Calories and hydration can go hand-in-hand when you are talking about tube feeding. When your child is labeled failure to thrive, all your focus goes on calories and weight gain. However, you should also be mindful of how much water or fluid your child is getting.

This page provides general information about how many calories your child should be receiving, as well as how much water he or she needs.

Caloric Intake

Caloric intake depends one a number of factors including the size of the child, if the child needs to catch up on weight gain, if the child should maintain weight, the activity level of the child, the child’s condition, how the child is fed, and the child’s diet. Caloric intake for a child who is tube fed doesn’t always match up to ranges recommended for typical children who eat orally. A child who is less active may require fewer calories. A child who has a medical condition that burns through calories more quickly may require far more calories.

Commonly, children with feeding tubes may vomit, reflux, or have diarrhea and frequent stools. These are considered “losses” of calories, and must be accounted for.

There isn’t a standard number of calories that a child of a certain age or weight should be getting. We recommend working with a dietitian (or your GI team) to work out the right amount of calories for your child. Make sure you understand how many calories your child should be getting each day, particularly if your child is also eating some calories orally.

Keep in mind that weight gain is a function of caloric intake. If your child isn’t gaining weight as he should, then you should discuss his caloric intake with your medical professionals. In many cases, the diet needs to be adjusted relatively often because children grow. Moreover, if your child is taking in enough calories (and keeping them in) to gain weight, but isn’t gaining, there could be a medical reason for the lack of weight gain that should be explored.


Hydration can easily be forgotten when the focus is on calories and weight gain. However, hydration is very important because it impacts how the body functions. Not getting enough fluids can lead to increased vomiting and constipation, and it can also affect kidney function and overall development.

Ask your medical professionals how you should be monitoring and calculating hydration. Even though formula is a liquid, it isn’t 100% water. Baby formula (20 calories per ounce) is about 95% free water, whereas pediatric formula (30 calorie per ounce) is about 85% free water.

If you are doing a blended diet of real foods, it may be difficult to calculate the water content. Often, you need to add additional fluids to the diet, keeping in mind what the diet would be if the child wasn’t tube fed.

There are some general guidelines out there to give you a ballpark of hydration needs:

Weight Fluid Amount
Up to 10kg 100ml for every kilo
10kg – 20kg 1000ml for the first 10kg, 50ml for every additional kg
20kg + 1500ml for the first 20kg, 20ml for every additional kg


There are some common sense considerations to hydration:

  • The higher the calories per ounce in the formula, the less free water. If you increase calories per ounce, you need to make sure that you add more water to the diet.
  • Bowel movements are impacted by hydration. If your child does not get enough fluids, your child can get constipated. If your child is having issues with constipation, you may need to add more water to the diet.
  • When it is hot out, a child has participated in a lot of activity, or is sweaty, she may require more water. Think of the times you get more thirsty; it isn’t much different for your child.
  • If you live in a hot or dry climate, your child may need more water.

Signs of Dehydration

  • Reduced amount of urine, which is also dark yellow in color
  • Dry membranes in the mouth
  • No tears when crying
  • Sunken eyes
  • Restlessness, irritability, lethargy, strong smelling urine


MyFitnessPal to keep track of calories
Fluid Requirements in Children from Complex Child
Signs of Dehydration from the Mayo Clinic