When to Consider Enteral Nutrition

Enteral nutrition should be considered when safety is compromised or growth remains inadequate despite oral nutrition support interventions. There are multiple indications for enteral nutrition, however, they are generally comprised of three categories: inadequate oral intake, airway protection, or inadequate intestinal function (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015).

Inadequate oral intake:

• increased nutrient needs, e.g. cystic fibrosis, lung disease, congenital heart disease, renal disease, infection, surgery, burns, trauma, malnutrition (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015)
• developmental, e.g. prematurity, prolonged neonatal intubation, neuromuscular disorder, neurological impairment (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015)
• behavioural, e.g. feeding aversion, unpalatable diet
• anatomical, e.g. cancer, burns, congenital malformation (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015)
• inability to meet >60-80% of individual requirements for > 10 days; consider initiating enteral nutrition in children < 1 year within 3 days, and within 5 days for children > 1 year (ESPGHAN Committee, 2010)
• total feeding time in a child with complex care needs > 4-6 hours/day (ESPGHAN Committee, 2010)

• growth faltering, wasting, and stunting (inadequate growth for > 1 month in children < 2 years, > 3 months in children > 2 years; triceps skinfolds < 5th percentile, a decline in height velocity) (ESPGHAN Committee, 2010)

Airway protection:

• anatomical or developmental condition leading to unsafe swallow or aspiration, e.g. neurodevelopmental delay, congenital malformation, vocal cord paralysis (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015)

Inadequate intestinal function:

• malabsorption, e.g. short bowel syndrome, Crohn’s disease, pancreatic insufficiency (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015)