What is feed progression?
Feed progression is the process of gradually increasing enteral feeds and introducing solid foods into your child’s diet to help them achieve enteral autonomy and wean them off parenteral nutrition (PN). Enteral feeding is started slowly with small volumes of food and limited food types. Depending on how well your child tolerates feeds, you may be able to increase their feeds and the types of foods in their diet in stages.
Factors to consider when increasing feeds
The following are some of the factors your child’s health-care team will consider when increasing your child’s feeds:
- How much intestine does your child have?
- How quickly does the feed move through the intestine? How long after a feed does your child have a stool in the stoma or from the bum?
- Is your child vomiting?
- Does your child have an enteral feeding tube or are they orally feeding?
Assessing tolerance
To assess if your child is tolerating feeds, you will need to observe their stools carefully.
If you child has a stoma:
If the output from your child’s ostomy becomes more liquid and increases as you increase feeds, this means the feeds are not being well tolerated.
Sometimes, the outputs may increase and get looser for a day or two before going back to what they were before increasing the feeds. For this reason, it is best to continue to give the feeds at the increased rate and volume for two to three days and observe outputs before decreasing back to the previously tolerated rate.
If the output continues to be loose and increases in volume after two or three days, go back to the previously tolerated rate and volume.
Stool output
If stool consistency is soft and pasty, you can increase your child’s feeds.
If stool consistency is liquid and pasty, hold your child’s feeds at the present rate and reassess is 24–48 hours.
If stool consistency is liquid or is soaked into your child’s diaper, consider reducing the rate of feed and discuss medications or formula options with your child’s health-care team.
Vomiting
Some children are sensitive to changes in volume and will need their formula to be fortified to a higher number of calories instead of increasing the volume of feeds. Small volume spit-ups (two or three tablespoons) can be tolerated without stopping feeds.
Progressing from breast milk or formula to solid foods
The general practice is to avoid liquids and give more solid foods as your child progresses from a liquid to a solid diet. This is because solid foods help to slow down and thicken the stools. The following are some considerations for introducing solid foods:
- All foods should be low in sugars.
- It is important to consider whether your child has a large intestine.
- Children with a large intestine benefit from more soluble fibre in the diet.
- All children should have fats added to their foods, especially fats such as olive oils and non-hydrogenated margarines.
It is important to introduce and progress foods carefully so that you can identify any foods that increase stools and remove them from your child’s diet. These foods can be re-introduced at a later date.
Foods are introduced in a staged approach from Stage 1 to Stage 4
Below are some of the foods to choose and foods to avoid during each stage of feed progression. Consult your child's health-care team before beginning each stage to make sure the foods are appropriate for your child. Some of the foods listed below may not be safe for all ages.
To skip ahead to the stage that is relevant to your child, click the appropriate stage number below:
Food selection — Stage 1
*NOTE: All food choices should be age appropriate. Consult your child's dietitian for further details.
Download PDF of Stage 1 food choices
CHOOSE All foods with NO added sugars or sweeteners | AVOID | |
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| Grain products | All white, low-fibre grains
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| Meat and alternatives | Offer cooked & tender
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| Vegetables and fruit | Offer cooked & soft
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| Milk and alternatives |
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| Others |
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Food selection — Stage 2
*NOTE: All food choices should be age appropriate. Consult your child's dietitian for further details.
Download PDF of Stage 2 food choices
CHOOSE All foods with NO added sugars or sweeteners | AVOID | |
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| Grain products | All white, low-fibre grains
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| Meat and alternatives | Offer cooked & tender
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| Vegetables and fruit | Offer cooked & soft
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| Milk and alternatives |
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| Others |
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Food selection — Stage 3
*NOTE: All food choices should be age appropriate. Consult your child's dietitian for further details.
Download PDF of Stage 3 food choices
CHOOSE All foods with NO added sugars or sweeteners | AVOID | |
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| Grain products | All white, low-fibre grains
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| Meat and alternatives | Offer cooked & tender
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| Vegetables and fruit | Offer cooked & soft
The following may be added if you have discussed them with your dietitian:
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| Milk and alternatives |
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| Others |
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Food selection — Stage 4
*Add as tolerated after STAGE 4 foods well established and as age appropriate
Download PDF of Stage 4 food choices
CHOOSE All foods with NO added sugars or sweeteners | AVOID | |
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| Grain products | All white, low-fibre grains
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| Meat and alternatives | Offer cooked & tender
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| Vegetables and fruit | Offer cooked & soft
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| Milk and alternatives |
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| Others |
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