Case Study: Managing Pediatric Malnutrition with Enteral Nutrition

Patient Profile:

• Name: Baby A (anonymous for confidentiality)
• Age: 2 years
• Sex: Female
• Weight: 7.5 kg (below the 3rd percentile)
• Diagnosis: Severe malnutrition with feeding difficulties due to cerebral palsy
• Presenting Symptoms:
  • Failure to thrive
  • Muscle wasting
  • Difficulty swallowing (dysphagia)
  • Frequent respiratory infections

Background & Initial Assessment

Baby A was referred to a pediatric nutrition clinic by her neurologist due to concerns about weight loss and persistent feeding difficulties. Her mother reported that feeding had become a major struggle. Baby A frequently coughed while eating, took a long time to finish meals, and often refused food altogether.

Upon assessment, the following findings were noted:
✔ Severe protein-energy malnutrition (PEM) – indicated by weight-for-age below the 3rd percentile.
✔ Dysphagia – choking and difficulty swallowing, making oral feeding unsafe.
✔ Delayed developmental milestones – unable to sit without support.

Nutrition Intervention

1. Feeding Route Decision: Enteral Nutrition

Given Baby A’s swallowing difficulties and malnutrition status, a nasogastric tube (NGT) feeding plan was initiated to ensure adequate nutrient intake.

✔ Short-term plan: NGT feeding for stabilization.
✔ Long-term goal: Transition to oral feeding with texture modifications and therapy.

2. Energy & Protein Requirements

Using WHO guidelines for malnourished children:

• Energy Needs: 130 kcal/kg/day → ~975 kcal/day
• Protein Needs: 2.5–3 g/kg/day → ~19 g/day
• Fluids: Adjusted to prevent dehydration or overhydration

Enteral Nutrition Plan

Formula: A high-energy pediatric formula was chosen, fortified with vitamins and minerals.
Feeding Schedule: Continuous feeding via NGT initially, then transition to bolus feeding as tolerated.
Monitoring: Electrolytes, weight gain, and tolerance to feeding.

Outcomes After 6 Weeks

✅ Weight gain: Baby A gained 1.5 kg, reaching 9 kg.
✅ Improved energy levels: More alert and responsive.
✅ Reduction in respiratory infections: Due to safer feeding methods.
✅ Oral feeding trial started: Texture-modified purees introduced with speech therapist guidance.

Key Lessons for Nutritionists & Healthcare Providers

✔ Early nutrition intervention is crucial in pediatric malnutrition cases.
✔ Interdisciplinary collaboration with doctors, speech therapists, and dietitians improves patient outcomes.
✔ Enteral feeding is life-saving when oral feeding is unsafe, but long-term plans should focus on rehabilitation.

Final Thought

Children with feeding difficulties require personalized nutrition care to thrive. If you work with paediatrics, always advocate for early intervention, specialized feeding techniques, and a holistic approach to care!