Nutrition Interventions for Children with Special Health Care Needs

Chapter 10 - Enteral Feeding
Other possible physical disadvantages are diarrhea, skin breakdown, or stoma site
granulation/infection. Mechanical disadvantages can be a dislodged or occluded
feeding tube (1-6).
Children who are either malnourished or at high risk for becoming malnourished can
benefit from tube feeding. When one or more of the following factors are identified,
tube feeding should be considered after other aggressive oral interventions have
been tried (1,6):
• Inability to consume at least 80% of energy needs by mouth
• Total feeding time more than four hours per day
• Inadequate growth or weight gain for more than one month (under age 2 years)
• Weight loss or no weight gain for a period of three months (over age 2 years)
• Weight for length or Body Mass Index (BMI) less than 5th percentile for age/sex
• Triceps skinfold less than 5th percentile for age
An interdisciplinary team should decide whether or not to begin tube feeding. At
a minimum, the team should include the child’s caregivers, the primary physician,
the surgeon, and the registered dietitian (RD). If the child has oral motor feeding
problems, the team should also include an occupational or speech therapist. Before
tube feeding is started, the child needs a medical work-up for the following purposes:
• To rule out contraindications for enteral feeding (e.g., malabsorptive disease)
• To diagnose possible gastrointestinal problems (e.g., gastroesophageal reflux, risk
of aspiration)
• To determine the optimal delivery site for the feeding (e.g., stomach, duodenum,
or jejunum)
• To determine an appropriate program for oral-motor stimulation
The feeding tube may be placed through the mouth or nose such as for gavage or
nasogastric (NG) feedings. A gastrostomy is placed surgically or by percutaneous
endoscopic gastrostomy (PEG). The choice of placement depends on many factors
(1-6):
• Expected duration of the need for tube feeding (generally, NG feeding tubes are
used for short periods of time only)
• Local resources for dealing with possible complications
• Family’s ability to learn the feeding technique required by the particular
placement
• Preference of the caregiver(s)
Oral-motor problems may improve with development, time, and treatment. All
enteral feeding techniques are reversible. Discontinuation of enteral feedings
requires the same careful planning and often the same detailed work-up that go into
the decision to start it.
122 Nutrition Interventions for Children With Special Health Care Needs