Determining When to Use Enteral Feeding

ASSESSMENT

INTERVENTION

EVALUATION/OUTCOME

Anthropometric

Measure and plot on appropriate growth chart. Please see section on Growth Assessment and Anthropometric Measurements.

• Height or length for age
• Weight for age
• Weight for height (or length)
• Head circumference (under 3 yr.)

Consider tube feeding if either of the following:

• Weight loss or no weight gain for 3 months (less for infants and very young children) OR decreased rate of weight gain such that weight percentile has dropped continuously over past 6-12 months.
• Skin fold thickness and arm fat area or indicators of muscle mass have decreased or are below 5th percentile

Caregiver(s) and interdisciplinary team decide either to tube feed, or to continue oral feeding alone with re-evaluation at later specified date.

Measure:

• Triceps skin fold
• Mid-upper arm circumference
• Subscapular skin fold

Calculate:

• Arm muscle area
• Arm fat area

(Note: reference values for these measurements in infancy are questionable. These values may be most useful in older children. Reference values may be found in Frisancho, 1981)

Obtain and plot all previous anthropometrics that are available.

Compare all current measurements to reference data and previous measurements.

Dietary

Assess dietary intake by diet history and food record. See section on Nutrition Assessment.

Assess adequacy of caloric intake based on growth records.

Estimate calorie needs. See section on Energy Needs.

Estimate fluid needs and assess adequacy of fluid intake. See section on Nutritional Intake Expectations.

Consider tube feeding if either of the following:

• Oral feeding providing less than 80% of required calories
• Oral feeding not meeting fluid needs

Feeding

Estimate number of hours per day spent feeding child.

Assess oral-motor skills to determine ability to take solids and liquids. See section on Assessment of Feeding.

Assess ability to swallow to determine risk of aspiration (e.g., videofluoroscopy).

Consider tube feeding if any of the following:

• Caregivers spending more than 4-6 hr/day feeding (less time, if few caregivers)
• Oral-motor skills preventing adequate oral intake of foods in a reasonable length of time
• Risk of aspiration when eating or drinking.

Medical

Obtain the following:

• Medical history
• Review of Systems
• Physical exam
• Supportive laboratory work and/or X ray (individual indications)

Consider tube feeding if any of the following:

• Aspiration pneumonia with or without heart disease or chronic lung disease
• Anatomic abnormality in airway, upper intestinal tract, cranium, or face
• Medical conditions characterized by hypermetabolic state (e.g., cardiopulmonary diseases)
• Neurologic abnormality that prevents efficient oral feeding (Feeding videofluoroscopy may document severity.)