) and growth chart GMFCS V <10th percentile
Nutritional intervention aims to increase weight of the patient consistently, thus goal was set at minimum realistic target. Using Dorothy (1987), the energy and protein requirement was set at minimum 150kcal/BW (960kcal/d) and 3.0-4.5g/kg/BW respectively. Parents was encouraged to provide high dense energy soft diet with thick consistency due to his current condition as well as increasing strength of formula milk with total estimated 900-1050kcal/d (94-109% adequacy, 4.3g/kgBW protein). Counselling was given to increase motivation for the parents.
Monitoring & Evaluation
Patient’s weight increased 600g in five months (not significant), the graph showed an increment trend from 5th percentile to 10th percentile. We aim for patient to increase 227g per month to maintain consistent weight gain, as well as the adequacy intake.