Is your tube-fed child dehydrated?

6 signs to monitor, plus tips to ensure adequate fluid intake.

When it comes to tube feeding, calorie consumption is often the primary goal — especially if your child has difficulty gaining weight. But to ensure proper enteral nutrition, dietary experts say it’s essential to provide the right balance of calories and hydration.1

Maintaining sufficient hydration levels is critical because water is fundamental to all bodily functions, enabling it to perform vital roles.2 For example, water aids in metabolism and digestion, transporting nutrients and waste products between major internal organs in the body.2 It also helps to regulate body temperature and lubricate moving parts. Studies show that mild dehydration (fluid loss of 1-3%) can impair energy levels and mood, and lead to major reductions in memory and brain performance.2 Dehydration also affects overall development in children.1 Researchers have demonstrated a relationship between low fluid intake and cognitive performance.2

6 signs of dehydration in children with feeding tubes.1

Reduced urine output
Increased thirst
Urine that’s dark yellow in color or has a strong odor
Dry skin
Dry mouth
Dizziness

What if your child shows signs of dehydration?3

  • Notify your healthcare professional immediately if your child has experienced vomiting, fever or diarrhea for more than 24 hours.
  • Keep a journal to record daily nutrition and fluid intake, as well as color and odor of urine.
  • Consult your physician or dietitian to help you reassess your fluid-to-nutrition ratio.
  • Don’t let dehydration persist.

How much fluid is necessary?

Your doctor or dietitian will determine the right level of hydration for your child. They’ll develop a plan to help you monitor and calculate daily fluid intake. But here are some instances to keep in mind, which may require an increase in fluids:1

  • Transitioning from formula to blenderized foods, different forms of nutrition contain varying amounts of water.
  • The higher the calories per ounce in formula, the less free water. If you increase calories per ounce, you need to add more water to the diet.
  • Bowel movements are impacted by hydration. Lack of fluids can cause constipation. If that occurs, more water may be necessary.
  • When it’s hot outside, or your child is active and sweating, they may require additional water

Fluid guidelines at a glance.

Although exact hydration needs are determined by your doctor or dietitian, this pediatric chart provides an example of how much fluid intake is recommended based on a child’s weight.1*

What is free water?

The term “free water,” also known as “feed water,” is the amount of water listed on the ingredient label of an enteral nutrition source, such as blenderized food or formula.5 This water is counted toward a patient’s fluid needs. Free water should not be confused with water flushes, which is additional water provided to clear the feeding tube or mix with medications, for example.3

How much fluid does formula provide?
Even though formula is a liquid, it isn’t 100% water. For example, baby formula (20 calories per ounce) is about 95% free water, whereas pediatric formula (30 calories per ounce) is about 85% free water. For adults and children, more calorically dense formulas contain less water, so you’ll need to supplement more water to prevent dehydration. 1

What about blenderized foods?
Real, blenderized foods typically contain less water than formula. However, they also provide more wholesome nutrition and less sugar, which can help strengthen one’s immune system.4Kitchen Blends blenderized meals are a healthy source of complete nutrition and hydration. See the chart on the left for the percentage of free water in each of the three recipes.

Want to learn more? Download this fact sheet.

Here are some helpful tips to achieve the right balance of hydration with blenderized meals:

  • Try administering a water bolus about 30 minutes prior to a meal to prepare the stomach for feeding.
  • Foods that are liquids at room temperature, such as sherbet, gelatin and ice cream can contribute to daily fluid requirements

Hydration is essential to a healthy tube-fed diet. Watch for signs of dehydration and rely on your doctor or dietitian to ensure your child is receiving sufficient fluid intake


*Always seek medical advice before changing any part of your daily food or water intake.

REFERENCES. 1. Feeding Tube Awareness Foundation, Calories and Hydration: https://www.feedingtubeawareness.org/calories-and-hydration. 2. Gibson-Moore, H. Improving Hydration in Children: A Sensible Guide. British Nutrition Foundation: https://onlinelibrary.wiley.com/doi/pdf/10.1111/nbu.12028. 3. Free Water in Tube Feeding Formulas, Visual Veggies: https://visualveggies.com/free-water-in-tube-feeding-formulas. 4. Weeks, Caroline, RDN, LD. Home Blenderized Tube Feeding: A Practical Guide for Clinical Practice: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6602605.5. DaVita Kidney Care: https://www.davita.com/diet-nutrition/articles/basics/food-that-counts-as-fluid-on-the-kidney-diet. All sources accessed April 17, 2020.

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