Nutrition Interventions for Children with Special Health Care Needs

Appendix N
activities. When feedings are delivered continuously, stool output is reduced, a
consideration for the child with chronic diarrhea. Continuous infusions of elemental
formula have been successful in managing infants with necrotizing enterocolitis,
short bowel syndrome, intractable diarrhea, and Crohn’s disease.
A disadvantage of continuous feeding is that although feedings can be scheduled
at night and during naptime, the child is “tied” to the feeding equipment during the
infusion. However, there are smaller and lighter pumps available to make life easier
for the family. Continuous feeding is more expensive because of the cost of supplies
including the pump. Management of a pump and its maintenance may be difficult for
some families. Finally, a child’s medication needs to be considered, as continuous
feeding may interfere with serum concentration of some medications (6,7).
Equipment for Tube Feedings
Feeding Tubes
When choosing a feeding tube, the following factors should be considered: the
patient’s age and size, the viscosity of the formula to be used, and the possible need
for a pump.
Nasogastric tubes
For nasogastric feeding, the smallest bore tube in a soft material will minimize child’s
discomfort. Large-bore tubes partially block the airways, may interfere with the
function of the gastroesophageal sphincter, and may irritate the nose and throat.
Tubes size 8 French or smaller are usually used for children. The size refers to the
outside diameter of the tube; one French unit equals 0.33 mm. Tubes this small
cannot accommodate thick or viscous feedings, e.g., homemade blenderized formula
or commercial formula containing fiber (1,3,4,5).
Most tubes are made of polyurethane or silicone, both of which remain soft and
flexible over time. These tubes are usually weighted at the end for easier insertion.
More flexible tubes are difficult to place without using a stylet. Non-weighted tubes
may be displaced during gagging, vomiting, or coughing spells; however, they are
used regularly and without difficulty for intermittent feedings in newborns.
Gastrostomy tubes
Skin-level gastrostomy feeding devices, such as the Bard ® button gastrostomy or the
MIC-KEY ® button gastrostomy are available. They allow feeding tubes to be attached
348 Nutrition Interventions for Children With Special Health Care Needs