Transition from parenteral to enteral nutrition.

Children are unique as their food intake must provide sufficient nutrients not only for the maintenance of body tissues but also for growth. Improvements in techniques for nutritional support has resulted in very long term parenteral nutrition being available for those with chronic intestinal failure in addition to those who require short term parenteral feeding either following surgery or whilst treatment for an underlying enteric disease becomes effective. Parenteral nutrition is required whenever insufficient nutrients cannot be provided enterally to prevent or correct malnutrition or to sustain appropriate growth. Somatic growth is fastest in infancy and puberty but other organs such as the brain may only grow and differentiate at one particular time. When a period of more liberal feeding intervenes catch-up of growth and function occurs. In adolescence the risk is of not achieving growth potential. Timing and methods of weaning from parenteral to normal nutrition remain controversial. In infants and children it is essential to consider carefully whether gastrointestinal function is sufficient for enteral nutrition to adequately support them. Thus the time when the infant and child can be weaned from parenteral nutrition will depend both on the activity of the underlying disease and the age and size of the infant or child.