Author: Sharon Wallace, RD, CSP, CNSD, LDN
TJ is a 1 year -old little boy who suffered a severe closed-head injury from a car accident. Before the accident, he was developing normally before the accident, but now had significant developmental delay and a seizure disorder. He was fed through gastrostomy feeding tube (G-tube), had poor vision and poor control of his upper body.
The nutritionist was asked to see him because he had been gaining weight very rapidly since his G-tube had been placed 3 months before. He had been a ?chubby? baby, but family members were concerned that he was growing out of his clothes very quickly. He now lived with his grandmother (his parents passed away at the accident scene), and she was very worried that he was getting too heavy for her to lift him from the bed to his chair.
Initially, his doctor had not planned to call the nutritionist because TJ plotted very well on his growth chart, and he felt he was receiving enough calories. However, grandmother persisted, and the doctor contacted the nutritionist.
Growth Values: Weight: 24 pounds (50-75th% for age on the growth chart) Height: 30 inches (also 50-75th% on the chart)
Weight for Height: 90th% on the chart
A tricep-skinfold measurement was taken on his right arm to determine a rough estimate of his body fat
Feeding Schedule: G-tube feedings of Kindercal (a 30 calorie per ounce nutrition supplement for children) given at 50 cc per hour for 12 hours overnight plus three 4 ounce bolus feedings (a feeding given at one time) during the day. He was not taking anything by mouth when the nutritionist first saw him. This regimen provided 960 calories per day (about 96 calories per kilogram).
After talking with both the doctor and TJ?s grandmother, it was decided to decrease the calories he received by about 15-20% to see if this would slow the rate of weight gain some. His feedings were kept at the same rate, but the hours overnight were decreased from 12 hours to 8 hours. This pleased his grandmother, as it allowed her to get him up earlier without having to worry about the feeding pump or about him vomiting. A consultation for a feeding and swallowing evaluation was set-up, with the hope that he would be able to take some of his nutrition by mouth over time and not need to use the G-tube as his only nutrition source.
The nutritionist saw TJ 3 months later at a follow-up visit. His rate of growth had slowed and his weight for height curve on the growth chart was leveling out. He was working regularly with the speech therapist on feeding, and was taking up to 3 jars per day of pureed baby foods. One of the bolus daytime G-tube feedings had been cut out to see if this increased his appetite. The goal was to not use the tube during the day to allow him eat a puree diet and use the tube overnight to give whatever calories he still needed.
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