February 18, 2010

Yesterday, Kiera had an appointment at the feeding clinic of the Rehabilitation Center for Children in Winnipeg.  The dietitian and the public health nurse on Kiera's case are very pleased with Kiera's progress.  We, on the other hand, have been frustrated with what seems to be a lack of progress.  Both professionals told us that Kiera's weight gain has been great and, although Kiera has reached a plateau on the amount of liquid she takes from the bottle (only consuming about 30% by bottle and the rest is tube-fed).  The dietitian suggested that we could start to challenge Kiera.

Our first goal for her is to drop one nighttime feeding and then increase the size of her feedings during the day.  Unfortunately, Kiera has been very cranky at night as she is adjusting to a mix of 50-50 formula/breast milk so she has been crying every hour during the night for the past few nights.  The sleepless nights make for very interesting mornings as many of you with children can appreciate.  There were a number of spills this morning but the worst was that Kiera's feeding tube hooked onto something and nearly came out.  Of course, that was extremely uncomfortable for her and sent her into a major crying spell.  Fortunately, I just needed to push the tube back in about 4 cm and resumed feeding her.

We were also told that the mucous problems that Kiera is experiencing is common in children with both nasograstric (NG) and gastric (G) tubes.  There is no doubt that the NG tubes cause some discomfort but Kiera is likely having difficulty swallowing mucous and will need to learn to do so more efficiently.  Surprisingly, this morning, Kiera did not produce the gurgle sound when she was quiet and calm.  We are hoping that this is a sign of more positive things to come (i.e., increased bottle feeding).


Another thing that is likely interfering with Kiera's desire to bottle feed is gastric reflux.  Gastric reflux occurs in approximately 75% of patients that have the repair of esophageal atresia.  Although Kiera is not vomiting any of her feeds (unless she is mucousy), she is likely feeling some discomfort from food traveling back up her esophagus during feeding.  The next step in weaning Kiera off of the NG tube may be to introduce medication to make feeding more comfortable.

Overall, Kiera is doing well.  We are to keep doing what we are doing and enjoy our little baby.