Pediatric Nutrition in Practice

Enteral Nutritional Support 153

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Ta b l e 2. Clinical indications for pediatric EN

1 Inadequate oral intake

Disorders of sucking and swallowing: prematurity, cleft lip and palate, neuromuscular

impairment (e.g. cerebral palsy, myopathies)

Congenital abnormalities of the upper gastrointestinal tract: tracheoesophageal fistula

Tumors of oral cavity, head and neck cancer

Trauma and extensive facial burns

Critical illness: coma, mechanical ventilation

Severe gastroesophageal reflux

Psychiatric disorders: food aversion, anorexia, depression

2 Disorders of digestion and absorption

Cystic fibrosis

Short bowel syndrome

Inflammatory bowel disease

Malabsorption syndrome due to food intolerances and allergy

Enteritis due to chronic infection (Giardia lamblia, protozoa, etc.)

Protracted diarrhea in infancy

Pancreatic insufficiencies

Severe primary or acquired immunodeficiency

Chronic liver disease

Graft-versus-host disease

Intestinal fistulae

Disorders of gastrointestinal motility with pseudo-obstruction

3 Increased nutritional requirements and losses

Cystic fibrosis

Chronic solid organ diseases: renal, heart, liver, lungs

Multiple trauma, extensive burns

4 Growth failure or chronic malnutrition (in addition to the above)

Nonorganic failure

Food deprivation

5 Altered metabolism and metabolic inborn errors

6 Primary disease management (e.g. Crohn’s disease)

Ta b l e 1. Suggested criteria for EN support for children with sufficiently preserved gut function [1, 2]

Insufficient oral intake

Inability to meet 60 – 80% of individual requirements for >10 days

Total time of feeding a disabled child of >4 – 6 h/day

Wasting and stunting

Inadequate growth or weight gain for >1 month below the age of 2 years

Weight loss/no weight gain for >3 months above the age of 2 years

Change in weight-for-age or weight-for-height over 2 growth channels

Triceps skinfolds consistently at <5th percentile for age

Treatment of disease

Metabolic diseases (galactosemia, primary lactose intolerance, etc.)

Food allergy in infants (cow’s milk protein allergy, multiple food allergy, etc.)

Crohn’s disease

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 152–157
DOI: 10.1159/000360330