Abstract
Aims & Objectives: The nutrition management of burn injury is important to sustain growth in children. Prolonged hypermetabolic state in some children may result in stagnant growth. Optimizing nutritional intake for children with severe burn injury can be challenging as elevated requirements from metabolic alterations can persist up to 2 years post-burn. We present a 1 year 11 month old Chinese boy with persistent growth failure 3 years post-burn injury and the challenges faced to optimize growth. Methods The child was presented with 25% TBSA, partial to full thickness burn over left and right anterior shoulders, anterior trunk and chin. Nasogastric tube was inserted for nutrition support upon admission. Despite optimal nutrition delivery, absorption of nutrients was likely impacted by prolonged feed intolerance (diarrhoea) from stress response, which resulted in 1.7kg (13%) weight loss over 1 month. Oral intake was commenced 1 month post-burn injury and nasogastric tube was removed before establishing adequate intake. Oral intake was variable and difficult due to fussy eating behaviours. Adjustment of oral nutrition supplement attenuated the weight loss. The cumulative weight loss at discharge was 1kg (7.7%). During rehabilitative phase, the challenge to meet nutritional needs was complicated by multiple teeth extraction for cavities, persistent fussy eating behaviours and permissive parenting style. Results Weight faltered from 90%ile to 10–25%ile over 3 years, however height continued to track along 3–10%ile. Conclusions Continuous monitoring and re-assessment of nutritional status are essential to support adequate growth. Nutrition support may be required for an extended period to optimize intake in cases of difficult feeding.
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