Scenario 2 - continued

Frank returns to see you at age 26 ½ months.

His length-for-age is still below the 5th percentile, but his rate of weight gain has increased. Weight-for-length remains below the 5th percentile.

Frank’s mother is pleased with the progress he has made with feeding therapy. He still has weeks where he refuses to eat, but the family is reassured that his nutrient needs are met with the tube feeding.

His current tube feeding regimen is 65 mL per hour for 11 hours at night and three 120 mL bolus feedings during the day.

His mother has begun making all of his formula at home using this recipe:

• 4 Tablespoons peanut butter
• 1 raw egg
• ½ avocado
• 1 cup standard pediatric formula
• ¼ cup buttermilk

What is your primary concern at this visit?