Pediatric home patient with GI issues

[zeebee14]

I am a home health nurse for a 5 year old that has a GT. When I started with him three years ago, he was on Pediasure for his feeds. He started getting really sick on it, vomiting nearly daily, as well as developing constipation (which I’m sure caused some of the vomiting, he got really backed up). He saw a dietician who recommended that he try Real Food Blends and to stop the Pediasure. The RFB caused him to have several loose stools (not watery diarrhea, just sticky and soft) every day, causing serious diaper rash. Pediasure got added back in at least one time a day just to help with the BMs. After adding that back in, he started throwing up again, not to mention the BMs didn’t really slow down. Recently, he went to a different dietician and she recommended (based on his mom’s preference) that he go on the Kate Farms pediatric 1.2cal formula. He has now been on that for about a week, and the BMs are just as bad and he’s getting a rash again. What could be causing this to occur? What can we do to keep him from having so many BMs? He goes through diapers like crazy and it is so bad for his poor butt. We are at a loss.

[caliotter3]

Maybe his GI doctor has a suggestion? And at five yrs  old there could be a behavioral component, at least for the emesis. Observe him to rule that out.

[LeChien, BSN, RN]

Keep in mind most tube fed kids will have liquid-type stool. I would speak to the pt's GI doctor to start ruling out different causes. It's possible he may need more fiber added to his feeds to bulk up his stool. Are the GI and dietician on the same treatment team, I.e. do they communicate with each other? Best of luck to you!