Establishing Home Enteral Nutrition (HEN)

The provision of enteral nutrition in the home setting is called Home Enteral Nutrition (HEN). HEN allows enterally fed hospital patients, who are otherwise medically stable, to be discharged into the community (ACI Nutrition Network, 2012); (Western Child Health Network, 2013).

The aims of HEN include provision of effective nutritional support, promotion of patient and family autonomy, ensuring safe maintenance of nutritional support, and maximizing the potential for improved lifestyle and optimized disease management (ESPGHAN Committee, 2010). When transitioning between care environments, consider how the enteral feeding plan is best communicated, ensure the enteral nutrition prescription and regimen is documented, and communicate the enteral nutrition regimen to the accepting care team (Boullata, et al., 2017).

Parent comfort, confidence, education and demonstration of appropriate administration of enteral feeds is paramount to a successful transition home. Parents need a clear understanding of the nutrition support plan including formula type, method of administration, feeding regimen, route, duration of therapy, information for reordering supplies, and how to contact their interdisciplinary team. They should be taught about their child’s tube type, insertion technique, care for the feeding tube, tube related complications, and assessment skills to troubleshoot problems that may arise such as tube dislodgement (Sevilla & McElhanon, 2016) (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015).

Creating a positive feeding experience while administering enteral feeds is equally as important as with oral feeding. Normalize the tube feeding environment as much as possible to mimic a typical oral feeding situation.

Some examples:

• encourage parents to provide infant skin-to-skin care, hold and, or position their infant or child to facilitate social interaction at tube feeding times
• if tube feeding is a pleasant experience for the child, commence the tube feed at the start of the meal or oral experience to promote the association between satiation and positive oral experiences
• respond to signs of discomfort during tube feeding by giving the child a break, venting or stopping the feed
• if not distressing to the child, eat in front of them, so they are able to observe normal eating function
• if safe to do so, offer a drop of warmed expressed breastmilk, formula or puree on the infant’s or child’s lip to promote licking and sucking response during tube feeding to help the child organize for oral feeding