Sunday, 16 May 2010
Peterson came to us last month. At 6 months old and weighing 8.5lb, he was very malnourished. His 17 year old mother didn't seem to understand the basics of child care. Giggling, she told us that she was still a child herself, and that she couldn't be expected to take care of a baby.
We knew that Judith would need a considerable amount of nurturing, training and education, to enable her to look after Peterson at home, and so we set to work. We had no idea of the scale of the challenge that faced us.
Peterson was difficult to feed. He had a weak suck, and a poor appetite and he did not spoon feed well at all. With lots of time and patience, we nurses were able to get Peterson to take enough milk to stay hydrated and encourage weight-gain. We persevered.
Two weeks ago, this sickly infant developed pneumonia. He was started on antibiotics and recovered well, until last Friday, when he began coughing and crying, turned blue, lost consciousness, became floppy and stopped breathing.
It was after 9pm at night and I was upstairs, with the only staff member who was on duty. To my consternation, Nurse Roselin, ran in the opposite direction from the resuscitation supplies, when I asked for help leaving me alone in the intensive care nursery. I had no choice but to begin mouth-to-mouth. Within seconds, Peterson gasped and began moving. In less than a minute, he was breathing regularly by himself. There are no words to explain the relief I felt when he began wailing and clasping my scrub top, pulling himself up onto my shoulder to be comforted and consoled!
A few days later, Peterson began spiking fevers. His blood pressure shot up and his fontanel bulged. He refused to suck and was unable to swallow. We suspected meningitis and began treating the baby with IV antibiotics and steroids. Although he responded to these drugs. He still would not feed. At this point, his mother told us that Peterson had always fed poorly. I was concerned to hear this. More concerning still, Judith disclosed to the orphanage Paediatrician that had been giving Peterson high doses of an appetite stimulant that is available over the counter in Haiti. I looked at the baby's bulging eyes, and wondered what affects this drug might have had on his developing brain.
As the days went by, and feeding Peterson became more difficult, I worried that this baby might have some brain damage. He cried whenever we tried to feed him with a nipple. He didn't like any of them. I could only get him to drink milk by drop feeding it to him, then stimulating him to swallow. That took several hours a day. I could not get him to feed from a spoon. He would only accept incredibly thick porridge, and then, only if I fed them to him on my finger. Throughout the feeding process, this wide-eyes baby would whimper, and shake his head from side to side. Feeding him was thoroughly exhausting, not to mention discouraging.
Eventually, although the orphanage Director was opposed to the use of feeding tubes, we placed a nasogastric tube to enable Peterson to get the nutrition he so desperately needed. His body was and still is deficient in essential immune supporting nutrients and if he is going to recover from his illness, gain weight and become stronger, he will need optimal nutrition.
Eventually, after a lot of experimenting, and a lot of discussion with his mother, Peterson has had a few key breakthroughs: I learned that Peterson will eat food that is laced with cinnamon and sugar. I also found a 'scoop' inset that fits into babies feeding bottles. Milk trickles through this slowly. Although it still takes a long time to feed Peterson this way, he is calm and doesn't struggle. As I commented on Friday afternoon that the baby no longer seemed stressed when he was feeding, there was a burst of laughter from his mother. She told our horrified staff that when Peterson refused to eat for her, she would slap him hard on his thigh!
Judith is young, and we know that this behaviour comes from ignorance. Peterson is an exceptionally quiet, watchful infant. Now we know why this wide-eyed baby is afraid. We are working hard to impress upon Judith that it is is unacceptable, and counterproductive for her to hit him. This morning, as the Haitian staff patiently explained that a 7 month old was too little to understand and respond to punishment, Judith laughed, and told them that she didn't like her son. He closed his mouth whenever she tried to feed him, she said. He knew what he was doing and so she would continue to slap him!
She is young, I reminded myself. Young and immature, so I swallowed my anger, and calmly told her that her infant was frightened and stressed. I pointed out that he didn't smile. I told her that unhappy babies often did not eat, in just the way that depressed adults sometimes lost their appetites. For the first time, I told her that what she was doing amounted to child abuse. Judith stopped laughing, and looked at me solemnly as I went on to tell her how we were going to try to resolve this situation:
She would nurse her son, because he likes being nursed. We would supplement his intake with high calorie milk, porridge and enriched peanut butter. At night, Peterson would receive tube feeds to get his weight up, since he needs to eat round the clock, but hates being wakened to be fed. Feeding is no longer to be a battle ground. We will do everything we can to make feeding time a happy time, and in-between times, Judith will be encouraged to hold her son, snuggle with him, sing to him, and play with him. I can only hope that she co-operates with us, and that Peterson responds to gentle loving care.
Note: For the benefit of the medically trained people who are reading this, I do know that performing mouth-to-mouth on a child with meningitis calls for preventative antibiotics and I did treat myself!
Posted by Susan Westwood at 08:20