APPENDIX 10: Tube Feeding Schedules/Regimens for Enteral Feeding

Defined as feeding for 24 hours continuously via an enteral feeding pump which allows for an accurate, slow and steady infusion.

Advantages:

Disadvantages:

• can improve feeding tolerance and reduce complications (e.g. diarrhea, vomiting, abdominal distension, bloating, and gastroparesis)
• can increase feeding tolerance for patient with volume sensitivity that manifests as discomfort or retching
• enhanced absorption for patients with decreased absorptive surface area
• decreased risk of aspiration
• preferred method when transpyloric feeding is required
• preferred in patients with significant vomiting and high risk for aspiration, with jejunal tube to prevent aspiration and achieve maximum caloric intake
• for older children using ready-to-use closed systems there is less handling of the formula and pump

• psychosocial impact of 24-hour continuous feeding in the home setting on not only the parent or caregiver but also the family dynamic
• reduced mobility for some children due to physical attachment to the feeding apparatus
• difficulty managing and supervising overnight feeds; disruption to sleep
• can be difficult with children who are mobile during the day
• expense of equipment (pump, feeding containers or bags)
• pumps require a power source or charged battery
• more equipment to maintain and clean than bolus feeding; physically demanding
• continuous feed interruption when maximum safe hang times for feeds are reached; potential risk of formula contamination if hang time is exceeded
• hunger suppression that may limit oral feeding progression

Defined as continuous infusion delivered over a shorter period or periods of time during the day and or night, usually ranging from eight to 18 hours. Can be given by feeding pump for consistent rate of delivery. Volume provided will vary, depending upon the child’s requirements and the duration of infusion.

Advantages:

Disadvantages:

• allows greater patient mobility
• allows breaks for physical activity
• administration of medications that are incompatible with feeds
• encouraging oral intake if applicable
• can be flexible to suit the child and/or parent’s lifestyle and improve quality of life
• may be more psychologically acceptable
• useful in the transition from continuous to bolus feeding, or from tube feeding to oral intake
• beneficial to supplement bolus feeding in children with smaller gastric capacity and increased risk of gastroesophageal reflux

• expense of equipment (pump, feeding containers or bags)
• more equipment to maintain and clean than bolus feeding
• potential risk of formula contamination if maximum safe hang times are exceeded
• larger hourly volumes or higher infusion rate, when compared to continuous feeding may be poorly tolerated in some children
• may increase risk of reflux, aspiration, abdominal distension, diarrhea and nausea due to higher infusion rate
• pumps require a power source or charged battery

Defined as rapid administration of a measured amount of feed/water by syringe or gravity bag.

May be administered via feeding pump when a more consistent rate of delivery is required for tolerance if gravity has been trialed first.

Bolus or intermittent feeds are given at intervals throughout the day, usually over 15 to 60 minutes each. Slow transition from full volume continuous feeds to intermittent feeds allows optimal tolerance, e.g. progression from continuous feeds to every two hours, then every three hours, etc. to a desired feed schedule is appropriate.

Bolus feeding is generally only administered via the stomach, which has the reservoir capacity to tolerate a large volume. The child must have a competent esophageal sphincter and be able to protect their airway adequately to minimize the aspiration risk associated with larger feed volumes and faster administration rates.

Advantages:

Disadvantages:

• more physiologically similar to a typical eating pattern
• allows greater patient mobility
• convenient for gastrostomy feeding
• can be used to supplement oral intake
• can be used in conjunction with other administration methods
• can be flexible to suit the child’s lifestyle
• may facilitate transition to oral intake
• less expensive as a pump and gravity sets are not required
• lower risk of microbiological contamination
• power source is not required
• can be administered by syringe

• generally not suitable for transpyloric feeding as may induce diarrhea or dumping syndrome
• may be more time intensive for parents or caregivers compared to continuous pump feeding
• highest risk of aspiration, reflux, abdominal distension

Gravity feeds can be used to administer small volume bolus, or intermittent feeds.

This method involves estimating the drip rate and adjusting it to administer the desired volume of feed in a desired amount of time.

Advantages:

Disadvantages:

• power source is not required
• feeding pump is not required

• less accurate measurement and control of feeding rate
• potential reduced mobility due to physical attachment to the formula bottle, container, or bag

Estimated Drip Rates

For example:

To calculate the drip rate to deliver 1200 mL over 14 hours (840 minutes).

Infusion sets are calibrated for a drop factor of 14.