Nutrition Interventions for Children with Special Health Care Needs

Appendix N
his family, and the home care provider. Children on enteral feeds are a high-risk
group that requires closer monitoring. What works best for the child and family is
a team of health professionals who work together. In Washington State, nutrition
assessment and monitoring is reimbursable for children with Medicaid services.
However, for many children with private insurance, enteral formula or assessments
may not be reimbursable benefits because enteral feeding is considered food.
Medications and Tube Feedings
The goal for children on enteral feeds is to optimize nutrition therapy and maximize
therapeutic response to medications administered through the feeding tube. Children
on enteral feedings often have extensive medication regimens; a benefit of tube
feeding is delivery of medication by tube. The child does not refuse to swallow, drool
or vomit medication, so he receives all of prescribed medication with better efficacy.
Feeding tubes may be a convenient avenue for medications, but some medicine may
be incompatible, causing the tube to clog, interact negatively with specific nutrients
or affect feeding tolerance. Formula or its components can interfere with the
absorption, distribution, metabolism or elimination of medication (see Chapter 5).
It is important for the pharmacist and physician to know that the child is receiving
medication via his gastrostomy tube. The pharmacist and RD can review his
medication list for compatibility with enteral feeds.
Medications should not be added to enteral formulas. Avoid mixing medications
together. Each medication should be administered separately. Families should be
encouraged to give medicine in a liquid form. Elixirs and suspensions can usually be
delivered through the feeding tube without a problem. Simple compressed tablets
can be crushed and mixed with water or the formula or added to a syringe with
water until they dissolve (about 30-60 minutes). In contrast, syrups are incompatible
with tube feedings because they tend to clog the tube unless diluted with water.
Solid medicines such as sustained-action tablets or capsules or enteric-coated tablets
should not be crushed and delivered through the tube; once crushed, their action
may be altered or they may cause gastrointestinal distress. Check with the child’s
physician for another medication preparation.
Medications are a common case of tube occlusion. To maintain patency of feeding
tubes, flush regularly with water, before, after, and in between giving medications.
Another common side effect with medications is feeding intolerance or GI
discomfort. Review medications to determine when it is best to administer each one.
Adjustments to the feeding and medication schedules may be needed to improve
tolerance and comfort. Table N-2 covers common tube feeding complications. For
more information on medications and drug-nutrient interactions, see Chapter 5.
358 Nutrition Interventions for Children With Special Health Care Needs