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MyTubeFeeding.ca | Feeding Intolerance & Problem Solving

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Feeding Intolerance
& Problem Solving

• What is feeding intolerance?
• Problem solving

Feeding intolerance

When you first start a tube feeding, it may take a few days for your body to adjust to the formula and feeding routine. But there are times, when you simply may not tolerate the feeding formula you have been asked to use – you may feel unwell and cannot take all of your formula each day. This can become a problem if you are not able to get the nutrition and water you need, or if you are having unpleasant symptoms that make you feel unwell. Feeding intolerance is often talked about by the signs or symptoms people have – which may vary from feeling full and having a swollen belly (abdomen) to vomiting or diarrhea. Being on a tube feeding does not mean that you should feel uncomfortable during or after you take your formula.

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Problem solving

Sometimes you may experience problems when tube feeding. This section provides information about some of the more common problems, possible causes and some steps you may take. The information provided here is not intended to replace the advice or instruction of your healthcare professionals, or to substitute medical care. If you have a problem, or have more questions, be sure to talk to your healthcare professional.

Problem

Nausea and/or Vomiting and/or Reflux (feeling like your stomach contents are coming back up into your throat)

Possible cause

  • Feeding too quickly
  • Slow digestion in the stomach
  • Other stomach/digestive problems or illness

What to consider

  • Slow or stop the feed until you are comfortable. If needed, delay the next feeding by 15-20 minutes and restart slowly.*
  • Slow down feed rate*
  • Sit upright or lie at a 45-degree angle (about the height of three pillows) during the feeding and for 30 to 60 minutes after the feeding. Do not lie flat during or just after a feeding.
  • Check with your healthcare professional to see if you should change to a special formula that may be easier to digest and absorb
  • Speak to your healthcare professional if this problem continues

* If you have slowed your formula flow rate this may reduce the amount of formula, water and nutrition you are getting. Check with your healthcare professional if you are not able to return to your original rate after 1 or 2 days and you are unable to get the amount of formula and water indicated in your feeding schedule.

Problem

Diarrhea (frequent, loose, watery or liquid stools)

Possible cause

  • Medication side effects
  • Formula is being fed too fast
  • No fibre, or not enough fibre, in your formula
  • Intolerance to the formula
  • You may have another illness, e.g. flu or infection
  • Your feeding tube may have moved out of place

What to consider

  • Talk to your doctor or pharmacist about your medications
  • Slow down the feeding rate*
  • Do not use formula that has been opened and left at room temperature for longer than recommended on the formula label
  • Do not use formula that has been opened and left in the fridge for longer than 24 hours
  • Wash your hands well, and use clean supplies/equipment
  • Replace your feeding container and tubing as directed by your healthcare professional
  • Check with your healthcare professional about changing to a formula that has fibre
  • Check with your healthcare professional to see if you should change to a special formula that may be easier to digest and absorb
  • Speak to your healthcare professional if this problem continues for more than 2 days

* If you have slowed your formula flow rate this may reduce the amount of formula, water and nutrition you are getting. Check with your healthcare professional if you are not able to return to your original rate after 1 or 2 days and you are unable to get the amount of formula and water indicated in your feeding schedule.

Bloating/Cramps/Feeling of fullness

Problem

Bloating or swollen belly/ abdomen; Stomach cramps; Feeling of fullness

Possible cause

  • Formula is being fed too fast
  • Formula is too cold
  • Too much formula
  • Lying flat while taking the feeding
  • Exercising or too much activity right after a feeding
  • Intolerance to the formula

What to consider

  • Slow down the feeding rate*
  • Use stored, unopened formula at room temperature for feedings. If you have opened formula in the refrigerator, remove for 30 minutes before feeding.
  • Make sure you are taking the right amount of formula and/or feeding rate
  • Sit upright or lie at a 45-degree angle (about the height of three pillows) during the feeding and for 30 to 60 minutes after the feeding. Do not lie flat during or just after a feeding.
  • Ask your healthcare professional to review your formula. You may need to switch to a formula that has more calories in less volume or to a special formula that may be easier to digest and absorb.

* If you have slowed your formula flow rate this may reduce the amount of formula, water and nutrition you are getting. Check with your healthcare professional if you are not able to return to your original rate after 1 or 2 days and you are unable to get the amount of formula and water indicated in your feeding schedule.

