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Pediatric Tube Feeding

Pediatric tube feeding, or pediatric enteral nutrition (EN), is commonly used when patients who have a functioning gastrointestinal (GI) tract but cannot ingest enough nutrients orally.1

Enteral feeding can be recommended for a child for a variety of reasons, including weight loss, severe lack of appetite, feeding and swallowing disorders or delays, or certain medical conditions or food allergies. Tube feeding formulas provide all the required macro- and micronutrients.

Nestlé Health Science offers a comprehensive portfolio of high-quality, science-backed enteral tube feeding formulas to support optimal growth, development, and improved nutritional outcomes for pediatric patients.

ABOUT PEDIATRIC TUBE FEEDING

Pediatric tube feeding, also known as enteral nutrition (EN), is a way of providing essential nutrition to infants and children who are unable or unwilling to meet their dietary needs orally.1

Enteral tube feeding is commonly used in patients with feeding and swallowing disorders associated with development delays, malnutrition, diseases of the digestive tract, neurological impairment, and may also be useful for the nutritional management of other conditions such as Crohn’s disease, multiple food allergy and/or intolerance to certain foods as well as medical conditions that interfere with normal eating, digestion, or absorption of nutrients, such as gastroesophageal reflux disease (GERD), esophagitis, cystic fibrosis (CF) or other acute and chronic illnesses.2,3

Determining whether a pediatric patient may need EN involves collaborative discussions between the child’s caregivers, the child (if appropriate), and multiple healthcare professionals, often including pediatricians, gastroenterologists, registered dietitians and other specialists involved in the child’s care.

Some medical conditions that prevent children from eating orally include:

  • Weight loss or poor weight gain (resulting in failure to thrive and/or malnutrition) or severe lack of appetite
  • Feeding and swallowing disorders or developmental delays
  • Food allergies
  • Cancer
  • Gastrointestinal issues such as an obstructed bowel, short bowel syndrome, or Crohn’s disease
  • Gastroesophageal reflux disease (GERD) or esophagitis
  • Cystic fibrosis (CF)
  • Neurological disorders including paralysis
  • Recovery from surgery or trauma
  • Other acute and critical illnesses

Once the decision to place a feeding tube is made, an appropriate tube feeding formula is then selected to meet the child's individual needs to promote tolerance and support growth and development.

The types of feeding tubes used to administer enteral formulas are2:

  • Nasogastric tube (NG-tube)
  • Gastrostomy tube (G-tube)
  • Jejunostomy tube (J-tube)

Ongoing collaboration between the child’s healthcare team, including pediatricians/pediatric gastroenterologists, dietitians, physician’s assistants, nurses/nurse practitioners, and speech-language pathologists, is key to managing a pediatric patient’s feeding tube and optimizing the child’s overall well-being and growth.

NUTRITION FOR TUBE-FED CHILDREN

Choosing the right type of nutrition or specific formula for pediatric patients is critical to meeting their nutritional requirements and supporting their overall health and growth. Each child will have their own unique nutritional needs depending on multiple factors, such as age, weight, growth, medical conditions, neurological factors, and developmental stage.

Collaboration between the child’s caregivers and healthcare professionals, including registered dietitians, pediatricians, physician’s assistants, nurses, and speech/language pathologists, is important to select the most suitable formula. The specific formula selected for enteral feeding should provide an appropriate balance of macronutrients (carbohydrates, proteins, fats, fiber) and essential micronutrients (vitamins and minerals).

Considering the lifestyle and quality of life of parents and others caring for their children is also important.3 Ideally, families will have access to options that are convenient, readily available, and promote a positive feeding experience for both the child and their caregivers.

 

PEDIATRIC TUBE FEEDING FORMULAS

There are several types of tube feeding formulas available to meet the unique needs of tube-fed children. Most can tolerate a standard intact protein formula4. However, there are situations in which a standard formula may not be tolerated, or a patient has certain dietary requirements or preferences, and options should be considered.

Nestlé Health Science offers a comprehensive portfolio of high-quality, evidence-based enteral tube feeding formulas to meet the unique needs of pediatric patients. Our portfolio includes standard formulas for normal digestion, peptide-based formulas for easier digestion and absorption, hypoallergenic formulas for food allergies and sensitivities, formulas with food ingredients for variety and tolerance, and commercially blenderized whole food formulas for a more natural feeding experience. These formulas meet the highest standards of nutritional quality, supporting optimal growth, development, and overall improved outcomes.

