From the Guidelines
The best course of action for this 17-month-old male with history of prematurity and low weight is a comprehensive nutritional assessment by a pediatric dietitian, along with evaluation by a pediatric gastroenterologist. The child should discontinue the use of adult Ensure and instead receive age-appropriate formula, preferably a specialized formula for catch-up growth, while transitioning to nutrient-dense solid foods appropriate for his developmental abilities, as recommended by the guidelines for pediatric health behavior 1. Caloric density of his diet should be increased by adding medium-chain triglyceride (MCT) oil or similar caloric supplements to his foods, starting with 1/2 teaspoon per meal and gradually increasing as tolerated. Parents should track daily intake, including volumes consumed and any feeding difficulties. Additionally, the child needs a thorough medical evaluation to rule out underlying conditions that might contribute to poor weight gain, such as malabsorption disorders, gastroesophageal reflux disease, or other chronic illnesses, as emphasized by the importance of identifying causes for poor growth in the WHO growth charts 1. This approach addresses both immediate nutritional needs while investigating potential medical causes for growth concerns, which is particularly important in former premature infants who often have higher caloric requirements and may have developed feeding aversions or gastrointestinal complications. Key considerations include:
- Dietary intake: 3-4 meals and 1-2 snacks per day offered every 90-120 min, with emphasis on nutrient-dense food choices from each food group, as outlined in the guidelines for toddlerhood 1
- Sleep and physical activity: ensuring adequate sleep and physical activity, with ≥ 180 min spent in a variety of activities at any intensity spread throughout the day, including energetic play, as recommended for toddlers 1
- Restrained time: limiting restrained time to ≤ 1 h at a time, such as stroller, car seat, or highchair, to promote interactive activities and floor-based play 1.
From the Research
Assessment and Recommendations
The patient's low weight for corrected age despite reportedly adequate intake requires a comprehensive nutritional assessment. The following steps can be taken:
- Conduct a detailed medical history, including the patient's history of prematurity and any underlying medical conditions 2
- Perform a nutritional history, including dietary intake, to identify any potential nutritional deficiencies or imbalances 2, 3
- Conduct anthropometric measurements, such as weight, length, and head circumference, to assess the patient's growth and development 2, 4
- Consider biochemical tests of nutritional status to identify any underlying nutritional deficiencies 2
Nutritional Support
The patient is currently being supplemented with Ensure and blended food, which may not be sufficient to support optimal growth and development. The following options can be considered:
- Consult with a pediatric gastroenterologist or a registered dietitian to develop a personalized nutrition plan 5, 6
- Consider alternative nutritional supplements or formulas that may be more suitable for the patient's needs 2, 3
- Monitor the patient's growth and development closely and adjust the nutrition plan as needed 2, 4
Ongoing Care
The patient's care should be transferred completely to the pediatrician in Lubbock, and regular follow-up appointments should be scheduled to monitor the patient's growth and development. The pediatrician should: