Nutrition Interventions for Children with Special Health Care Needs

Appendix N
Children with cystic fibrosis or anomalies of the distal ileum and ileocecal valve may
fail to absorb fat-soluble vitamins or to reabsorb bile salts (See Chapters 17 and 20).
Formulas
A wide variety of commercial formulas are available for tube feeding. See
Appendix S for information about the various commercial nutrition products and
formulas. Formula selection should be individualized, based on nutrients and fluid
requirements, gastrointestinal function and reimbursement coverage.
Standard infant formulas (or specialized infant formulas, if needed) can be given
via tube. Pediatric enteral formulas are designed specifically to meet the nutrient
requirements of most children 1-10 years of age. These formulas are complete and
balanced, i.e., about 1000-1300 ml will meet 100% of the DRI/RDA for vitamins and
minerals. These formulas are isotonic and easily tolerated by most children. There
are disease specific formulas that may or may not meet pediatric nutrition needs. An
adult formula may be used for the older child, however the adult formula may not
meet the child’s vitamin and mineral needs. The protein and fiber content of adult
formulas are higher than a child may require, so special attention is needed to make
sure a child receives adequate fluid. One formula may not meet all the needs of a
child; 2 or more different formulas may be needed to individualize a specific nutrition
plan. When selecting an appropriate formula, the factors to consider include the
following:
• Age and medical condition
• Nutrient requirements and goals
• History of food intolerance or allergy
• Intestinal function
• Route of delivery
• Formula characteristics, e.g., osmolality, viscosity, nutrient content, convenience
and cost
• Availability of product
The osmolality of a formula has a direct influence on the gastrointestinal (GI) side
effects that occur with enteral feeding. Osmolality refers to the concentration of
osmotically active particles per kilogram solution of formula, expressed as mOsm/
kg. The osmolality of a formula is affected by the concentration of amino acids,
carbohydrates and electrolytes. Formula with a higher osmolality than that of
normal body fluids produces an osmotic effect in the stomach and small intestine;
this hyperosmolality draws water into the GI tract to dilute the concentration of the
formula. An influx of water into the GI tract may cause diarrhea, nausea, cramping,
and distention. Isotonic formulas are designed to prevent these problems. The
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