Standard Formulas

A standard pediatric tube-feeding formula that is designed for children who have normal digestion and absorption. Standard formulas include all of the nutrients required to maintain health. Some standard formulas can be used for both enteral feeding and as an oral supplement. They can contain added ingredients, such as fiber for digestive health and bowel management.

Related Products

Peptide-Based Formulas

Peptide-based formulas differ from standard formulas in that the protein source is hydrolyzed, or broken down into smaller components or peptides.(7) This makes the proteins easier to digest and absorb for patients with GI impairments, including malabsorption, short bowel syndrome, inflammatory bowel disease, cystic fibrosis and other conditions.

Related Products

Formulas with Real Food Ingredients

Tube-feeding formulas with real food ingredients are made from a blend of ingredients such as chicken, grains, vegetables, and fruit. They may be suitable for children who have difficulty digesting or tolerating a standard formula, or for those who will require tube feeding for a long period of time. A formula made with real food ingredients can also help provide more variety.

Related Products

Blenderized Formulas

Blenderized tube feeding (BTF) is the use of blended whole foods. Recent focus on more natural foods has led to increased interest in BTF. Many patients and families choose BTF because of its perceived health benefits, intolerance to commercial feeding formulas, or to normalize the tube feeding experience by offering foods the entire family eats. (5,6)

Resources are available to help your caregivers blend nutritionally appropriate recipes for pediatric patients at home. Ready-to-use commercial BTF formulas are also available and have the added benefit offering convenience for those who want a BTF, but cannot prepare their own. Recent studies have demonstrated that commercially blenderized formulas are associated with improved GI tolerance in pediatric patients with chronic conditions such as malnutrition, digestive diseases, cerebral palsy, and seizure disorders. (8)

Related Products

Hypoallergenic Infant & Junior Formulas

Infant formulas, especially those recommended for specialty/medical use, such as hypoallergenic extensively hydrolyzed, or amino acid-based formulas needed for complete nutrition for infants with cow’s milk protein allergy (CMPA) or other food allergies and intolerances or sensitivities.

Related Products

Objectives:
• Identify gastrointestinal (GI) symptoms that show improved outcomes with food-based tube feeding formulas
• Describe real-world evidence demonstrating clinical and health economic outcomes with tube feeding formulas containing real food ingredients
• Apply case-based studies to current practice for managing GI intolerance in pediatric tube-fed patients

Watch now

Objectives:
• Describe normal feeding patterns in children
• Identify common feeding problems in pediatrics
• Explain several strategies to avoid or ameliorate feeding problems
• Describe the differences between feeding problems and a pediatric feeding disorder

Watch now

Objectives:
• Identify common challenges associated with feeding tubes and strategies to avoid such challenges
• Describe key parameters used to assess GI intolerance and identify feeding regimen options to alleviate symptoms
• Describe dos and don’ts when recommending a blenderized or commercially prepared food-based tube feeding

Watch now

Learning Objectives:
1. Explain recently published real world evidence on the clinical and health economic outcomes of utilizing commercially blenderized formulas for tube-fed children and adults.
2. Describe at least two examples of how this recent data will change clinical practice.
3. Apply learnings through a case-based approach to identify how and when to utilize commercially blenderized formulas with tube fed patients.

Watch now

In this presentation, a multidisciplinary panel consisting of a physician assistant specializing in pediatric neurological impairment and complex GI disorders, a dietitian specializing in adult home enteral nutrition support and a pediatric gastroenterologist address evidence and current experience with food-based tube feeding formulas for their patients receiving tube feeding.

Watch now

Nutritional Management of the Medically-Complex Pediatric Outpatient Receiving Food-Based Tube Feeding.

This presentation focuses on the efficacy of real food-based tube feeding formulas through a review of the recent literature, highlighting the results of a recent tolerance study, and providing a case-based approach to describe pediatric patients with impaired GI function who demonstrated positive outcomes from receiving this type of formula.

