The goal of providing nutrition to a child is to support growth and development. This may come from food or fluid taken by mouth, a tube feeding or sometimes both. A healthy diet is more than just “food” – it provides fuel as well as the building blocks to keep or restore health and to help with healing.

Maintaining a healthy diet and good nutrition is important for everyone, but is crucial to the child who has an illness, is receiving certain medical treatments, is recovering from surgery, or who is not gaining weight and growing like other children the same age. A child’s body may be working extra hard to restore good health, and this may increase his or her nutrient needs. Some children may also have special needs such as digestive problems or food allergies that affect their food or formula choices. Your healthcare professional will consider all of these factors when deciding the type of formula and amount needed each day. Good nutrition is important to support your child’s needs. The nutrients needed by the body include:

• carbohydrates
• fat
• protein
• vitamins
• minerals
• water

These nutrients work together to maintain and build body tissue and provide energy for your child’s body. Normally, these nutrients are provided by eating a variety of foods. However, because of your child’s special needs, he or she is getting their nutrition in a liquid form through a tube.

There are many ways to make sure your child is getting the right types and amounts of nutrients, including:

• Growth charts – tracking weight and height for your child over time
• Blood tests – to see blood levels of certain factors like iron, proteins or blood glucose
• Checking skin, bones, hair and teeth for overall health and development

Your healthcare team will set up a care plan to monitor how your child is doing with their tube feeding, including tracking his or her weight and height to make sure the nutrition in the tube feeding is supporting your child’s growth and overall needs.

Standard formulas are nutritionally complete, designed for children who require tube feeding and have normal digestion. They are designed to contain nutrients required for a growing child between the ages 1 to 13. Standard formulas can be administered through a feeding tube or taken orally; depending on the formulation, product packaging and the persons feeding needs. Some formulas also contain additional ingredients, such as fibre, to support digestive health.
Examples of standard formulas include Nutren® Junior and Resource® Kid Essentials 1.5. Ask your Healthcare professional which formula is right for you.

Ready-To-Use Commercial formulas

Some commercially prepared formulas are made with real food ingredients such as vegetables, fruit, brown rice and chicken, along with added vitamins, minerals, fibre and other nutrients. These formulas may be suitable for adults and children who are looking for a convenient ready-to-use formula that contains real food ingredients that are familiar and recognizable. They are appropriate for both short and long term tube feeding.

Example of real food containing formula is Compleat® Pediatric

Home-made Blenderized tube feeding formulas

Tube feeding formula can also be prepared at home by blending together your own food ingredients. While home-prepared formula can be more economical than commercial formulas, daily preparation may be time-consuming and care must be taken to make sure all nutrient needs are provided, including protein, carbohydrate and fat and important vitamin and minerals. Care must also be taken to follow clean handling, preparation, and storage of the home-blended formula, to help ensure a food-safe final product. Consult with your Healthcare Professional for help and advice for preparing home blenderized tube feed.

Some individuals choose to use a commercial ready to use formula as a base for their homemade blenderized tube feeding recipes. A nutritionally complete formula such as one of the Compleat Pediatric® products may be used as a base for a home-blenderized tube feeding. A variety of other foods, including fruits, vegetables, and a protein source, can then be added to the base and blended together. Benefit of Real Food Ingredients

A formula with real food ingredients, whether commercially prepared or homemade, may help to normalize meal times for you and your loved ones as everyone is consuming easily recognized, real food ingredients.

Ask your Healthcare Professional which formula is right for you.

Like standard formulas, semi-elemental formulas are nutritionally complete. Semi-elemental formulas are different because they contain some nutrients, like protein and fat, which are ‘broken down’ into smaller units to make them easier to digest. This is the reason these formulas are also called “peptide-based” formulas – because “peptides” is the name used to describe smaller units of protein. Some semi-elemental/peptide-based formulas can also be used for both tube feeding and oral feeding, and some contain ingredients, such as fibre.

PEPTAMEN^® Junior is an example of a semi-elemental/peptide-based formula.

Specialized formulas are available for children with particular needs such as Crohn’s disease, multiple food allergies, or those with severe issues digesting fat and protein.

Modulen^® IBD and Vivonex^® Pediatric^® are examples of specialized formulas.

Modular products are individual nutrients that may be added to formula for children who require additional nutrition. Modular products provide extra protein, fat or calories without adding much volume to the formula itself. If modulars are needed, your healthcare professional will teach you how to use them and provide a recipe if needed.

Microlipid, MCT Oil and Beneprotein are examples of modular products.

Tube feeding formulas come in different types of packages:

• Ready-to-use liquids in ‘drink box’ packaging, bottles, or cans
• Powder in a can or small packet that is prepared by mixing with water

All of these formulas are fed using either a syringe or container that the formula is poured into before feeding.

The term “formula hang time” refers to how long a tube feeding formula should remain at room temperature for feeding – after the formula package has been opened or the original package seal has been broken. The following are commonly suggested hang times:

• Up to 8 hours* for ready-to-use liquids
• Up to 4 hours* for powders or formulas that have been mixed with water or other modular products

*Important Note:
Always check with your healthcare professional about the formula hang time for your child’s tube feeding formula. A shorter open-time may be recommended for your child, depending on his/her medical condition.

Do I need to refrigerate my child’s formula before opening?
No. Most often, tube feeding formula is stored and used at room temperature.

If a liquid formula package is opened and not used right away, it should be kept in the refrigerator for up to 24 hours.

• Check the expiry date on the formula. Throw away formula that is past its expiry date.
• Packages that have not been opened can be stored at room temperature.
• Once a formula package is opened it should be used right away OR covered and stored in the refrigerator. Use it within 24 hours. If not used in 24 hours, throw it away.

• Check the expiry date on the formula. Throw away formula that is past its expiry date.
• Store powdered formula in a cool, dry place.
• Check the package to see how long to keep the powdered formula after it is opened.

Should I shake liquid feeding formula before using?

• Yes. Always gently shake unopened liquid formula packages before using.

Do I need to refrigerate my child's formula before opening?

• No. Most often, tube feeding formula is stored and used at room temperature. If a liquid formula package is opened and not used right away, it should be kept in the refrigerator for up to 24 hours.

Will using cold formula upset my child's stomach?

• Cold formula may upset your child's stomach. You can take refrigerated formula out of the refrigerator for 30 minutes to slowly warm up to room temperature before feeding.