In a previous post (NASPGHAN: Enteral Nutrition for Crohn’s Remission | gutsandgrowth), this blog provided a link to NASPGHAN information on enteral nutrition. Having reviewed this information further, I wanted to post some more information about one of the references which offers a terrific professional-quality 32 minute video (from IWK Health Centre in Canada). This You-tube video on tube feeds provides interviews mostly from kids/family members along with some input by physicians and nutritionists; it is a fabulous resource for families weighing the option of tube feeds. Around minute 23, a teen walks through the process of NG placement including advice on taping. Around minute 31, a number of written tips are given like cleaning tubing with vinegar (& then rinsing with water). According to the website there were only 275 views when I had clicked on this. If that is accurate, it is a real shame.
Here’s the link:
Other information from the NASPGHAN handout (which offers CME) in the link above:
- Duration of enteral nutrition to induce remission: 8-12 weeks. Enteral nutrition can induce remission in about 80% and is similar in effectiveness as corticosteroids.
- Caloric needs: typically 120% of recommended daily allowance
- Other foods? usually allowed water or clears like sodas, soup broth, and popsicles. In some studies, up to 10% of energy intake as various other foods have been allowed; however, this creates a lot of difficulty monitoring.
- Maintenance strategies: partial enteral nutrition (nighttime feeds only) can reduce recurrence. More typical approaches included maintenance medication for long-term treatment, or enteral therapy in combination with maintenance medical therapy. Alternatively, maintenance treatment can be instituted with cycles of 1 month exclusive enteral nutrition every few months.
- What type of formula for NG tube? most commonly polymeric formulas
- Refeeding syndrome: in children with severe malnutrition institution of tube feedings should be instituted more slowly over several days with electrolyte monitoring.