enteral feedings

  1. My question is related to a pediatric home health case that I do. The child is 12 years old and NPO, on Gt feedings QID. She has a hx of Sz disorder, encephalopathy, CP and reflux. The main issue is her wt. gain. It is has been very hard over the past 2 years to get wt. on her. She gets 38oz. of Ensure/Ensure Plus (mixed) and is having a really hard time tolerating anymore. As we try to gradually increase the amt., she has more episodes of reflux--a lot of gagging with occasional emesis. I thought I remembered hearing about something that you could add to the Gt feedings, some type of additive to help boost calories. Does anyone know of such a product or have any suggestions. Thanks
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  2. 12 Comments

  3. by   Jolie
    I've never worked with a child this old, but in the NICU, we sometimes add Polycose and/or Medium Chain Triglyceride (MCT) Oil to the feedings of babies with poor weight gain, alternating one or the other with each feeding to boost the caloric intake. They are usually pretty well tolerated and don't add too much volume. I'm sorry, I don't recall the usual starting dose, but you could look it up in a Neofax.

    Do you have access to a Pediatric Dietician? If so, I'm sure she could make some more suggestions. Good luck to you and your little patient!
  4. by   nur20
    Also another procedure that helps with the reflux. You didn't mention whether the child gets bolus feedings or by pump.Decreasing the rate of the pump. Can receive same amount over a longer period of time seems to help greatly. Also making sure the child is not overly active during feeding times. REGLAN seems to help greatly given 30 min. before feedings, also maybe a change of formula or med times may help
  5. by   canoehead
    Would overnight continuous feedings in addition to the QID be helpful? You could start with a small amt and increase if tolerated.
  6. by   PhantomRN
    What about Promod powder it is a rich source of protein supplement that we add to peoples diets who have a difficult time putting on weight.
  7. by   kids
    I have an 11 yo girl on case load with the *exact* same problem, except has Retts instead of CP. She failed a Nisson. She has never tolerated bolus feedings at all and it was very marginal using a pump, and not at all if we added any suppliments (ie; Promod, Polycose or microlipids). We recently switched her to Boost 1:1 Nutrin Jr. with fiber. If she is prone to reflux w/ or w/o aspiration stay away from the oily additives...can cause an ugly pneumonia.

    Also, I esta-guessed the kCals your kid is getting and its only about 1700/day...which I think is just enough to barely maintain but not gain any weight.

    Good luck
    -nancy
  8. by   Jackie8087RN
    After all, I finally remembered the additive that I was thinking of--Sustacal. I remember adding it to some pedisure on another homecare case that I worked. Does anyone have any experience with sustacal (the powder that you can add)? And, no, nightime feedings are not in the plan right now. Thanks for any input.
  9. by   nurs4kids
    Jackie,
    We use the sustacal, occassionally, but quite honestly the dietician does that figuring, so I'm clueless about it. Still sounds like the answer would be night feeds, though. Also, why did this child not get a fundo when she got the GT, to prevent the emesis/reflux?? How about adding some Carnation IB (just a thought, I'm no nutritionist by any means!! lol)


    Nancy,
    How about a Redo Nissan? Many of our kids will take the second time around. Normally, they do the first ones laparoscopic, and if it fails, they do an open.


    tracy
  10. by   kids
    Originally posted by nurs4kids
    Nancy,
    How about a Redo Nissan? Many of our kids will take the second time around. Normally, they do the first ones laparoscopic, and if it fails, they do an open.
    tracy
    Wow, I don't think I've heard of them doing anything but an open Nisson on the kids out here-the pediatric gastros say the fail rate is to high in kids to do it lap or endo, I really with they would give some of the kids a chance at the 'less invasive' method anyway- I feel like there less to lose and a lot to gain. They do a lot of adults endo or lap out here tho. Poor kid is a poor post-op recoverer, reserves are so low she had to gain some weight feeding through the GT (yeah, right) so they would place a JT to feed her post op on the last Nisson. Surgery was 6 weeks ago and she still has unhealed spots on her incision (no infection thank goodness). She does seem to be handling the Boost Hi-Energy 1:1 Nutrin Jr for the time being.

    The general pattern I've been seeing is: if they are urpers pre-op it 'cures' them, if they are projectile pukers it makes them urpers (unless its a complete failure). Some kids just wretch and gag and nothing comes up, all you can do is vent the heck out of their GT and give them TLC.

    Poor kids, vomiting aside-reflux hurts.

    -nancy
  11. by   nurs4kids
    Wow, nancy. One of our docs was, I BELIEVE, the first one to do it lap, went out to Houston and was in on the research, so perhaps he's perfected it somewhat. They do most of ours lap and honestly have a very low failure rate. Amazing how different things are done in different parts of country.
  12. by   kids
    Thanks for the input, amazingly even with the OHSU/Doernbeckers/Shriners network we have so close by some fields are slow to pick up on some technologies. My kids and my general surgeon was the first in the area to do lap chole & appy. He has since moved 'back home' to TN.

    -nancy
  13. by   PammieRN
    I work at a long term care center for children. There are various things we do.

    1. Find a good pediatric nutritionist. They are the experts.
    2. We do use the MCT oil and sustical.
    3. For children who have reflux problems, their feeds are overnight continuous at a VERY slow rate.
    4. We have one child who has a very labile blood glucose level. If it gets high, he has a lot of emesis. You may want to evaluate that.
    5. We have another who was switched to a j-peg. This bypasses the stomach completely and his feedings are also very low rate and continuous overnight.

    Hope this helps....

    Pammie
  14. by   semstr
    we give these kids jpegs too. No problems anymore, well in the first few days you have to watch for diarrhea and change the proteins.

    Take care, Renee

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enteral feedings