Name of the Procedure:

Enteral Formula, Pediatric, Nutritionally Complete, Calorically Dense (B4160)

• Common names: Pediatric Nutritional Formula, Tube Feeding
• Medical terms: Enteral Nutrition, Enteral Feeding, Nutritionally Complete Formula

Summary

Enteral formula is a liquid food designed specifically for children that provides complete nutrition. This formula is calorically dense — meaning it contains a high-calorie content (0.7 kcal/ml or greater) — and includes essential nutrients such as proteins, fats, carbohydrates, vitamins, and minerals. It can also include fiber and is administered through a tube directly into the stomach or small intestine.

Purpose

Medical Conditions or Problems Addressed:

• Malnutrition or inability to take food orally
• Chronic medical conditions affecting nutrient absorption
• Recovery from surgery or severe illness

Goals or Expected Outcomes:

• Meeting daily nutritional requirements
• Promoting growth and development in pediatric patients
• Improving overall health and recovery rates

Indications

Specific Symptoms or Conditions:

• Difficulty swallowing or eating (dysphagia)
• Chronic illnesses (e.g., cystic fibrosis, gastrointestinal disorders)
• Post-surgical recovery requiring nutritional support

Patient Criteria or Factors:

• Pediatric patients with a medical need for nutritional support
• Inability to consume adequate calories orally
• Medically assessed requirement for nutritional supplementation

Preparation

Pre-procedure Instructions:

• No specific fasting required generally
• Review of current medications and potential adjustments

Diagnostic Tests or Assessments:

• Nutritional assessment
• Gastrointestinal evaluations
• Blood work to check for nutritional deficiencies and overall health

Procedure Description

Step-by-Step Explanation:

1. Assessment: Healthcare provider evaluates the child’s nutritional needs.
2. Preparation: Formula is carefully chosen and prepped according to the nutritional plan.
3. Administration:
   • Nasogastric (NG) tube: Inserted through the nose into the stomach.
   • Gastrostomy (G) tube: Surgically placed directly into the stomach.
4. Feeding: The formula is delivered through the tube either continuously with a pump or in set meal times.

Tools, Equipment, or Technology Used:

• Feeding tubes (NG tube, G tube)
• Feeding pumps (if continuous feeding is required)

Anesthesia or Sedation Details:

• Generally, anesthesia is only needed if a surgical insertion of a feeding tube is required.

Duration

• Feeding sessions can vary from short intervals (20-30 minutes) to continuous 24-hour delivery depending on the patient’s needs.

Setting

• Hospital, outpatient clinic, or home setting with appropriate medical oversight.

Personnel

• Pediatricians
• Dietitians or Nutritionists
• Nurses or clinical staff
• Specialists (e.g., Gastroenterologists, if needed)

Risks and Complications

Common Risks:

• Minor discomfort or nasal irritation (if using NG tube)
• Blockage of the feeding tube
• Gastrointestinal discomfort (bloating, cramping)

Rare Risks:

• Infection at the tube insertion site (for G-tubes)
• Accidental displacement of the tube
• Aspiration pneumonia (if the formula goes into the lungs)

Benefits

• Complete and balanced nutrition tailored to pediatric needs.
• Supports growth and development.
• Helps in recovery from illnesses or surgeries.
• Improved overall health outcomes.

Recovery

Post-Procedure Care and Instructions:

• Regular tube site care to prevent infections.
• Monitoring by healthcare providers for any complications.
• Adjustment of feeding schedules as needed.

Expected Recovery Time:

• Varies based on the underlying condition but immediate nutritional benefits begin with the first use.
• Long-term use may be required depending on the patient's condition.

Restrictions or Follow-Up Appointments:

• Regular follow-ups with healthcare providers.
• Continuous assessment to adjust nutritional needs.

Alternatives

Other Treatment Options:

• Oral nutritional supplements (if oral intake is possible)
• Total parenteral nutrition (intravenous feeding) as a more invasive option.

Pros and Cons:

• Oral Supplements: Easier to administer but may be insufficient for severe cases.
• Total Parenteral Nutrition: Bypasses the digestive system entirely, suitable for severe gastrointestinal issues but has higher risk and complexity.

Patient Experience

During the Procedure:

• Insertion of the NG tube may cause initial discomfort or nasal irritation.
• Continuous feeding might require carrying a portable pump.

Post-Procedure:

• Increased energy and improved growth in pediatric patients.
• Regular monitoring to address any discomfort or complications.

Pain Management and Comfort Measures:

• Local anesthesia for surgical tube insertions.
• Ongoing care to minimize discomfort and ensure the tube is functioning correctly.