Enteral Formulas for Pediatric Patients
Criteria for considering enteral nutrition for children:
 Unable to meet 80% of energy needs by mouth
 Minimal or no weight gain for 3 months
 Documented weight loss over 3-month period
 Weight/height ratio decreased to below the 5th percentile
 Triceps skinfold below the 5th percentile
 Total oral feeding time more than 4 to 6 hours/day
 Impaired assimilation or delivery of nutrients
 Oral aversion
 Mechanical problems with chewing, swallowing, or peristalsis
Tube feeding routes can include:
 Orogastric
 Nasogastric
 Gastrostomy
 Nasojejunal
 Gastrojejunal
 Jejunostomy
Indications for selection of route
Length of time the feeding is used vs permanent enteral access.
Short-Term Feeding
Nasogastric
Nasojejunal
Orogastric
Permanent Enteral Access
Gastrostomy
Gastrojejunal
Jejunostomy
Indications for enteral tube feeding
The following are conditions that may require or justify enteral nutrition support:
 Prematurity
 Respiratory distress
 Congenital anomalies of the heart (coronary heart disease)
 Cystic fibrosis
 Neurological disorders
 Burns
 Malignancies
 Gastrointestinal disorders
 Short gut syndrome
 Chronic diarrhea
 Biliary atresia
 Inflammatory bowel disease
 Hypermetabolic states
 Inborn errors of metabolism
 Renal diseases
Age of patient
 If patient is younger than 1 year of age, use infant formulas to a dilution of 20
kilocalories/fluid ounce
 If patient is within 1 to 10 years of age, use enteral formulas designed for pediatric
patients
 If patient is older than 11 years of age, use adult enteral formulas
Formulas
A variety of formulas are available for infant and pediatric enteral nutrition. The different
types of feeding include:
 Human milk: From mothers who breastfeed or express milk or from human milk
banks; used for preterm and full-term infants
 Human milk fortifiers: Added to human milk to meet nutrient needs for premature or
low-birth-weight infants
 Preterm formulas: Contain higher amounts of protein, vitamins, and minerals
 Preterm discharge formulas: For the continued feeding of preterm infants
 Milk protein-based formulas: For infants birth to 1 year
 Soy protein-based formulas: For infants birth to 2 years with allergy or intolerance to
cow’s milk; lactose free, so able to use with inborn errors of metabolism such as
galactosemia
 Semi-elemental formulas: Hypoallergenic formulas for infants to 1 year of age who
are sensitive to intact proteins in milk- and soy-based formulas
 Elemental formulas: Amino acid-based formula for infants and young children with
severe allergy to intact protein
 Formulas for older babies: Milk protein-based, nutritionally complete
 Oral electrolyte maintenance solutions: For infants and children to replace fluids and
electrolytes lost during diarrhea and vomiting
Information on specific feedings for infants and children are available from the
manufacturers of these products:
 Abbott Nutrition: http://abbottnutrition.com/our-products/brands.aspx
 Mead Johnson: http://www.meadjohnson.com/Brands/Pages/Products-by-Need.aspx
 Nestlé Nutrition: http://www.nestlenutrition.com/Products/Category.aspx?CategoryId=4d17c252-63e8-4b99-91cc18e380a6c645
 Nutricia: https://www.neocate.com/shop/c-6-nutriciacategory.aspx?gclid=CN3g_ImW6LUCFQ4GnQodljMACA
References and recommended readings
Florida Dietetic Association. Manual of Medical Nutrition Therapy: The Florida Diet
Manual 2012 Edition. Tallahassee, FL: Florida Dietetic Association; 2012.
Pediatric Nutrition Care Manual®. Academy of Nutrition and Dietetics Web site [by
subscription]. https://www.nutritioncaremanual.org/index.cfm. Accessed May 9, 2013.
Review Date 5/13
K-0532