Pediatric parenteral nutrition

What is pediatric parenteral nutrition?

Sometimes, a child's digestive system can't process food or absorb nutrients the way it should. Parenteral nutrition gives your child liquid nutrients through a thin tube, also called a catheter. Our expert surgeons and radiologists insert this tube into one of your child’s veins. The tube sends liquid nutrients directly into your child’s bloodstream, bypassing the digestive system.

The liquid nutrients (solution) include proteins, carbohydrates, fats, vitamins and minerals. Our team prescribes the exact mixture based on your child’s specific health needs. The tube delivers the solution into their bloodstream continuously.

Parenteral nutrition is different from enteral nutrition, also called tube feeding, which provides nutrients directly to the stomach for digestion.

What are the different types of pediatric parenteral nutrition?

Depending on their specific health needs, your child might need total parenteral nutrition alone, or in tandem with enteral nutrition. Some children may need total parenteral nutrition for years, or even permanently, if they have a chronic (long-term) condition that affects their ability to digest food.

Our gastroenterology team use different types of catheters in different areas:

• Central line catheters - We place catheters into a large vein in your child’s chest or neck and then through a larger central vein (superior vena cava). This route allows for a larger catheter to deliver higher concentrations of nutrition with more calories. We typically use central lines for parenteral nutrition for infants and children.
• Peripherally inserted central catheter (PICC) lines - These lines go into a smaller, peripheral vein in your child’s arm or leg and then threaded to the larger central vein (superior vena cava). PICC lines can also be used for the delivery of both parenteral nutrition for infants and children.

What are the benefits of pediatric parenteral nutrition?

Parenteral nutrition is a lifesaving feeding method that provides a child with the nutrients and calories they need to grow strong and be healthy.

Your child may need parenteral nutrition if:

• It’s hard for them to move food through the digestive system, or absorb nutrients due to a health condition.
  • short bowel syndrome
  • intestinal failure, malabsorption
  • chronic idiopathic pseudo-obstruction
  • megacystic microcolon intestinal hypoperistalsis syndrome
• A surgery or other treatment has negatively affected how your child digests food.
• They had treatment or surgery on the digestive tract and need time for it to rest and heal

What are the side effects of pediatric parenteral nutrition?

Although rare, side effects can occur with parenteral nutrition.

These may include:

• Line infections, bloodstream infections, or skin infections near the central line
• Liver disease
• Electrolyte or salt imbalances
• Fever

What are the risks of pediatric parenteral nutrition?

To help reduce the risk of complications, our team will provide complete instructions for you and your child’s other caregivers. We explain how to take care of your child’s line and the insertion site, how to administer the nutrition, and what to do in case of an emergency.

Some possible risks of parenteral nutrition:

• Infection - Your child’s care team will explain the signs to watch for, especially fever >/= 100.4 which could indicate bloodstream infection
• Liver disease or damage  - If your child receives total parenteral nutrition for a long time, we will monitor their liver health closely with blood tests.

Contact your child’s doctor right away if your child experiences:

• A temperature of 100.4°F (38.0°C) or higher
• Diarrhea for more than one day
• Shortness of breath or coughing
• Unusual sleepiness, disorientation or confusion

What are Children’s Health’s outcome metrics for pediatric parenteral nutrition?

Children’s Health has over 50 patients on at-home parenteral nutrition. The team closely monitors these children for side effects, like infection or effects on the liver. And they have a very low rate of these effects due to the careful training provided to families by the care team.

What to expect with pediatric parenteral nutrition

Parenteral nutrition requires attaching an intravenous (IV) catheter to your child. These procedures are minor, but it’s important to know how to support your child before, during and after.

What to expect before pediatric parenteral nutrition

One of our surgical experts will place your child’s IV during a short procedure. Your child’s care team will walk you through what your child’s surgical preparation will look like.

To place the IV, your child will need medications called anesthesia. Anesthesia puts your child in a sleep-like state so they are comfortable during the procedure and will not remember it. Your child’s care team will explain how to prepare your child.

What to expect during pediatric parenteral nutrition

Parenteral nutrition involves delivering nutrients directly into your child’s bloodstream using an IV catheter. Doctors work with dietitians and pharmacists to fill an IV bag with a nutrient-rich solution and attach a small tube to carry the solution from the bag to your child’s body.

What to expect after pediatric parenteral nutrition

After our team places an IV for your child, we will give you and your family detailed instructions on how to care for it. Our specially trained gastroenterologists, dietitians and nurses will create an individualized feeding schedule and daily calorie intake for your child. They will also show you how to make sure your child’s IV is working properly.

At first, when your child is in the hospital, doctors will make sure they're getting the right nutrients through parenteral nutrition and that they're gaining weight with the current formula. When your child goes home, they will have lab tests every week to check their health and make any necessary changes to their nutrients. You'll also receive new nutrition IV bags from our team every week, delivered straight to your house.

How do I prepare my child for pediatric parenteral nutrition?

• Supporting your child - Children may be afraid of needles and surgery. Our team will do our best to help your child feel relaxed throughout the process. If your child is old enough to understand how the new nutrition plan will help them, you can help put them at ease by going over those benefits. You can also assure them that they will have anesthesia to help them sleep and feel no pain.
• Prep instruction - If your child receives anesthesia, their care team will explain exactly what you should do to prepare. For example, they will need to stop eating and drinking a certain time before the procedure, and they may need to stop taking medications. Your child’s care team will give you complete preparation instructions that are specific to your child’s treatment, health history and preferences before the procedure.

Child life services for pediatric parenteral nutrition 

Our child life services team helps education children and their families on their parenteral nutrition. The child life experts also help your child emotionally prepare for the procedure, and life with parenteral nutrition.

What questions should I ask my provider about Pediatric Parenteral Nutrition?

• Will my child need to spend the night at the hospital after having an IV placed?
• Are there other treatment options for my child?
• What medications should my child stop taking before starting parenteral nutrition?
• How soon will I be able to see my child after they have their IV placed?