Choosing the Best Enteral Nutrition Formula for Your Child

You’re on a new tube-feeding journey, and we’re here to help you navigate all the different formula options and nutrition information. There are many types of enteral formulas available, so if your child isn’t responding well to the first or second formula they try, know there are many options you and your healthcare team can explore. For example, some families find that using a plant-based formula helps decrease GI symptoms. If your child is having trouble tolerating their formula, let your healthcare team know as soon as possible so you can adjust accordingly.

Below you’ll find information about common characteristics of enteral formulas to help you better understand your child’s formula.

Calorie concentration.

Pediatric formulas for ages 1 and up are available in different calorie concentrations: less than 1.0, 1.0, 1.2, and 1.5 calories per milliliter. A higher calorie concentration means more calories per container. Example: 8 oz (240 mL) of a formula that has 1.0 calories/mL provides 240 calories. The same amount of a 1.5 calorie/mL formula provides 360 calories.

Your healthcare provider may recommend a lower or higher calorie concentration, depending on your child’s calorie and fluid needs. You might also use a formula with a higher calorie concentration to reduce feeding time while still meeting your child’s nutrition needs.

Protein type.

Protein helps repair and build cells, and it’s an important component for growth and development. Enteral formulas contain protein in various forms: intact, hydrolyzed, and elemental. We like to use a metaphor of a string of pearls to explain the difference between the three different forms of protein.

• Intact protein formula (aka standard formula): The protein has not been broken down — it remains a “long strand of pearls.” This type of formula would be used if digestion and absorption are not impaired.

• Hydrolyzed formula (aka peptide formula): The protein is partially broken down (partially hydrolyzed) into smaller chains, or a “smaller strand of pearls.” This type of formula is sometimes recommended if digestion or absorption is impaired, or if an intact/standard formula isn’t tolerated.

• Elemental formula (aka amino acid formula): The protein is completely broken down into its simplest form: individual amino acids, or “individual pearls.” This type of formula may be recommended if a peptide formula is not tolerated.

Protein source, fiber content, and taste.

The protein you’ll find in enteral formulas typically comes from either animal-based sources, like milk (sometimes listed in the ingredients as casein or whey), or plant-based sources, such as pea or soy. Food allergies or intolerances to milk or soy may play a role in which formula you and your healthcare team decide on.

Fiber is important to support normal bowel function. Talk to your healthcare team if your child’s formula does not contain fiber.  

Even though your child is using a feeding tube to get their nutrients, taste is still important! They may “taste” the formula while burping it up or smell it when you open the container, so keep in mind that taste still matters.

Blended formulas. 

Blended formulas provide a way to include more whole foods in your child’s diet. Some people use them to help with symptoms of intolerance associated with conventional formulas. They can be used alone or combined with other types of formula.

Commercially prepared blended formulas are available with intact or hydrolyzed protein. Whether you’re making blenderized tube feeding recipes at home or using a commercial blended formula, be sure to work with your healthcare team to make sure your child’s nutrition needs are met.

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