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Childhood Formulas for Children with Disabilities

Formulas designed for children older than one year are sometimes required for children with cerebral palsy and other chronic conditions, either because the child is tube fed, or to supplement nutrition in an underweight child.

Generally after age one, children requiring supplemental or complete nutrition from a formula are changed from an infant formula to one designed to give a better balance of nutrition for the older child. Although childhood formulas are recommended for children ages 1-10, it may be appropriate to continue some teenagers, especially those with severe disabilities, on these formulas because they provide a better ratio of protein to overall calories.

The Medical Home should prescribe sufficient formula so that the child receives adequate calories for growth. This will depend on the age of the child and his/her weight. Weight checks will need to be done at regular intervals to avoid over- and undernutrition. In a child who is eating table food and supplementing with childhood formula, a three day diet recall and a nutrition referral may be helpful to ensure adequate calories, fluids, and micronutient intake.

The correct amount of formula to maintain weight may not be enough to supply the fluid the child needs. The family and physician should monitor that the child receiving childhood formula for complete nutrition maintains adequate fluid intake. Families need to know appropriate management of fluids/feeds in the face of sickness (diarrhea, vomiting, fever) or conditions that increase losses (outings on hot days), including when to contact the Medical Home.

Although all of these formulas are "nutritionally complete", the child needs to receive a minimum of 1000cc per day to meet the recommended daily allowance (RDA) of some of the micro-nutritients in the formulas. If a child's formula intake is less than 1000cc per day, review their dietary needs with a nutritionist. Vitamin or mineral supplementation may be indicated.

Many formulas come two different ways: one for oral feeding and one for tube feeding. The oral feeding preparation has a lot of sugar and other substances added to enhance palatability. This increases osmolality and may make the formula more difficult to tolerate. Many preparations are available with fiber. Some examples of childhood formulas are:
  • Resource Just for Kids, or Resource Just for Kids with Fiber (1 cal/ml) and Resource Just For Kids 1.5 Cal (1.5 cal/mL). For oral or tube feeds. These are complete formulas and can be purchased in a juice box type box.
  • Pediatric Peptinex DT, and Pediatric Peptinex DT with fiber. This is a semi-elemental formula designed for tube feeding, and is useful when other formulas aren't well tolerated.
  • Pediasure and Nutren Jr. - both are semi-synthetic formulas.
  • Nestle Compleat Pediatric - this formula is designed for tube feeding and is made from traditional foods.
  • Peptinex Creamy Drink - designed for oral feeding, 100% peptide and amino acid free, designed for children with impaired digestion.
  • Vivonex Pediatric formula - designed for oral or tube feeding, designed for children ages 1-10. Also 100% amino-acid free.
If the Medical Home is unfamiliar with these formulas, nutrition and gastroenterology referrals may be helpful.

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Authors

Author: Lisa Samson-Fang, MD - 12/2013
Compiled and edited by: Lynne M Kerr, MD, PhD - 12/2013
Content Last Updated: 12/2013