Watch now

ABOUT PEDIATRIC TUBE FEEDING

Pediatric tube feeding, also known as enteral nutrition (EN), is a way of providing essential nutrition to infants and children who are unable or unwilling to meet their dietary needs orally.1

Enteral tube feeding is commonly used in patients with feeding and swallowing disorders associated with development delays, malnutrition, diseases of the digestive tract, neurological impairment, and may also be useful for the nutritional management of other conditions such as Crohn’s disease, multiple food allergy and/or intolerance to certain foods as well as medical conditions that interfere with normal eating, digestion, or absorption of nutrients, such as gastroesophageal reflux disease (GERD), esophagitis, cystic fibrosis (CF) or other acute and chronic illnesses.2,3

Determining whether a pediatric patient may need EN involves collaborative discussions between the child’s caregivers, the child (if appropriate), and multiple healthcare professionals, often including pediatricians, gastroenterologists, registered dietitians and other specialists involved in the child’s care.

Some medical conditions that prevent children from eating orally include:

  • Weight loss or poor weight gain (resulting in failure to thrive and/or malnutrition) or severe lack of appetite
  • Feeding and swallowing disorders or developmental delays
  • Food allergies
  • Cancer
  • Gastrointestinal issues such as an obstructed bowel, short bowel syndrome, or Crohn’s disease
  • Gastroesophageal reflux disease (GERD) or esophagitis
  • Cystic fibrosis (CF)
  • Neurological disorders including paralysis
  • Recovery from surgery or trauma
  • Other acute and critical illnesses

Once the decision to place a feeding tube is made, an appropriate tube feeding formula is then selected to meet the child's individual needs to promote tolerance and support growth and development.

The types of feeding tubes used to administer enteral formulas are2:

  • Nasogastric tube (NG-tube)
  • Gastrostomy tube (G-tube)
  • Jejunostomy tube (J-tube)

Ongoing collaboration between the child’s healthcare team, including pediatricians/pediatric gastroenterologists, dietitians, physician’s assistants, nurses/nurse practitioners, and speech-language pathologists, is key to managing a pediatric patient’s feeding tube and optimizing the child’s overall well-being and growth.

NUTRITION FOR TUBE-FED CHILDREN

Choosing the right type of nutrition or specific formula for pediatric patients is critical to meeting their nutritional requirements and supporting their overall health and growth. Each child will have their own unique nutritional needs depending on multiple factors, such as age, weight, growth, medical conditions, neurological factors, and developmental stage.

Collaboration between the child’s caregivers and healthcare professionals, including registered dietitians, pediatricians, physician’s assistants, nurses, and speech/language pathologists, is important to select the most suitable formula. The specific formula selected for enteral feeding should provide an appropriate balance of macronutrients (carbohydrates, proteins, fats, fiber) and essential micronutrients (vitamins and minerals).

Considering the lifestyle and quality of life of parents and others caring for their children is also important.3 Ideally, families will have access to options that are convenient, readily available, and promote a positive feeding experience for both the child and their caregivers.

 

PEDIATRIC TUBE FEEDING FORMULAS

There are several types of tube feeding formulas available to meet the unique needs of tube-fed children. Most can tolerate a standard intact protein formula4. However, there are situations in which a standard formula may not be tolerated, or a patient has certain dietary requirements or preferences, and options should be considered.

Nestlé Health Science offers a comprehensive portfolio of high-quality, evidence-based enteral tube feeding formulas to meet the unique needs of pediatric patients. Our portfolio includes standard formulas for normal digestion, peptide-based formulas for easier digestion and absorption, hypoallergenic formulas for food allergies and sensitivities, formulas with food ingredients for variety and tolerance, and commercially blenderized whole food formulas for a more natural feeding experience. These formulas meet the highest standards of nutritional quality, supporting optimal growth, development, and overall improved outcomes.

Standard Formulas

A standard pediatric tube-feeding formula that is designed for children who have normal digestion and absorption. Standard formulas include all of the nutrients required to maintain health. Some standard formulas can be used for both enteral feeding and as an oral supplement. They can contain added ingredients, such as fiber for digestive health and bowel management.

Related Products

Peptide-Based Formulas

Peptide-based formulas differ from standard formulas in that the protein source is hydrolyzed, or broken down into smaller components or peptides.(7) This makes the proteins easier to digest and absorb for patients with GI impairments, including malabsorption, short bowel syndrome, inflammatory bowel disease, cystic fibrosis and other conditions.

Related Products

Formulas with Real Food Ingredients

Tube-feeding formulas with real food ingredients are made from a blend of ingredients such as chicken, grains, vegetables, and fruit. They may be suitable for children who have difficulty digesting or tolerating a standard formula, or for those who will require tube feeding for a long period of time. A formula made with real food ingredients can also help provide more variety.

