Most expectant parents picture their baby being born perfect, and they are eager for their child to begin developing: to start feeding and taking its first steps. When a child is born sick, these preconceived hopes are quickly extinguished. Feeding is essential for a child to intake vital nutrients in order to grow both physically and mentally. It is also a way for parents to bond and spend time with their child.
Children born with congenital heart disease (CHD) may have difficulty in feeding. Studies show that there is a link between malnutrition and a of lack physical development, which affects 40% to 60% of children who suffer from CHD. Typically, in six months a baby doubles in weight, but a baby with CHD does so more slowly. This is because the heart defect affects their energy levels. The heart failure might make it difficult for a child to control feeding and nursing simultaneously, or they could be too tired to eat or feel nauseous. If a newborn baby must have surgery, this will most probably interrupt nursing which will leave the child at a disadvantage because the oral reflex is not active. In older children, previous experiences with feeding tubes might affect their willingness to feed, and typically, malnourished children do not feel hungry.
If the feeding problems eventually go away as the child grows, then the repercussions are usually nothing to worry about. However, if the child continues to have problems, they risk becoming malnourished. This can lead to the delay of the maturity of the gastrointestinal tract. Heart failure may also cause oedema in the intestines or the inability to coordinate swallowing and breathing. One of the best options to correct this problem is surgery, which will allow the child to grow, and gain weight and height. Some of the more complex heart failure cases may require multiple surgeries that can cause feeding problems for many years.
Babies are either breast-fed or bottle-fed, with some requiring tube feeding. When a child cannot be breast-fed due to surgeries, then the mother must pump milk from her breast every 12 to 24 hours in order to maintain the milk flow. Breast-feeding is less strenuous than bottle-feeding for the child because it is easier to control swallowing, breathing and sucking whilst breast-feeding.
Parents sometimes worry that their baby is not ingesting enough milk. Typically, if a baby is fed 8 to 12 times a day and their nappy is changed 6 to 8 times a day, then they are probably getting enough milk. Gulping noises indicate that the baby is latching on to the breast correctly. If the baby is being bottle-fed then the best type of formula to use should be talked over with a pediatric dietician or doctor. Any nursing questions should be asked when visiting a consultant or nurse.
Normally, solid food is introduced into the baby’s diet at 6 months old. The consistency is gradually changed from smooth to lumpy. The type of food, the volume and the consistency should be varied, but portions should be small and served frequently.
Some children with congenital heart disease need extra nutrition via a nastrogastric tube, which is a tube passed through the nose down to the stomach. If the child requires assisted feeding for along time, then a gastrostomy tube (GT) or jejeunostomy tube (JT) are used. The GT is surgically inserted into the stomach and the JT is surgically inserted into the intestines. With regards to babies that are tube fed, oral feeding is still essential because the taste buds must be stimulated in order to encourage the oral motor function.
Digoxin or Furosemide is usually given to children with heart failure in order to control it. For babies it is administered through the mouth with a dropper. The medicine should never be mixed into the formula. If the baby vomits do not attempt give the medicine again. Any unusual side effects should be noted and discussed with a doctor.
Reluctance to Eat
After surgery, some children are still not interested in eating. They may be uninterested because their oral motor functions lack stimulation. This is why they must practice physically eating. A speech therapist may be able to help in this case.
How To Encourage Appetite
Children who have been tube fed for a long time can have trouble beginning to eat with their mouths. Newborns have a great ability to use most of their senses. They can feel, smell and taste to find food in order to survive. It is very important for a child to discover their appetite. Parents must talk to their child in a way that is stimulating and that describes what is happening. The speech should be firm, not to let the child dominate and refuse to eat. The focus must be on the food, so if the child is not concentrating, they must be shown that eating is about enjoying food and being with family. Patterns of the child’s food preference should be noted, yet they should not be allowed to stick to only a small number of foods. If the child tries a food but does not like it, they should not be forced to eat it. Instead, an alternative should be found, in order to keep exploring new flavours.
Some children connote eating to anxiety. If this is the case, changing the setting of the meal might help. The meal should be relaxing, without the disturbance of many people. It is good to serve small portions, so the child can see that they consumed a ‘plateful’ of food.
Seek Help from the Dietician
Do not feel reluctant to ask for help from a nurse or dietician. They can help you the best when it comes to providing sufficient nourishment for your child. A child with CHD needs many more calories than the average child. The way in which the food is presented is also important. Small portions should be given to make the child feel like they have accomplished something once they finish their plate.
The Psychology of Eating
Eating is symbolic; during a festivity food is always present, families eat together, when a mother feeds her newborn child it brings them closer. Food represents the positive aspects of life. Our emotions are connected to eating. When a child does not want to eat, the parent can feel like they have failed their child. If the child is too sick and weak to eat, the parent can feel worried. All this may result in feelings of frustration, which can further be aggravated by tiredness, insecurity and stress. To avoid this, parents should look at their situation from all angles: nutritional, speech therapy, medicinal, psychological.
Many children with CHD have teeth that are in poorer condition than those of other children. Excessive vomiting or eating, sucrose in their medicine and diuretics can all affect the teeth’s health. Therefore, good dental hygiene is important. Older children with CHD who have a lot of energy need to eat more, so again, good dental hygiene is important.