Pediatric Nutrition in Practice

Enteral Nutrition for Paediatric Inflammatory Bowel Disease 241

3

with a variety of both polymeric (usually high-
fat) and elemental (usually low-fat) formulae
suggests that efficacy does not depend solely on
fat content.
For those determined to drink the liquid diet,
a polymeric formula must be used because of its
greater palatability. If the formula is to be admin-
istered by NG tube, its palatability becomes un-
important. Given the inf luence of fat content on
efficacy, a conventional elemental liquid diet (low
fat content) may offer some therapeutic advan-

tage. The treatment benefit of a low-fat compared

with a conventional polymeric diet is admittedly

small [3].

Duration of EEN

The required duration of EEN has not been well

defined. Improvements in clinical and laboratory

parameters occur quickly, often by 2 weeks, but

the optimal time for achievement of mucosal

healing has not been established. Most gastroen-

terologists suggest continuing the therapy for a

Ta b l e 1. Proposed protocol for the initiation of EEN

Initial rate of feeds Start with half of the target hourly volume and give continuously over

24 h

Increasing feeds Increase by 10 ml/h every 3 – 6 h, depending on symptoms

Cycling feeds Decrease the overall feed duration by 2 – 3 h every day; the rate is

determined by the total volume to be given over the desired number of

hours

Final goal of feeds The maximum rate is usually 6 – 8 ml/kg/h; the final duration of feeding

is 10 – 14 h

Ta b l e 2. Sample protocol for reintroduction of solid foods

Day of

introduction

Type of food Examples

1 – 4 Grains; low fibre White flour bread, crackers, pasta, rice

Hot cereal: cream of wheat

Cold cereal (low fat, low fibre)

5 – 9 Meat, fish and

alternatives;

low fibre, low fat

Plain (not fried, not processed) lamb, veal, beef, pork,

chicken, turkey

Fish (low fat)

Tofu

Eggs

10 – 14 Fruits and vegetables;

low fibre, low fat

Raw fruits without skin/seeds

Canned fruits without skin/seeds

Cooked vegetables without skin/seeds

15 – 17 Dairy; low fat Milk, yogurt, cheese

18 Regular diet Slowly increasing fat and fibre content based on

tolerance

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 239–243
DOI: 10.1159/000360345