Dear Parent,
Thank you for your consult at DoctorSpring.com. I understand your concerns. But, I need to understand a few things before I can be of any help.
1. Why is your son on feeding tube? Did he have any neurological problems such as perinatal asphyxia, developmental delay, etc? What sort of a feeding tube does he have - a gastrostomy or duodenostomy or nasogastric tube?
2. What formula is he on? What are his growth parameters and does he fail to thrive? How is his motor, fine motor and language developments?
You basically have noticed that his gut motility has reduced over the last three days.. The causes could be any of the following:
a. Electrolyte imbalances such as hypokalemia - (Get a serum electrolyte testing to rule it out)
b. Paralytic ileum due to drugs/ medications that the child may be on.. Simple cough and cold medications may have anti-cholinergic effect that would decrease gut motility.
c. Intestinal obstruction secondary to adhesions or congenital problems such as malrotation or volvulus or other causes
d. Septic ileum due to an underlying infection and impaired gut motility. The gut could also be the source of infection.
Hope this helps, please feel free to discuss further.
Regards
Dr. Saptharishi L G
Dr. Saptharishi L G
MBBS, MD (Pediatrics), PGDCRL
Division of Pediatric Critical Care
Dept. of Pediatrics
Advanced Pediatrics Center
Post-Graduate Institute of Medical Education & Research
Patient replied :
Thank you so much for responding.
Here are the answers to your questions:
1. Why is your son on feeding tube? Did he have any neurological problems such as perinatal asphyxia, developmental delay, etc? What sort of a feeding tube does he have - a gastrostomy or duodenostomy or nasogastric tube?
His feeding tube is because he was diagnosed failure to thrive at 6 months due to severe oral aversion. He does not have any neurological problems we know of. He has a gastrostomy tube. He does not have any other diagnosis and is not on any medications right now.
2. What formula is he on? What are his growth parameters and does he fail to thrive? How is his motor, fine motor and language developments?
He is on Elecare Jr 24 calories 5 ounces every 3 hours. He is doing really well and is catching up. He was an IUGR baby and is only now starting to stand unassisted.
You basically have noticed that his gut motility has reduced over the last three days.. The causes could be any of the following:
a. Electrolyte imbalances such as hypokalemia - (Get a serum electrolyte testing to rule it out)
What would be the treatment in this case? I have started giving him more pedialyte for electrolytes.
b. Paralytic ileum due to drugs/ medications that the child may be on.. Simple cough and cold medications may have anti-cholinergic effect that would decrease gut motility.
c. Intestinal obstruction secondary to adhesions or congenital problems such as malrotation or volvulus or other causes
d. Septic ileum due to an underlying infection and impaired gut motility. The gut could also be the source of infection.
He does not have fever or cold or diarrhea right now and seems to be is excellent spirits. Do you still think there could be an infection in his gut?
Hope this helps, please feel free to discuss further.
Hello,
Dear parent,
Thank you for your detailed response. Really appreciate it.
An infant who is not thriving well at 6 months of age and has severe oral aversion must be evaluated for the cause. Why would an otherwise normal baby have an aversion to feeding? Was there gastroesophageal reflux? Was there any swallowing difficulty?
And at 17 months of age, he definitely seems to have a developmental delay. His failure to thrive and difficulty in swallowing seems to be due to an underlying neurological problem. He needs to be seen by a pediatrician and evaluates for all the underlying causes. He also needs to undergo a neurological evaluation. This would be a must.
Secondly, I was just discussing the causes for decreased gut motility. Please do not empirically give Pedialyte and that too in excessive doses.
Please feel free to discuss regarding any other concern that you may have.
Regards
Dr. Saptharishi L G
Patient replied :
Hi,
His oral aversion was because he was on oxygen when he was born - he does not like anything near his mouth and has only just started letting me put my finger in his mouth. Recently he is seeing other kids in his daycare eat and he is showing interest in eating food. He came home drinking formula. He had no diagnosis of any reflux since he never threw up or seemed to be in any distress. He also had an MRI which came back normal. He has had NO difficulty swallowing milk. He never had any aspiration problems. Please remember that he is 17 months actual age which is 15 months adjusted and he is actually treated as a 15 month old by the pediatricians here in the USA. He has physical delays but he was born IUGR and is still catching up.
We also had him evaluated for delays. He actually tested advanced/at his age for most things except for his physical milestones.
My only concern is the sudden start of delay in emptying his tummy. It was not gradual and he is just not digesting food as fast. Since he is happy and active his pediatric GI says she is not concerned and they don't want to do anything. He does seem to have constipation. He is not going as regularly as he used to. Not sure if this is causing any issues. Do you think there are any tests his GI doctor can do to root cause his issues? I want to be aware of our options before our next appointment.
Thanks!
Dear parent,
Thank you for the reply. It has helped me understand the situation better.
The corrected age is 15 months for sure but, even then the motor delay is significant. If the other milestones are appropriate, then we need to look at why the child is having a motor sectoral delay alone.
This time when you visit your pediatrician ask him/ her as to why your child is having a motor delay? IUGR has nothing to do with developmental milestones. It only affects the weight and height gain. It is also important to rule out rickets/ osteopenia of prematurity and hypothyroidism in such children.
Regarding the delayed emptying of his tummy, we do not need to worry much as long as the child is otherwise well. At this point, no testing is required. We would rather wait and watch.
Regards
Dr. Saptharishi L G
DM (Pediatric Critical Care) Senior Resident
MBBS, MD (Pediatrics), PGDCRL