What is Enteral Feeding?
A way to provide food/nutrition through a tube placed in the nose, the stomach, or the small intestine. Enteral feedings are indicated for infant/children who are unable to ingest an adequate amount of nutrition orally. This may include; who are unconscious, unable to swallow, ventilated, transitioning from parenteral nutrition, or have a primary aspiration.
A tube in the nose is called a nasogastric tube (NG) or nasoenteral tube. A tube that goes through the skin into the stomach is called a gastrostomy (GT). It may be placed there using a technique called percutaneous endoscopic gastrostomy (PEG). A tube into the small intestine is called a jejunostomy (JT). It may be placed there using a technique called percutaneous endoscopic jejunostomy (PEJ).
The most common method of enteral feeding delivery for infant/children is an enteral feeding pump, which controls delivery.
Complications of enteral feeding
- Bacterial contamination of enteral feeding tubes can cause a serious infection. Administration sets and feed containers should be discarded every 24 hours to minimize the risk of infection.
Gastroesophageal reflux and aspiration
- Reflux occurs frequently with enteral feeding, in patients with impaired consciousness, poor gag reflex and when fed in a supine (i.e. face up) position. Patients should be propped up by at least 30° whilst feeding and should remain in that position for a further 30 minutes to minimize the risk of aspiration. Post-pyloric tubes should be used in an unconscious patient who need to be nursed flat.
- Reflux is more likely with accumulation of gastric residues. Gastric aspirates should be measured regularly and the feeding regimen altered or prokinetics added to reduce gastric pooling.
- Gut motility and absorption are promoted by hormones released during mastication (i.e. chewing), with coordinated stomach emptying and the presence of intraluminal nutrients.
- As the usual physiological mechanisms are bypassed during enteral feeding, gastrointestinal symptoms such as abdominal bloating, cramps, nausea, diarrhea and constipation are common.
- Symptoms may respond to reduced feed administration rates, continuous rather than bolus feeding, alternative feed preparation or the addition of prokinetic agents
Monitoring should include the general observations, particularly if your child is at high risk of refeeding syndrome.
Consideration should also be given to:
- Gastrostomy and jejunostomy stoma sites, should be checked each day for tube position and signs of infection.
Types of Enteral Feeding Machines (shown below)