Nutritional management of chronic disease — structured clinical encounter

A four-month-old infant with a large ventricular septal defect and pulmonary hypertension is reviewed in clinic. He is tachypnoeic, sweats with feeds, takes small volumes and tires within minutes, and his weight has fallen from the twenty-fifth centile to below the third over eight weeks while his length has tracked along the tenth. He is on a standard infant formula at around one hundred kilocalories per kilogram per day. You are the paediatric registrar working through the recognition of failure to thrive, the anthropometric assessment, the nutrition management and the feeding route, and why nutrition is an outcome of his cardiac care.