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Tube Feeding Routes of Delivery and Selection of Continuous vs. Intermittent Feedings

The enteral nutrition delivery route chosen is highly individualized and dependent upon the anticipated duration of the tube feeding as well as individualized tolerance and the child's medical history. The predominant routes of enteral nutrition include:

  • Nasogastric (NG) and Orogastric (OG) - usually for short term (< 3 months)
  • Gastrostomy (Surgical or Percutaneous Endoscopic Gastrostomy)
  • Transpyloric Feedings -may be better tolerated in patients with head injuries (studies not definitive) or those who are at high risk for aspiration; in pancreatitis patients best to feed naso-jejunally beyond the ligament of Treitz

Selection of Continuous vs. Intermittent Feedings in Pediatric Patients
Tube feedings can be administered via continuous drip using a pump or via intermittent feedings, using gravity drip or a pump.

Continuous versus Intermittent Feedings

Continuous Feedings
Intermittent Tube Feedings
Better tolerated than intermittent or bolus delivery particularly in patients with limited absorptive surface area results in less reflux, dumping and diarrhea.

Better tolerated in critically ill children. In the PICU, best to start with a continuous schedule and to progress to intermittent schedule once clinical status is improved.

Recommended for delivery of nutrients directly into the small bowel.

Recommended for preterm or term infants with persistent feeding intolerance, significant respiratory instability or significant gut resection.

Useful for overnight nasogastric for children with chronic diseases i.e. renal disease, CF, CHD.

 More physiological and practical for home enteral feedings.

Indicated for children who are more medically stable, have achieved full tolerance of continuous feedings and are ready to transition to a more intermittent schedule.

Allows for greater patient mobility, more appropriate for both the rehab and the home setting.

Promotes cyclic bursts of GI hormones such as gastrin in preterm infants, thus promoting GI development and maturation.