Section 4: Management of Tube Feedings

For some children, an oral intake is not adequate to meet nutrient needs. Sometimes, a child cannot eat safely. Other times, a child cannot consume enough because of increased needs, oral-motor problems, or fatigue. The nutrient needs of these children are often met with non-oral enteral feedings (tube feedings).

Sometimes, tube feedings are used for short periods of time (e.g., after surgery or recovery from an acute illness).

Tube feedings are also needed long-term (e.g., because of oral-motor problems or risk of aspiration because of swallowing difficulties).

Indications for tube feeding can include:

• Inability to consume more than 80% of energy or 90% of fluid needs by mouth
• Malnutrition (e.g., as evidenced by serum albumin, skinfold measurements, weight, stature)
• Repeated upper airway infections (indicating aspiration)
• History of gastroesophageal reflux that cannot be managed with medications

Management of tube feedings involves a team of health care professionals with experience with tube feeding and children with special health care needs. Coordination between the child’s family, primary care physician, the physician who placed the tube, a registered dietitian, and the home infusion company is critical.

This section reviews some basic information about tube feeding and presents some tools for assessment.