Monday, April 11, 2016

Compassionate Care Helps Patient Find Love for New Foods

At the dinner table, Ella Dumais’s plate has many of her favorite foods – steak, broccoli and a side of fruit. Just a few months earlier, Ella’s dinner would have looked much different. For the first two years of her life, Ella, now 3, was receiving food through feeding tubes and was hesitant to try new foods.

 

Ella and Lauren Fiechtner, MD
Fiechtner and Ella at Ella's feeding tube graduation party.

Ella’s feeding difficulties began when she was two weeks old, said her mother, Maureen. “I noticed she wasn’t feeding well, so we brought into the doctor’s office. She was eventually diagnosed with reflux at eight weeks old in July 2012,” said Maureen.

On some days, said Maureen, Ella was eating less than one ounce of formula. At that time, the Dumais family was referred to Lauren Fiechtner, MD, MPH. After seeing how much trouble Ella had with feeding, Fiechtner recommended that Ella have a nasogastric (NG) tube placed in September 2012.

“An NG tube is a type of feeding tube inserted through the nose to deliver food directly to the stomach,” said Fiechtner, the director of the Center for Pediatric Nutrition at MassGeneral Hospital for Children (MGHfC). “When children have difficulty keeping up with their nutrition by mouth, a feeding tube is the safest option.”

Feeding tubes can also make it easier for children to practice feeding and exploring new foods between meals, said Fiechtner. This way, children can meet their nutrition needs and be introduced to new foods at an easier pace.

Over the course of Ella’s infancy, Maureen tried giving Ella small bites of different foods between meals. “She was very selective with food textures, types of food and food temperature,” said Maureen. “I’d also give her a taste of new foods on her pacifier. Sometimes it worked, sometimes it didn’t.”

While the NG tube helped Ella meet her nutrition goals, she didn’t enjoy having the tube on her face. In April 2013, Fiechtner suggested that Ella get a more permanent feeding tube, called a MIC-KEY® button, placed in her stomach. The button made feeding easier and a little over two months later, Ella started to try more solid foods by mouth with help from her mother, Fiechtner and a team of feeding therapists.

In December 2015, Ella had reached all of her nutrition goals and expanded her palate to include a variety of foods. Ella’s family gathered in Fiechtner’s office for a feeding tube removal party, complete with party blowers and plenty of cheers.

“We had always talked about a feeding tube graduation day. Ella paraded around the room pointing to her stomach saying ‘All gone!’ when I asked her where her feeding tube went,” said Maureen. “Looking back, we think Ella’s autism diagnosis might have played a role in her feeding difficulties. Now, there’s nothing Ella won’t try and she loves to eat. It’s almost like she’s making up for lost time.”

Ella’s favorite food is Cheez-Its®, but she also likes guacamole, hummus, pepperoni, cucumbers and donuts. “Being able to watch Ella grow out of her feeding difficulties has been so rewarding,” said Fiechtner. “She’s now able to sit at the dinner table and enjoy meals with her family. Food is such a large part of our culture and it’s exciting to see Ella participate in holiday meals and everyday meals without difficulty and with a love for food.”

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