Problem

Constipation (bowel movements occur less than usual or are hard, dry and painful or difficult to pass)

Possible cause

  • You are not taking enough fluid or water
  • No fibre, or not enough fibre, in your formula
  • Not enough exercise or activity
  • Medications

What to consider

  • Take more water through your feeding tube if advised by your healthcare professional
  • Check with your doctor or dietitian to see if you should change to a formula that contains enough fibre
  • Be more active - if this is possible (check with your doctor)
  • Talk to your doctor or pharmacist about your medications

Problem

Dehydration (the amount of water in the body has dropped below the level needed for normal body function); Passing less urine/dark yellow urine; Feeling thirsty

Possible cause

  • You are not taking enough fluid or water
  • Illness with diarrhea, fever, heavy sweating

What to consider

  • Make sure you are taking the right amount of water every day before and after your feedings
  • Talk to your healthcare professional to make sure you are getting the right amount of water each day

Problem

Gaining weight quickly (more than 5 pounds or 2 kg per week)

Possible cause

  • You may be getting too much fluid or water
  • You may be getting too much formula

What to consider

  • Make sure you are taking the right amount of formula and water every day
  • Talk to your healthcare professional to see if you need to change the amount of formula and water each day

Possible cause

  • You may not be getting enough calories

What to consider

  • Make sure you are taking the right amount of formula every day
  • Talk to your healthcare professional to see if you need to change the amount or type of formula you are taking

Sudden Coughing/Trouble Breathing

Problem

Aspiration (breathing in foods or liquids into the airway or lungs);

Sudden coughing or trouble breathing during feeding or right after feeding

Possible cause

  • Your formula may be coming back up from your stomach and it could be breathed into your lungs
  • Lying flat during feeding
  • Illness such as a chest infection or pneumonia

What to consider

  • Sit upright or lie at a 45-degree angle (about the height of three pillows) during the feeding and for 30 to 60 minutes after the feeding. Do not lie flat during or just after a feeding.
  • If symptoms continue, call your doctor or go to the hospital

Problem

Blocked feeding tube or formula will not run through the feeding tube

Possible cause

  • There may be a kink or bend in your feeding tube or the feeding set
  • Formula or medication may have blocked the tube

What to consider

  • Check the feeding tube and feeding set to make sure the tubing is not bent or kinked
  • Flush the tube with warm water before and after feeding or medications
  • Do not give pureed foods or other liquids through the tube before talking with your health care professional
  • Do not mix anything new into the formula without consulting your health care professional
  • Use only liquid or finely crushed medicine dissolved in water
  • If your tube is blocked, do not try to remove the blockage yourself. Consult with your healthcare professional for advice on what to do next.

Problem

Feeding tube falls out

Possible cause

  • Your tube may have come out by accident

What to consider

  • Cover the opening with a clean cloth or towel (if you have a gastrostomy or jejunostomy tube which goes directly in through your skin into your stomach or small intestine)
  • Call your healthcare professional or go to the nearest emergency department with your feeding tube

Helpful Tip

Helpful Tip

helpful

POSTURE MATTERS: Try not to lie flat during or just after a feeding. Sit upright or lie at a 45-degree angle (about the height of three pillows) during a feeding and for 30 to 60 minutes after the feeding to help prevent nausea or reflux.

Helpful Tip

Helpful Tip

tips

KEEP A DIARY: to help you and your healthcare professional keep track of your progress and any questions you might have.

Helpful Tip

Helpful Tip

helpful

PLAN AHEAD: If you will be traveling away from home, plan ahead. Leave early to allow plenty of time and bring extras of all your supplies. Find out if and where you can get supplies or formula at your destination and know the location of the nearest hospital, in case you need it.

OWN YOUR FEEDING TUBE:
 Learn how to use and live with your feeding tube in this five-part video series with Gunnar Esiason.

Nestlé Health Science has made every effort to include on this website only information that it believes to be accurate and reliable. This site contains information from a variety of sources including practice-based resources, guidelines from professional organizations, and experiences of healthcare professionals who have managed patients on home tube feeding. Information provided on this site is for education purposes. It is not intended to replace the advice or instruction of your healthcare professionals, or to substitute medical care. Contact a qualified healthcare professional if you have any questions regarding your tube feeding product, prescription and supplies, or if you have a specific question or issues about what is best for you as you manage your tube feeding at home.

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