Transition Home and from Program when on Enteral Feeds

For infants, children, and youth on enteral feeds, the transition to home continues to require a collaborative, interdisciplinary approach. The child’s primary medical team works with the home enteral nutrition support program to provide support, and is ultimately responsible for the child’s enteral nutrition follow-up care. Each Eating Feeding Swallowing program may have their own criteria for admission or discharge to the program. When possible prior to discharge, the original goals of care and intervention should be reviewed. If a mutual understanding between family and caregiver determines that all goals have been sufficiently met, then the child/family may be discharged from the program. With respect to home enteral nutrition support programs, this may occur when the enteral tube is removed. For nasoenterically-fed children, there may be a grace period to ensure that the tube can remain out to confirm that program service is no longer required. With gastrostomy type tubes, discharge may occur at the time of removal, or once the stoma has closed. If a child is exclusively consuming a formula by mouth, they also will be discharged from the home enteral program. See See Table 18.

Table 18: Sample Checklist for Preparation of Transition Home for Pediatric Patients Receiving Home Enteral Nutrition

Patient assessment

 
  • medically stable to transition home
  • exhibits tolerance to current feeding regimen
  • anticipate tolerance to home progression of feeds
  • family willingness to continue HEN
  • suitable home environment to provide safe enteral feeding care, e.g. clean water supply, area for preparation, a means to communicate with care team and order supplies
  • language considerations

Caregiver education

 
  • identification of caregivers
  • development of training schedule
  • completion of stay in hospital for 48-72 hours (to demonstrate care)
  • education on feeding tube care and troubleshooting
  • education on assessment of feeding tolerance
  • education on formula preparation and feeding schedule
  • education on use of feeding pump if applicable

Planning for transition home

 
  • identification of primary physician to manage enteral nutrition for regular follow up
  • communication with primary physician of clinical status
  • initial post-transition home appointment set
  • family knows who to contact with which issues and has appropriate contact information
  • coordination of clinic appointments, home care, early intervention, school services, and therapies as applicable

Adapted from Sevilla & McElhanon, 2016