Feeding children older than 6 months with severe cleft palat

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Anonymous 106

Normal user

9 Mar 2009, 03:47

In one of the refugee camps I am supporting the health agency nurse has 2 cases of children with severe cleft palat's enrolled in SFP that can not take solid food. They are both older than six months and I have asked the nurse to provide me with their actual ages and more details. One of the children is being fed by nasogastric tube. Due to their older age and developmental needs we are concerned about their nutrient intake. Are there recommended foods/formulas for this type of situation until the children are able to have surgery to improve their condition? We do have Dumex and Carnation products in the area. Any suggestions or recommendations would be greatly appreciated.

Nina Berry

IFE Consultant

Normal user

17 Mar 2009, 23:54

Hi Erika
I see you haven't had any replies. There are complete liquid diets available but they are quite expensive and I imagine they might be quite difficult to procure (much less to ensure on-going supply). Perhaps you could chat to local medical officers in the capital to find out which ones they use. At least one of the companies you mention does an enteral feeding formula. Perhaps you could call their regional offices to find out what they have to offer. I would suggest having a nutritionist look over the contents to ensure that the renal solute loads are suitable for your patients.
Cheers
Nina

Marie McGrath

ENN

Technical expert

22 Mar 2009, 08:43

Dear Erika
It is difficult to respond to individual case situations without knowing all the details, but some things that I would use to consider the way forward, to add to Nina's feedback.
As you mention, surgical intervention for these children is needed - is this available or scheduled? This will make the greatest difference to these infants. What is the current nutritional status of these infants - assuming they are enrolled in SFP because they are moderately malnourished? Is their nutritional status being/continuing to decline (e.g. serial weight measures? This should inform their current management and will have a bearing on what product(s) are used. Is nasogastric feeding being managed at home, how long for, and what are they currently receiving via NG tube at the moment? Have these infants ever managed to breastfeed? Do they both have primary carers responsible for their care?

In terms of products, there are many produced by the companies you mention. Access to a ready to feed paediatric enteral formula would be useful but, as Nina points out, I am guessing impractical. An appropriate breastmilk substitute is another option that would need additional support and resources for careful preparation, storage, and monitoring. It is especially important that naso-gastric tubes are kept clean, and if home feeding then a detailed guide and support for the carers would be needed. A breastmilk substitute should fulfil Codex Alimentarius requirements; http://www.codexalimentarius.net Another 'stop-gap' option would be full fat milk, like animal milks. Infants would need micronutrient supplementation, as many would be limiting. If these infants are malnourished, then therapeutic milk would be indicated and you should refer to the WHO guidance and standard protocols on that.

There are useful resources on the ENNs website: Module 2 on IFE and the Operational Guidance on IFE. Visit www.ennonline.net and follow links.
Some guidance on managing artificially fed infants is included in Module 2 on IFE, Chapter 8. The Operational Guidance on IFE is useful to guide minimising the risk of artificial feeding, including ensuring that any securing and distribution of breastmilk substitutes to infants upholds the provisions of the International Code on Marketing of Breastmilk Substitutes. http://www.ibfan.org/English/resource/who/fullcode.html

Finally, if UNHCR is operating in this camp, then these infants may well fall within their commitment of care. They may be able to help you in procurement?
Sorry that I seem to have given more questions than answers. It would be really useful to let us know how you get on, how and if you manage to resolve this situation - to help others in similar situations.

Best regards
Marie