The right recipe for recovery and growth

Singapore — While most children her age eagerly tuck into their favourite food, five-year-old Isabelle Tay struggles with the most basic of eating skills.

The simple act of chewing and swallowing soft foods requires immense effort from the preschooler, who was born with a complex congenital heart condition and underwent three major heart surgeries before the age of one. She currently relies on a pacemaker to regulate her heartbeat.

While battling serious medical issues in her first year, Isabelle had missed the opportunity to learn the skills required for eating, said her mother, Ang Siew Cheng, 30, an administrative clerk. “After undergoing so many medical procedures, Isabelle feels that whatever goes into her mouth is bad,” said Mdm Ang. “Although she is now able to chew, she doesn’t like the feeling of food disintegrating in her mouth. To her, it feels so unusual she would rather starve than eat. At family meals, she never shows any interest in food on the table.”

For the past five years, the only food Isabelle has willingly stomached is a special milk formula and medical nutritional supplement that provides extra calories, and is fed to her through a feeding tube via the nose several times a day. Prescribed by her dietitian at the National University Hospital (NUH) and costing about S$500 to S$600 each month, it has helped Isabelle to grow and thrive despite her medical issues and aversion to eating.

Nutritional therapy is an important part of medical care for some children with chronic illnesses, as it supports their treatment and recovery, and supplies them with the nutrients needed for growth and development.

NUH’s Dietetics Department sees about 10 paediatric patients a day, of whom half require nutritional therapy. The KK Women’s and Children’s Hospital (KKH) receives about 3,000 new referrals each year for paediatric patients requiring nutritional therapy.

“Childhood is a vital time for both physical growth and cognitive development, hence it is important to optimise the nutritional status for each and every child. Children with chronic illnesses require an assessment of their nutritional status as they are at risk of stunted physical growth and delays in cognitive development as a result of their medical conditions,” said Associate Professor Marion Aw, senior consultant at NUH’s Paediatric Feeding and Nutrition Clinic.

In nutritional therapy, a dietitian assesses the child’s nutritional status, plans and ensures the right intake, and tracks growth. Depending on their medical condition, some children may also need to consume “special food” in order for them to digest and absorb nutrients well, said Assoc Prof Aw. “For instance, children with liver disease who cannot digest regular fat well may need special fats, in the form of medium chain triglycerides, which can be found in some specialised milk formulas or coconut oil.”

Some of the more expensive supplements and milk formula used in nutritional therapy cost about S$500 to S$1,500 a month, according to NUH. Studies have established that paediatric patients who are malnourished have poor clinical outcomes, including reduced immunity, poor wound healing and a higher risk of infection and death, said KKH’s Dr Han Wee Meng, head of its nutrition and dietetics department.

Providing nutritional support is important to children who are vulnerable to malnutrition, such as premature infants, those on cancer treatment, or who have growth failure or fussy eating behaviours, she said.

For such young patients, missing out on timely nutritional intervention and support could have serious repercussions. “For example, children with inherited metabolic conditions may suffer from neurological damage if certain amino acids are not restricted in their diet,” said Ms Charlotte Lin, senior dietician at NUH’s Paediatric Feeding and Nutrition Clinic.

The youngest patient seen by NUH’s dietetics department was a one-week-old infant, she said.

The majority of KKH’s paediatric patients on nutritional therapy require follow-ups on a monthly to six-monthly basis, depending on the patient’s condition and nutritional requirement, said Dr Han.

For Isabelle, nutritional therapy ensures that her growth in weight and height is on track and that she does not run into complications from her heart condition. But she is also undergoing feeding therapy with an occupational therapist and speech therapist to help her learn how to eat normal table food.

“Her doctors hope to remove her feeding tube permanently at the end of the year, and we’re working towards that goal. Her grandmother and I take turns to spoon-feed her milk or soft cereal, which can take up to an hour for each meal,” said Mdm Ang. “One day, I hope to be able to sit down and have a proper meal with my daughter.”

FINANCIAL AID AVAILABLE FOR NEEDY PATIENTS
Help is available for paediatric patients on nutritional therapy at National University Hospital and KK Women’s and Children’s Hospital who require financial aid.

The CapitaLand – NUHkids Nutrition Fund, comprising a $50,000 donation from CapitaLand Hope Foundation to NUH’s Paediatric Cluster, was recently set up for financially needy paediatric patients who require nutritional therapy.

The KKH Health Endowment Fund, set up in 2002, is available to needy patients who have exhausted all options and are in need of financial assistance for medical treatment, including nutritional therapy, to manage their conditions. More information at www.kkh.com.sg/kkhhef.

Correction: In an earlier version of this story, we denoted Dr Han Wee Meng as male, instead of female. We apologise for the error.