Nutrition Interventions for Children with Special Health Care Needs

• Can the child eat safely? How are his oral skills?
Appendix N
• Has the child shown appropriate growth on enteral feedings? Often a child will not
show hunger until an appropriate weight for height is reached.
• Has the medical condition for which the child had tube placed been corrected?
• Are the parent and child ready to transition? Do they have the time to devote to
transitioning?
A common approach to transition is to begin by promoting the child’s recognition of
hunger cues. If necessary, “normalize” the feeding schedule to include three large
and two to three small bolus feedings each day to resemble meals and snacks. This
will help the child to recognize hunger and satiety. To stimulate hunger, caloric intake
may need to be decreased by 25% and/or night-time feeds discontinued. Oral intake
may be minimal so supplemental feedings are offered via the tube after each meal.
As the child is able to consume more food orally, the tube feeding can be decreased.
It is important to ensure an adequate fluid intake—continue to meet water needs by
tube or orally.
It takes time to change feeding behaviors. The longer a child goes without eating by
mouth, the longer it will take to transition to oral feeding. Small steps are important
so the child feels that she is in control. The child has the benefit of using the feeding
tube to meet nutritional requirements (12).
The tube can be removed when the child can eat an adequate amount of food orally
to support growth. It may be prudent to wait until the child demonstrates that he
does not lose excessive weight with illness. Weaning from tube feeding is often a
time when a child may not be meeting nutrition or hydration needs and will require
increased monitoring.
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