Enteral nutrition in infants and children
- Sharon Collier, RD, MEd
Sharon Collier, RD, MEd
- Clinical Nutrition Director
- Children's Hospital, Boston
- Christopher Duggan, MD, MPH
Christopher Duggan, MD, MPH
- Professor of Pediatrics, Harvard Medical School
- Division of Gastroenterology, Hepatology, and Nutrition
- Boston Children’s Hospital, Boston, MA
Enteral nutrition consists of providing nutrients via the gastrointestinal tract. Although the term technically refers to nutrition given either by mouth or through a feeding tube, in common usage the term usually refers to tube feeding. In comparison to parenteral nutrition (the provision of nutrients via a venous catheter directly into the bloodstream), enteral nutrition offers several advantages, including lower costs, beneficial effects from utilization of the gastrointestinal tract, and avoidance of the many potential complications of parenteral nutrition. (See "Parenteral nutrition in infants and children".)
For many pediatric patients with suboptimal nutrition, intake by mouth can be improved by offering high-calorie foods, oral supplements, or boosting the nutrient density of foods by adding high-energy supplements such as fats (oils, cream, or butter), carbohydrates (sugars and powdered supplements), and proteins (milk or other protein powders). Children who are still unable to take in sufficient energy through these approaches, or those who are unable to tolerate oral feedings because of the underlying disease, are candidates for enteral nutrition.
NUTRITIONAL ASSESSMENT IN CHILDREN
The decision about whether to initiate enteral nutrition in children should begin with a thorough and valid measure of nutritional status.
For premature infants, evaluation of the degree of prematurity is critical and often leads to a decision to initiate tube feedings until oral feeds are possible. Enteral and/or parenteral nutrition usually is required until a premature infant reaches approximately 34 weeks gestational age. Appropriate growth curves or correction for gestational age should be employed when judging the nutritional status of premature infants. The evaluation for and management of enteral feeds in premature infants are discussed in separate topic reviews. (See "Approach to enteral nutrition in the premature infant" and "Growth management in preterm infants", section on 'Normative growth data'.)
Plotting and interpreting weight, length, and head circumference on sex- and age-specific growth curves is the hallmark of nutrition assessment. For full-term infants and children up to 24 months of age, the growth charts developed by the World Health Organization (WHO) should be used; these standards were derived from healthy infants who were exclusively breastfed . For children 2 to 20 years old in the United States, the growth charts developed by the Centers for Disease Control (CDC) should be used. These growth charts include curves for weight for age, length (height) for age, as well as body mass index (BMI) on which an individual patients values can be plotted and tracked over time. (See "Measurement of growth in children", section on 'Recommended growth charts'.)
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- NUTRITIONAL ASSESSMENT IN CHILDREN
- INDICATIONS FOR ENTERAL NUTRITION
- Decreased ability to ingest nutrients by mouth
- Inability to meet increased metabolic demands through oral nutrition
- Altered absorption or digestion requiring modification of dietary intake
- DISEASE-SPECIFIC CONSIDERATIONS
- Cardiorespiratory diseases
- Gastrointestinal disease and dysfunction
- Renal disease
- Critical illness and post-operative states
- - Burns
- - Cancer
- Neuromuscular impairment
- FORMULA SELECTION
- Protein source
- Age considerations
- Specialty formulas
- NUTRITIONAL REQUIREMENTS
- Children with healthy growth
- Children needing catch-up growth
- Adjustments for children with obesity
- Nasogastric or orogastric route
- Gastrostomy route
- Transpyloric route
- SUMMARY AND RECOMMENDATIONS