Related Products

Blenderized Formulas

Blenderized tube feeding (BTF) is the use of blended whole foods. Recent focus on more natural foods has led to increased interest in BTF. Many patients and families choose BTF because of its perceived health benefits, intolerance to commercial feeding formulas, or to normalize the tube feeding experience by offering foods the entire family eats. (5,6) Resources are available to help your caregivers blend nutritionally appropriate recipes for pediatric patients at home. Ready-to-use commercial BTF formulas are also available and have the added benefit offering convenience for those who want a BTF, but cannot prepare their own. Recent studies have demonstrated that commercially blenderized formulas are associated with improved GI tolerance in pediatric patients with chronic conditions such as malnutrition, digestive diseases, cerebral palsy, and seizure disorders. (8)

Related Products

Hypoallergenic Infant & Junior Formulas

Infant formulas, especially those recommended for specialty/medical use, such as hypoallergenic extensively hydrolyzed, or amino acid-based formulas needed for complete nutrition for infants with cow’s milk protein allergy (CMPA) or other food allergies and intolerances or sensitivities.

Related Products

Objectives:
• Identify gastrointestinal (GI) symptoms that show improved outcomes with food-based tube feeding formulas
• Describe real-world evidence demonstrating clinical and health economic outcomes with tube feeding formulas containing real food ingredients
• Apply case-based studies to current practice for managing GI intolerance in pediatric tube-fed patients

Watch now

Objectives:
• Describe normal feeding patterns in children
• Identify common feeding problems in pediatrics
• Explain several strategies to avoid or ameliorate feeding problems
• Describe the differences between feeding problems and a pediatric feeding disorder

Watch now

Objectives:
• Identify common challenges associated with feeding tubes and strategies to avoid such challenges
• Describe key parameters used to assess GI intolerance and identify feeding regimen options to alleviate symptoms
• Describe dos and don’ts when recommending a blenderized or commercially prepared food-based tube feeding

Watch now

Learning Objectives:
1. Explain recently published real world evidence on the clinical and health economic outcomes of utilizing commercially blenderized formulas for tube-fed children and adults.
2. Describe at least two examples of how this recent data will change clinical practice.
3. Apply learnings through a case-based approach to identify how and when to utilize commercially blenderized formulas with tube fed patients.

Watch now

In this presentation, a multidisciplinary panel consisting of a physician assistant specializing in pediatric neurological impairment and complex GI disorders, a dietitian specializing in adult home enteral nutrition support and a pediatric gastroenterologist address evidence and current experience with food-based tube feeding formulas for their patients receiving tube feeding.

Watch now

Nutritional Management of the Medically-Complex Pediatric Outpatient Receiving Food-Based Tube Feeding.

This presentation focuses on the efficacy of real food-based tube feeding formulas through a review of the recent literature, highlighting the results of a recent tolerance study, and providing a case-based approach to describe pediatric patients with impaired GI function who demonstrated positive outcomes from receiving this type of formula.

Watch now

References:

  1. https://www.merckmanuals.com/professional/nutritional-disorders/nutritional-support/enteral-tube-nutrition
  2. https://www.nutritioncare.org/about_clinical_nutrition/what_is_enteral_nutrition/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788946/
  4. McClave SA, Taylor BE, Martindale RG, et. Al., Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient; Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 2016;40:159-211.
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6575127/#:~:text=the%20feeding%20tube.-,Blenderized%20tube%20feeding%20(BTF)%20is%20defined%20as%20the%20use%20of,Table%201)%20%5B1%5D.
  6. Bobo E. Reemergence of blenderized tube feedings: exploring the evidence. Nutr Clin Pract. 2016;31(6):730–735. doi: 10.1177/0884533616669703.
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9103110/
  8. Henrikson A et al. Chronic Conditions in Children Receiving Commercially Blenderized Tube Feeding Formula in the Post-Acute Care Setting: Real World Evidence of Clinical and Health Economic Outcomes. J Parenter Enteral Nutr.2023;47(S2):S218.
  9. From 2017 publication in NCP: Mundi MS. “Prevalence of Home Parenteral and Enteral Nutrition in the United States https://aspenjournals.onlinelibrary.wiley.com/doi/full/10.1177/0884533617718472