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Case Study: Elizabeth J |
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CASE STUDY: Elizabeth J
Date of Birth: July 2, 1986
Birth Weight: 4.225g (9.6oz) (normal delivery)
Discharge Weight: n/a
Infant's particular difficulty with oral feeding
Elizabeth was born with a hare lip and cleft palate.
The method of feeding prior to prototype feeder:
Mrs J breastfed for a day or two but Elizabeth was unable to fix. She commenced bottle feeding on Cow & Gate Premium in hospital and was managing to take 50 - 57-mls per feed.
On her discharge home Mrs J commenced a feeding chart enabling her and community staff to keep a record of Elizabeth's daily intake. From 7th - 11th July she took the following amounts:-
7 feeds - total 415mls
6 feeds - total 393mls
6 feeds - total 365mls
6 feeds - total 338mls
6 feeds - total 338mls.
Elizabeth had been feeding via soft hospital teats supplied by the midwife but she was taking only small feeds and also becoming very tired. She had been seen by the orthodontist and supplied with a plastic palate. Elizabeth often pushed this out of her mouth but Mrs J was easily able to replace it.
On examination Elizabeth was a sturdy baby but still had not regained her birth weight of 9lb 6oz. On the ninth day she weighed 9lb 0oz. Her muscle tone and reflexes were good. Eyes, mouth and umbilicus were clean. Scriver and hyperthyroid consent was obtained and blood samples submitted.
Mrs J was coping very well but concerned regarding Elizabeth's weight and time taken to feed. She was hoping to obtain a prototype teat for babies with hare lip and cleft palate from Mrs Haberman.
12/7/86 Prototype teat obtained and Elizabeth commenced occasional feed as mother had only one special teat to sterilise. Elizabeth had been taking feeds from 30-80mls but a marked improvement was noted on commencing with the prototype teat and she was now able to manage a feed of 138mls.
From 12th to 19th July 1986 a gradual increase of feeds was noted.
6 feeds - total 368mls
5 feeds - total 453mls
6 feeds - total 440mls
6 feeds - total 445mls
7 feeds - total 470mls
5 feeds - total 370mls.
From July 19, 1986 the prototype teat was used at every feed and Elizabeth took 530mls of milk. When weighed on July 21, 1986, Elizabeth had regained her birth weight of 9lb 6oz. From then on Mrs J became more confident in using the new teat and Elizabeth was seen to feed very well. There was a noted improvement in her daily milk intake.
7 feeds - total 545mls
6 feeds - total 590mls
6 feeds - total 590mls
8 feeds - total 670mls
6 feeds - total 680mls
6 feeds - total 595mls
6 feeds - total 565mls
6 feeds - total 660mls
6 feeds - total 600mls
7 feeds - total 740mls
6 feeds - total 560mls.
Changed to Cow & Gate Plus:
7 feeds - total 700mls.
(Further impression taken by Orthodontist for new plastic palate)
6 feeds - total 685mls
6 feeds - total 655mls
6 feeds - total 710mls
6 feeds - total 655mls
6 feeds - total 600mls
6 feeds - total 625mls.
Elizabeth was now sleeping long periods at night and on August 14, 1986 weighed 11lb 6oz and her six week development assessment was satisfactory.
By September 15, 1986 Elizabeth was taking 230mls feeds and approximately 1000mls per day. It was decided to commence her on gluten free baby rice and introduce her gradually to a plastic weaning spoon.
On October 13, 1986 Elizabeth was admitted to hospital. She had an operation for repair of hare lip on October 15, 1986 and was discharged home on October 22, 1986.
After her return from hospital, she took a while to settle as her arms were splinted and also the Consultant thought she was teething but she continued to feed well from the prototype feeder.
Elizabeth is now nine months old. She is a happy, alert baby. She enjoys her breakfast and has cereal followed by an 8oz (240mls) bottle of milk taken via the prototype feeder. She has another feed from her feeder of 8oz (240mls) at night-time.
Elizabeth is sometimes in the care of grandmother who has been able to sterilise and assemble teats without any problems.
Health Visitor's point of view:
The only problem I considered was that the teat had no cover. Mrs J has overcome the problem of sterilisation by having a small portable Tupperware box in which she keeps the teat in a sterilising solution. I feel that the teat has given Mrs J the confidence to feed Elizabeth since she obtained it when Elizabeth was seventeen days old.
Elizabeth is due to have a repair of cleft palate between the age of eleven and fourteen months. I have encouraged Mrs J to attempt to give Elizabeth a cup but mother says at present she is much happier with the feeder. |
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