Complementary food introduction practices in infants with intestinal failure

Area of Science:

• Pediatric Nutrition
• Gastroenterology
• Infant Feeding Practices

Background:

• Infants with intestinal failure (IF) often have limited oral intake due to intolerance or feeding difficulties.
• No current guidelines exist for introducing semisolid or solid complementary foods (CFs) to infants with IF.
• Assessing CF intake and caloric contribution is challenging due to malabsorption and incomplete recording in this population.

Purpose of the Study:

• To identify and describe current institutional approaches to introducing CFs to infants with IF.
• To understand the practices of Registered Dietitian/Nutritionists (RDNs) in managing CF introduction for infants with IF.

Main Methods:

• A 10-question online survey was designed by the American Society for Parenteral and Enteral Nutrition (ASPEN) Pediatric Intestinal Failure Section RDN working group.
• The survey assessed RDN practices related to introducing CFs to infants with IF.
• Twenty-six RDNs completed the survey.

Main Results:

• Fifty percent of RDNs recommend introducing CFs between 4 and 6 months of age.
• Seventy-six percent recommend adding pureed foods to gastrostomy tube feedings.
• Specific food recommendations to minimize stool output include green beans, bananas, infant cereals, and meats/protein (92% of respondents).

Conclusions:

• Institutional practices for introducing CFs to infants with IF are inconsistent.
• Similarities were noted in first food choices and foods to avoid.
• Evidence-based guidelines are needed to establish best practices for CF introduction in IF, aiming to reduce stool output, facilitate parenteral nutrition weaning, and achieve enteral autonomy.