Monitoring Enteral Nutrition
Monitoring should be child specific based on age, disease, severity of illness, degree of malnutrition, and metabolic stress. A quarterly assessment for all enteral nutrition patient populations is recommended as a minimum (Boullata, et al., 2017). Monitoring should include evaluation of growth and nutrition adequacy, tolerance of feed type and delivery, as well as oral feeding readiness and/or progression, to guide revisions to the enteral feeding plan (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015). A physical exam and medication review are also recommended. Although lab monitoring may be recommended as part of inpatient care, it is not routinely indicated in the outpatient clinics/community setting for medically stable children who are tolerating their feeds and growing well. Targeted laboratory investigations may be needed based on disease state or if a nutrition-focused physical exam identifies signs of nutrient excess or deficiency. Ongoing monitoring with adjustments should be made towards achieving both long and short-term goals. See routine monitoring parameters in Table 16 (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015). These recommendations do not apply to children on home parenteral nutrition who also have enteral nutrition.
Table 16: Parameters for Monitoring Enteral Nutrition
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Parameters for Monitoring Outpatient Enteral Nutrition With or Without Oral Intake Reassess the home tube fed patient at least quarterly, considering patient acuity and progression of clinical care. |
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Growth parameters In general, growth should be assessed at each appointment or as per clinic practices |
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*If clinic visits are less frequent than the parameters above, assess whether this reduced frequency is appropriate. |
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Intake Parameters |
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GI tolerance |
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Physical |
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Adapted from (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015); (Boullata, et al., 2017)
