Nutrition Interventions for Children with Special Health Care Needs

Administration of Feeding
Formula delivery will depend on tolerance, volume requirements/limits, safety, and
the family’s home schedule. What works for a hospital setting may not fit into the
child’s home, school, therapy, and/or daycare schedule. Compliance often relies on
making enteral feeding simple for the family.
Appendix N
Children beginning tube feedings may be started on full strength isotonic formulas,
given in small volumes (see recommended rate below). Hypertonic formulas should
be started at half strength. Some children who have not had oral or tube feedings
for a long period of time or have a history of formula intolerance (such as premature
infants or children with short gut syndrome) may require half-strength formula
initially, with gradual increases to full strength. In general, if a child needs diluted
formula, it is best to increase volume to make sure the child meets fluid needs; then
gradually increase concentration. Concentration and volume should not be increased
at the same time. Frequent adjustments may be necessary as the child adjusts and
as the family schedule changes.
Suggested schedule to initiate enteral feedings (3,4):
• Infants 10 ml/hour
• Child 1-5 years 20 ml/hour
• Child 5-10 years 30 ml/hour
• Child >10 years 50 ml/hour
Advance the delivery rate as tolerated to meet the goal for the child’s nutrition
needs. Increase volume every 4-12 hours, monitoring carefully for tolerance.
Tolerance is defined as absence of diarrhea, abdominal distension, vomiting or
gagging. If a child is bolus fed, start feeds at 25% of goal volume increasing as
tolerated.
The physician may require that residuals be checked when a tube feeding is initiated
or when formula or medications are changed. To check residuals, attach syringe to
feeding tube and “pull back” stomach contents. If residuals are greater than 25-50%
of previous bolus feeding or 2 times the hourly volume for continuous drip feeding,
reduce the feeding to the previous volume and advance at a slower rate. Return
residual contents to the stomach.
Monitoring
Monitoring home enteral for children varies greatly. Often enteral supplies and
formula are delivered to the home, which may be the only contact between a child,
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