How to Feed Infants with Heart Disease

Given by Linda Leatherbury MD, Ped. Cardiology - Sept 96

Introduction: Babies with heart disease, and particularly with heart failure, require up to 130-150 calories/kg/day. If calories are given early, babies can gain early, before signs of actual heart failure appear. (often at 4-6 weeks of age).

Methods of getting more calories into children with heart disease:

1. Preparation of higher calorie formulas:

A. Infants

24 calorie per ounce: mix the usual 13 ounces of formula with 9 ounces of water
28 calories per ounce: mix 1 tsp of polycose powder/ every 2 ounces of formula e.g. of the 13 plus 9 ounces in the 24-calorie formula (22-oz) add 11-tsp polycose.or:
27 calories per ounce: mix 2 tsp of MCT Oil (7 cals/cc) to 22 oz above 24 cal. prep.
30 calories per ounce: mix 4 tsp of MCT Oil to 22 oz of above 24-calorie preparation

There is no advantage to try more than 30 calories/ounce and babies will usually not take more than 150 cals/kg/day.

MCT Oil, Corn Oil, and Polycose Powder: which to use when:

MCT Oil: 7 cals/cc (WIC will not always pay for this, but mixes better than corn oil)
Corn Oil: 8.4 cals/cc (not recommended because of poor mixing)
Polycose Powder: 7 calories/teaspoon.

B. Older Children: May give Pediasure (has iron in it; 30 calories/ounce); If this is rejected can give Carnation Instant Breakfast to children age’s 4-5 years.

2. G Tube or NG Tube Feedings: The decision whether or not to use these procedures should be made by the pediatric cardiologists: not the generalist.

Indications for procedures:

inability of gaining weight despite trying the above high calorie formulas
work of eating is so much that losing weight from that activity due to energy expenditure.

Night-Time feedings by tube: Never send a baby home on more than 7 feedings/day. Sleep-deprived parents cannot keep up with such a schedule.

Risks of NG Tube: aspiration pneumonia; at MCG we have had several children aspirate while being given NG tube feedings. children never learn to eat properly: This is an important issue, because some children get imprinted on the type of feeding they are exposed to. If never asked to take in po fluids or foods, the children may never learn to take anything by mouth. There is a 4 year old in the hospital at this time who fits this description.

Key Point: Even if children require G tube or NG tube, these children should be offered bolus feedings by mouth in addition to what is given by tube. While fewer calories go in this way at first, ultimately this can be an important determinant of whether children learn to eat.

3. High Calorie Solid Foods: At the appropriate age to start solids, give only high calorie foods such as sweet potatoes and bananas (90 cals/jar). Never put cereal in bottles of heart babies.

Department of Pediatrics | Medical College of Georgia
Please email comments, suggestions or questions to:
John T. Benjamin M.D., jbenj@mcg.edu

February 27, 2004

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