Case Studies

Case 3: Gastrointestinal (reflux, constipation) and nutritional (poor weight gain) issues

Helen is a 24-year-old woman with Retts syndrome. At her annual health check, it was noted that Helen had moved from within normal range to underweight on the body mass index (BMI). She had recently moved into a privately owned and supported living scheme. She sees her parents weekly at her home. Staff stated it was getting difficult to support Helen to eat her meals as she kept putting her hands in her mouth. They took this to mean she no longer wanted her food. Helen's parents have offered advice to the home, suggesting that staff hold her hand when she tries to put her hands in her mouth, to ensure that she eats properly. Staff felt this wasn't right and refused to hold her hands.

• 1. Might Retts syndrome be a factor here and, if so, why?

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  Correct answer: Involuntary stereotypical hand movements can make eating very difficult in someone with Retts syndrome.

• 2. What else needs to be considered?

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  Correct answer:

  • Has the weight loss any connection with Helen moving into the supported living scheme?
  • May Helen need further assessment around her mental health state?
  • How does she interpret the move from her family home?
  • Are there any other health issues, for example dental hygiene and swallowing reflex?

• 3. How would you approach this situation?

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  Correct answer: A thorough assessment of Helen's health is required - as well as gathering information from all professionals involved with her care, including Helen and her family. A speech and language therapy assessment and occupational therapy assessment would also be required to ensure that the act of swallowing was not compromised. The use of splints and aids for eating could assist Helen in being more engaged with her own eating.

• 4. What vulnerability issues are involved in this case?

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  Correct answer:

  • Mental capacity in respect of Helen's understanding of the implications of not eating
  • Staff being adequately trained in supporting someone who is at risk of choking
  • Staff having the required support structures internally and externally to support someone with Retts syndrome