What is enteral nutrition?
Enteral nutrition is any method of feeding that uses the gastrointestinal (GI) tract to deliver nutrition to your child. It can include food given through their mouth or through a feeding tube.
Enteral nutrition in intestinal failure
Enteral nutrition is important in caring for a child with intestinal failure for a few reasons:
- The more enteral nutrition you provide to your child, whether by mouth or by a feeding tube, the better their intestine can grow and adapt to absorbing nutrients via the GI tract.
- Some parts of the intestine are better able to absorb nutrients than others. Therefore, your child’s intestine may absorb some nutrients more than others, depending on the part of the intestine that your child is missing or had removed. Each child will have a personalized enteral nutrition feeding plan based on their bowel length and diagnosis.
- Enteral nutrition helps the intestines adapt to taking in nutrition and absorb the nutrients from food via the gut. This helps to wean your child off parenteral nutrition, if they are receiving it, and protect the liver from overworking.
- It provides vital nutrients for growth and development.
It is important to start giving your child foods through the mouth as soon as it is safe and they are able to tolerate them. This will help your child develop normal eating habits and wean off parenteral nutrition, if they are receiving it. Foods that are offered by mouth should be those that will help the intestine to grow and develop, such as foods that are low in sugar.
Key nutrients
Whether your child is eating through their mouth or a feeding tube, it is important that their diet include the following nutrients.
Protein
Amino acids are the most broken-down form of protein. The protein source in elemental formulas is in the form of amino acids. This type of protein can be helpful for children with gastrointestinal disorders or allergies. However, your child may not always require a predigested protein and this may change as they get older.
Fat
Fats play an important role in helping the intestine adapt. There are two main types of fats: long chain triglycerides (LCTs) and medium chain triglycerides (MCTs). LCTs are the most helpful nutrients to help the intestine to grow and absorb more nutrients, followed by protein. However, LCTs may not be absorbed well. MCTs are absorbed better but can cause loose stools. Your child’s enteral nutrition will need to have the right balance between LCTs and MCTs.
Carbohydrate
Carbohydrates break down in the body into simple sugars, like glucose, and complex sugars, like fibre. Children with intestinal failure often cannot tolerate simple sugars. Simple sugars need to be kept to a minimum in enteral nutrition. Soluble fibres that dissolve in water are beneficial to help the intestine to grow and absorb nutrients, but they are most beneficial to children with a functioning large intestine.
Micronutrient supplementation
A significant portion of children with intestinal failure require micronutrient supplementation for months to life. The most common supplements required are vitamins D, B12 and E. The most common minerals are iron, calcium, selenium and zinc.
Other important principles
Enteral nutrition for babies with intestinal failure
When possible, breast milk is the preferred food for children aged 0–6 months. If breast milk is not available or your child cannot tolerate it, a special formula (called elemental formula) that is already broken down and predigested may be prescribed by the health-care team. Once your child’s intestine adapts, your child may be able to transition to a regular formula.
Fluid intake
In children with intestinal failure, fluid intake is closely monitored and controlled as fluids can change stool output. When giving your child fluids, keeping the following in mind:
- All liquids containing simple sugars should be avoided (e.g., juice, soda, etc.).
- You may give your child water based on their tolerance to it, but an oral electrolyte solution is preferred.
- Lactose is not well digested by children with intestinal failure. Cow’s milk should be avoided for a period of time until it is established that your child can tolerate some lactose. Lactose-free milk may be recommended by your health-care team as an alternative.