Maintaining Hydration in Enteral Tube Feeding: Tips for Patients and Caregivers

3 Min Read

Some children who have sustained a birth injury may have difficulty feeding themselves and require a feeding tube. Children with feeding tubes have a higher risk of dehydration, so it is imperative to ensure your child is getting enough water.

The Risk of Dehydration With Feeding Tubes

Children with cerebral palsy are more likely to suffer from issues using their mouth, throat, and neck muscles, causing difficulties with chewing and swallowing. Individuals with enteral feeding tubes are unable to drink water orally and must stay hydrated with fluids that are put directly through their tubes.

Hydration is a very important factor in living with a feeding tube and is often forgotten about since feeding tubes primarily focus on caloric intake. This can put children with enteral feeding tubes at a higher risk for dehydration.

Some children who require feeding tubes may not be able to effectively communicate that they are thirsty, increasing their risk of becoming dehydrated.

For these reasons, it is very important that parents and caregivers are maintaining hydration in enteral tube feeding.

What Is an Enteral Feeding Tube?

An enteral feeding tube is a tube inserted directly into the stomach to help aid with feeding. These tubes use powdered formula mixed with liquids to provide children with the nutrition their bodies need. There are several different types of feeding tubes available to your child depending on their specific nutritional needs.

According to the University of North Carolina School of Medicine Department of Pediatrics, different types of feeding tubes include standard gastronomy tubes, low-profile gastrostomy tubes (buttons), non-balloon buttons, jejunostomy tubes, and others.

The tube is installed during a procedure called a gastronomy, during which the device is inserted through the nose and down to the stomach or directly into the stomach wall itself. The scope and duration that the feeding tube is needed for can impact which type of tube your child will need.

Staying Hydrated: Information For Children With Cerebral Palsy

Staying hydrated is a vital factor that impacts our overall health. Water provides our body with essential vitamins and nutrients that help us stay alive. Water soluble vitamins include vitamin B6, vitamin B12, vitamin C, thiamin, riboflavin, niacin, biotin, and more.

Some medications prescribed to treat cerebral palsy can affect your child’s vitamin intake. For example, seizure medications may decrease the amount of vitamins D, K, B6, B12, C, etc. absorbed by the body. Keeping hydrated and replacing these lost vitamins and nutrients is essential in maintaining hydration in enteral tube feeding.

Additionally, water regulates overall body temperature and keeps joints, tissues, and muscles moist to help with movement, according to the Mayo Clinic. Children with cerebral palsy require adequate water intake to hydrate and loosen tight muscles.

How Much Water Does My Child Need?

The amount of water your child requires can vary depending on their specific hydration needs. It is important to take any factors that may decrease your child’s hydration levels into consideration, such as living in a dry, hot climate.

According to the Feeding Tube Awareness Foundation, the algorithm below can help with maintaining hydration in enteral tube feeding.

  • For children up to 22 pounds: ½ cup of water for every pound
  • For children 22 to 44 pounds: 4 ½ cups for first 22 pounds, ¼ cup for every additional pound
  • For children over 44 pounds: 6 ⅓ cups for the first 44 pounds, 1 cup for every additional pound

Some parents may choose to skip pre-packaged feeding tube formulas and opt to prepare their own blended foods for their child. Incorporating foods with high water content can also help your child stay hydrated. According to Cleveland Clinic, foods with the highest water content include cucumbers, celery, zucchini, watermelon, strawberries, iceberg lettuce, and cauliflower.

How Do I Know If My Child Is Getting Enough Water?

To determine if your child is getting enough water, look for symptoms of dehydration:

  • Changes in urine — dark yellow color, strong smell, decreased amounts
  • Constipation
  • Sunken eyes
  • No tears when child is crying
  • Dry membranes in the mouth
  • Irritability, restlessness, lethargy

Cerebral Palsy Feeding Tube Cleaning and Maintenance

An important part in maintaining hydration in enteral tube feeding is flushing. According to Shield Healthcare, regularly flushing your child’s feeding tube with water can help prevent clogging. Flushing the enteral feeding tube is also important because it gives your child an extra dose of water.

Flush the feeding tube before and after every use to ensure all food, formula, and medications are cleared from the tube so they are able to enter your child’s system.

The type of water used to flush your child’s feeding tube can vary by their specific needs:

  • Tap water: Use when flushing a gastrostomy tube. Tap water is safe to use for most enteral feeding tube patients unless specified otherwise.
  • Purified water: Use when flushing a jejunostomy tube, mixing powder formula, diluting medications, or if your child has a weakened immune system.

If you have any additional questions about caring for your child’s birth injury, contact us to learn more information.

Birth Injury Support Team

The Birth Injury Justice Center was founded in 2003 by a team of legal professionals to educate and empower victims and families affected by birth injuries. Our team is devoted to providing you with the best resources and legal information for all types of birth injuries.

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  2. Dehydrated? These 7 Foods Will Satisfy Your Thirst and Hunger. (2020). Cleveland Clinic. Retrieved from https://health.clevelandclinic.org/dehydrated-these-7-foods-will-satisfy-your-thirst-and-hunger/
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