BNF for Children 2011-2012

BNFC 2011–2012 743A2Borderline substancesA2.1 Enteral feeds (non-diseasespecific) 744A2.1.1 Enteral feeds (non-diseasespecific): less than 5 g protein/100 mL 744A2.1.2 Enteral feeds (non-diseasespecific): 5 g (or more) protein/100 mL 747A2.1.3 Enteral feeds (non-diseasespecific): Child under 12 years 750A2.2 Nutritional supplements (nondiseasespecific) 756A2.2.1 Nutritional supplements: lessthan 5 g protein/100 mL 756A2.2.2 Nutritional supplements: 5 g(or more) protein/100 mL 758A2.3 Specialised formulas 763A2.3.1 Specialised formulas: Infantand child 763A2.3.2 Specialised formulas for specificclinical conditions 768A2.4 Feed supplements 771A2.4.1 High-energy supplements 771A2.4.2 Fibre, vitamin, and mineralsupplements 776A2.5 Feed additives 777A2.5.1 Special additives for conditionsof intolerance 777A2.5.2 Feed thickeners and pre-thickeneddrinks 777A2.5.3 Flavouring preparations 777A2.6 Foods for special diets 777A2.6.1 Gluten-free foods 777A2.6.2 Low-protein foods 780A2.7 Nutritional supplements formetabolic diseases 781In certain conditions some foods (and toilet preparations)have characteristics of drugs and the AdvisoryCommittee on Borderline Substances (ACBS) advisesas to the circumstances in which such substances maybe regarded as drugs. Prescriptions issued in accordancewith the Committee’s advice and endorsed‘ACBS’ will normally not be investigated.General Practitioners are reminded that the ACBSrecommends products on the basis that they may beregarded as drugs for the management of specifiedconditions. Doctors should satisfy themselves thatthe products can safely be prescribed, that patientsare adequately monitored and that, where necessary,expert hospital supervision is available.Foods which may be prescribed on FP10, GP10(Scotland), or WP10 (Wales) All the food productslisted in this appendix have ACBS approval. The clinicalcondition for which the product has been approved isincluded with each entry.Note Foods included in this appendix may contain cariogenicsugars and appropriate oral hygiene measures should be taken.Enteral feeds and nutritional supplements Formost enteral feeds and nutritional supplements, themain source of carbohydrate is either maltodextrin orglucose syrup; other carbohydrate sources are listed inthe relevant table, below. Feeds containing residuallactose (less than 1 g lactose/100 mL formula) aredescribed as ‘clinically lactose-free’ or ‘lactose-free’ bysome manufacturers. The presence of lactose (includingresidual lactose) in feeds is indicated in the relevanttable, below. The primary sources of protein or aminoacids are included with each product entry. The fat oroil content is derived from a variety of sources such asvegetables, soya bean, corn, palm nuts, and seeds;where the fat content is derived from animal or fishsources, this information is included in the relevanttable, below. The presence of medium chain triglycerides(MCT) is also noted where the quantityexceeds 30% of the fat content.Enteral feeds and nutritional supplements can containvarying amounts of vitamins, minerals, and trace elements—themanufacturer’s product literature should beconsulted for more detailed information. For furtherinformation on enteral nutrition, see section 9.4.2.Feeds containing vitamin K may affect the INR inchildren receiving warfarin; see interactions: Appendix1 (vitamins).The suitability of food products for patients requiring avegan, kosher, halal, or other compliant diet should beconfirmed with individual manufacturers.Note Feeds containing more than 6 g/100 mL protein or 2 g/100 mL fibre should be avoided in children unless recommendedby an appropriate specialist or dietician.Standard ACBS indications: Disease-related malnutrition,intractable malabsorption, pre-operativepreparation of malnourished patients, dysphagia,proven inflammatory bowel disease, following totalgastrectomy, short-bowel syndrome, bowel fistulaPaediatric ACBS indications: Disease-relatedmalnutrition, intractable malabsorption, growth failure,pre-operative preparation of malnourishedpatients, dysphagia, short-bowel syndrome, bowelfistulaAppendix 2: Borderline substances