Trends and challenges in home enteral feeding methods for children with gastrointestinal disorders: an expert review on bolus feeding delivery methods

Figures & data

Table 1. A summary of studies reporting the overall HEN prevalence and indications in children.

Population	Data Collection Period	Overall HEN Prevalence	Indications	Ref
Children from 4 Italian centers	1996 – 2009	No. of cases = 757	Neurogenetic and digestive diseases, followed by congenital heart and lung diseases, chronic renal failure, inborn error of metabolism, liver diseases, and others.	[29]
Children from Southern Italy	2006 – 2012	55 cases in 2006 and 101 in 2008	Neurological (49.4%) Chronic intestinal failure (19.7%) Cancer (12.3%) Others (19.7%).	[30]
Children registered at the national database in Poland	2010 – 2018	743 cases in 2010 to 1875 in 208 Prevalence increased from 104.1 cases in 2010 to 270.3 per million children in 2018.	Neurological (21.9%) Endocrine, nutrition, or metabolic diseases (21.9%) General health conditions (8.6%) Digestive disorders (7.7%) Congenital diseases (4.6%) Lung diseases (0.8%) Cancers (0.6%) Others (33.7%)	[5]
Children registered at the national database in Poland	2010 – 2011	Prevalence increased from 11.34 cases per million in 2010 to 525 per million in 2011.	Neurological (64.2%) Genetic (17.7%) Digestive (5.8%) Cystic fibrosis (3.8%)	[31]
Children from a single center in France	1990 – 2000	416 patients	Digestive disorders (35%) Neuromuscular diseases (35%) Cancer (11%) Failure to thrive (8%).	[21]

Table 2. Types and characteristics of the feeding methods for EN in clinical practice [7].

Feeding Method	Characteristics and Advantages	Disadvantages
Continuous	Delivers formula at a constant rate over 20–24 hours. Usually requires an enteral feeding pump. Often used in critical care settings. Ideal for patients who can’t handle large volumes at once.	Unsuitable for outpatient and home use
Cyclic	Delivers formula over a period of <24 hours. Administered via enteral feeding pump. Often used in critical care settings. Used as a transition phase from the continuous feeding to stimulate the patient’s appetite.	Unsuitable for outpatient and home use
Intermittent	Delivers formula multiple times daily, over 20–60 minutes every 4–6 hours. Administered with or without a pump. Can have breaks in the feeding of ≥6 hours depending on the patient’s needs. Suitable for HEN.	Associated with greater disruption to daily activities and social life. May be associated with difficulty incorporating feed into the daily routine, resulting in missed meals and malnutrition.
Bolus	Delivers formula 3–6 times a day over 4–10 minutes. Closely resembles a normal eating pattern. Typically uses a syringe to deliver the formula. Suitable for HEN. 34.1%-74.4% of adults with HEN were on bolus feeding. 32%-92% of children with HEN.	May be associated with difficulties to fit feeds into daily routines, leading to missed meals and malnutrition. HEN with homemade compound feed can lead to malnutrition. Prolonged handling and manipulation of formula may increase the risk of contamination. Bolus feeding is unsuitable for patients with nausea/vomiting.

Table 3. Description and limitations of bolus feeding delivery methods in clinical practice.

Delivery Method	Description	Limitations
Syringe	Enteral formula is manually pushed through the feeding tube using a large syringe.	Requires significant caregiver involvement and careful handling of equipment and formula. Increased risk of malnutrition if feeds are rushed or skipped due to time constraints or caregiver discomfort. Higher risk of contamination. Requires a level of dexterity and strength. May be unsuitable for patients experiencing nausea/vomiting. Patients are not able to be mobile as the formula can spill
Feeding Pump	Feeding pumps deliver a specific volume of formula at a set rate. They are more precise and can be programmed for convenience.	Less manual handling than syringe methods, but still requires set up and maintenance. Requires pump use and a method of delivery Requires a level of dexterity for setting up, giving set, and feeding pump. Patients are less mobile.

Figure 1. A graphical representation of SimpLink™ system. This new cap-based bolus feeding system is securely fixed onto Nestle Health Science’s SmartFlex™ collapsible semi-rigid bottles allowing secure and convenient administration of formula without the need for open administration through a syringe. SimpLink™ is compatible with ENFit feeding tubes, ensuring a tight connection.

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