Nutrition Interventions for Children with Special Health Care Needs

Appendix N
osmolality of full-strength isotonic formulas is similar to the osmolality of normal
body fluids, approximately 300 mOsm/kg water.
For infants, the volume of formula provided can be determined by calculating the
amount of formula necessary to meet estimated protein needs. If additional energy
is needed, fat and/or carbohydrate can be added, See Appendix T. Water must be
provided to meet fluid requirements. Another method to determine formula volume
for children is to calculate amount of formula needed to meet energy needs and then
add supplements to meet other needs. Try to minimize the addition of supplements,
for ease of preparation, improved tolerance and decreased risk of error.
Sometimes parents feel that because enteral formulas are not solid food, they are
not feeding their child enough. Parents need reassurance that you will help their child
to not be hungry and that nutrient needs can be met by formula alone.
Complete or Standard Formulas
Complete or standard formulas are nutritionally complete and made of complex
proteins, fats, carbohydrates, vitamins, and minerals. Complete formulas are
designed for patients who have normal digestion, but cannot consume adequate
energy and nutrients orally. The advantages of complete formulas are that they
have low osmolalities and are lactose-free, easy to use, and sterile. Some complete
formulas have added fiber.
Elemental Formulas
Elemental formulas are “predigested” formulas made from amino acids or hydrolyzed
protein, simple carbohydrates, and fat in the form of medium chain triglycerides
and essential fatty acids. They contain all the essential vitamins and minerals. The
major advantages of elemental formulas are that little or no digestion is required,
stool volume is low, and the stimulation of bile and pancreatic secretions is minimal.
Elemental formulas are hyperosmolar however, and if infused too rapidly, may cause
cramping and osmotic diarrhea. They are more expensive than standard formulas
and offer no advantage to a child whose gut is intact. Clinical indications for the
use of elemental formulas include short gut syndrome, malabsorption syndromes,
delayed gastric emptying or gastroesphageal reflux, inflammatory bowel disease,
gastrointestinal fistulas, cystic fibrosis, and nonspecific malabsorptive states.
354 Nutrition Interventions for Children With Special Health Care Needs