One of the first signs of illness can be feed intolerance. Coughing, retching, vomiting, and irritability can start before the fever or other signs of obvious illness.
When we are sick, we do not eat the same way. The body slows down and so does digestion and motility. We tend to eat less and focus on staying hydrated. It is the same for our children who are tube fed. Tube feeds need to be adjusted when children are sick.
The focus needs to be on hydration, not calories. This can be painful when your child is failure to thrive. But, keeping calories the same is likely to result in additional vomiting and loss of both nutrition and hydration.
If your child isn’t tolerating feeds, a good starting point is at 50% formula and 50% hydration solution, like Pedialyte. We recommend not using sports drinks because added sugars can make other symptoms of the illness, like diarrhea, worse. For older children, you may be able to dilute with water if they aren’t experiencing as much vomiting and diarrhea.
Very often you need to slow feeds down. Whether you are continuous or bolus feeding, you likely will need to run feeds for longer than you usually do. If your child is running a fever, you may also need to add additional free water to maintain hydration. This can be done in the form of water flushes throughout the day.
If you are using a blenderized diet, consider the foods you include in your blend. Stick to the basics of what you would eat while you are sick. Avoid foods that are harder to digest, like dairy and oils.
There can be some trial and error. If your child still isn’t tolerating 50% of his calories, you may opt to go to 100% Pedialyte and/or water and slow feeds down further.
If you are J feeding, you may not have to make as many modifications. However, you may still need to lower calories and increase hydration. If you see increased retching and vomiting, you may have to vent or drain the G-port more often.
It can take a week or so for full motility (how food moves through the GI tract) to return to normal – it can be longer depending on the severity of the illness. You can increase calories and return to the normal schedule as tolerated.
When to Call Your Doctor
If you are new to this and this is the first illness your child had since tube feeding, you should discuss changes in the feeding regimen with the doctor managing your child’s feeds.
If your child is getting dehydrated, you should definitely see your child’s doctor. Watch for these signs of dehydration:
- Dry mouth
- Sleepiness or tiredness
- Decreased urine output or no wet diapers for three hours for infants
- Few or no tears when crying
- Dry skin
- Headache, dizziness, or lightheadedness
Children with blood sugar issues, hypoglycemia, or children who cannot have Pedialyte should have a protocol in place for when they are sick and not tolerating feeds. Some children need additional dextrose during illnesses.
It should go without saying, but call your doctor if your child needs to be seen because of the illness itself. This may be a visit to the regular pediatrician, rather than a specialist.