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Slow Weight Gain

 
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Question

Regarding 10-month-old male with CdLS. He had a Nissen performed at nine months of age but pediatric surgeon is concerned with lack of weight gain. Recommending placement of g-tube for night feedings. Mom is hesitant. Encouraged mom to seek a consultation with her gastroenterologist. Her general questions are: Is the placement of a g-tube for additional feedings the best way to increase weight gain

Is growth in individuals with CdLS sporadic (in addition to small stature)

When is assistance with weight gain needed? What are the determining factors?

Answer of our experts

The weight-for-height relationship is more important that the weight. It is often hard to get an accurate height due to contractures and lack of cooperation. There are growth charts that look at the weight for a given height. We don't want to make the child fat and too heavy for the parents to lift and care for. We also don't want the child too thin. Malnutrition effects the immune function, making you more likely to get sick, or more severely sick with a given illness. It also negatively impacts tissue-healing, etc

When recommending supplemental feeding, it is important to see what fits in the child's life best. If they are active in the day and eat some by mouth, I often use night drip feeds because children aren't tied to a pump during the day and feeding time can be social and fun rather than hitting your head against the wall in a fight to get the calories in. I start the drip when the child goes to bed and run it as fast as I can so the parents can turn it off and forget about it and the child can wake up hungry. If the child eats almost nothing by mouth and doesn't move around during the day, a day drip or bolus feed may work better

G-tubes are probably the easiest feeding tube to use

CP/TK 7-13-10

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Find other pages that share the same topic as this page Growth in Childhood 14 Feeding and Dental Difficulties 47 Feeding and Dental Difficulties 1 Cognitive and behavioural characteristics in CdLS 1 Cognitive and behavioural characteristics in CdLS 9

Recommendation(s)

Growth in Childhood

R11
The growth of every child with CdLS should be monitored by using CdLS-specific growth charts.

Recommendation(s)

Feeding and Dental Difficulties

R12
In every CdLS individual with prolonged and marked feeding difficulties, the multidisciplinary assessment (from healthcare workers across many disciplines) should consider (temporary) placement of a gastrostomy (surgical opening through the abdomen into the stomach) as a supplement to oral feeding.
R13
In individuals with CdLS who have recurrent respiratory infections, reflux and/or aspiration (breathing foreign objects into airways) should be ruled out.
R14
The palate should be closely examined at diagnosis. In case of symptoms of a (submucous) cleft palate, referral for specialist assessment is indicated.
R15
Dental assessment and cleaning should take place regularly; a more thorough dental examination or treatment under anaesthesia may be necessary.

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