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

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.

Growth parameters

In general, growth should be assessed at each appointment or as per clinic practices

  • weight
  • length or height
  • head circumference
  • weight velocity and z scores
  • monthly (< 2 years of age) to every 3 months (> 2 years of age) *
  • monthly or at clinic
  • monthly or at clinic
  • weekly or monthly

*If clinic visits are less frequent than the parameters above, assess whether this reduced frequency is appropriate.

Intake Parameters


  • oral or enteral intake, energy, protein, vitamins, minerals, fluid
  • monthly

GI tolerance


  • abdominal girth
  • gastric residuals
  • emesis
  • stool
  • ostomy
  • as indicated based on patient report



  • physical exam
  • temperature
  • tube placement
  • tube site care
  • balloon volume
  • medications
  • labs


  • report when > 38.5 degrees
  • prior to each feeding
  • daily
  • when medication changes occur
  • as required

Adapted from (Corkins, Balint, Bobo, Yaworski, & Kuhn, 2015); (Boullata, et al., 2017)