Formula selection for children and adolescents

Indications	Formula description	Age	Examples (listed alphabetically, not comprehensive)
Intact gut	0.67 to 1.3 kcal/mL Intact carbohydrate, protein, and fat Polymeric Usually isotonic Contain fiber	1 to 11 years	Standard: Boost Kid Essentials, Nutren Jr, PediaSure, PediaSure Reduced Calorie^* Blenderized (homogenized food)^¶: Compleat Organic Blends, Nourish, RealFood Blends
Intact gut		≥12 years	Standard: Boost, Ensure, Nutren 1.0, Osmolite Blenderized^¶: Real Food Blends, Compleat Organic Blends, Nourish, Liquid Hope
Lactose intolerance	1 to 1.2 kcal/mL Intact carbohydrate, protein, and fat Polymeric Most are isotonic Lactose free	1 to 11 years	Boost Kid Essentials, Nutren Jr, PediaSure, PediaSure Reduced Calorie^*
Lactose intolerance		≥12 years	Boost, Ensure, Nutren 1.0, Osmolite
Diarrhea, constipation, or expected long-term use	1 to 1.2 kcal/mL Intact carbohydrate, protein, and fat Polymeric Most are isotonic Lactose free Contain fiber	1 to 11 years	Boost Kid Essentials with fiber, Nutren Jr with fiber, PediaSure with fiber
Diarrhea, constipation, or expected long-term use		≥12 years	Boost with fiber, Ensure, Jevity, Nutren 1.0 with fiber
Increased protein needs	1 to 1.2 kcal/mL Contain approximately 30% more protein than standard versions Intact carbohydrate, protein, and fat Polymeric Usually isotonic Lactose free	≥12 years	Boost High Protein, Ensure High Protein, IsoSource HN, Osmolite HN, Promote, Nutren Replete Contain fiber: FiberSource HN, Jevity Plus, Promote with fiber, Nutren Replete with fiber
Volume restriction (calorie dense)	May contain MCT oil May contain increased protein May have higher osmolalities Most contain intact carbohydrate and protein Polymeric Lactose free Available with and without fiber	1 to 11 years	1.5 kcal/mL: Boost Kid Essentials 1.5, Pediasure 1.5
Volume restriction (calorie dense)		≥12 years	1.5 kcal/mL: Ensure Plus, IsoSource 1.5, Nutren 1.5, Osmolite 1.5, Jevity 1.5 (with fiber only), Glucerna 1.5 2 kcal/mL: Novasource Renal 2.0, Nutren 2.0, TwoCal
Hypermetabolism	1 to 1.5 kcal/mL May have higher osmolalities May be low fat May contain MCT May contain increased protein May contain some amino acids thought to be conditionally essential (eg, glutamine, arginine) May contain fish oil Lactose free May contain fiber	1 to 11 years	Hydrolyzed protein: Pepdite Jr, Peptamen Jr, Peptamen Jr 1.5, Pediasure Peptide 1.0, Pediasure Peptide 1.5
Hypermetabolism		≥12 years	Polymeric: Impact, Impact with fiber, Impact 1.5, TraumaCal Hydrolyzed protein: Crucial, Perative, Vital 1.0 cal, Vital 1.5 cal, Pivot 1.5, Optimental, Peptamen, Peptamen 1.5
Impaired digestion or impaired gut perfusion	0.8 to 1.0 kcal/mL Free amino acids ("elemental") May have higher osmolalities May contain MCT oil May be low fat May contain increased protein Lactose free Most are fiber free	1 to 11 years	Elecare Jr, Neocate Jr, Vivonex Pediatric, EO28 Splash
Impaired digestion or impaired gut perfusion		≥12 years	Tolerex, Vivonex Plus, Vivonex TEN, Vivonex RTF

MCT: medium-chain triglycerides.

* Reduced-calorie formulas (eg, 0.6 kcal/mL) may be useful for children with reduced calorie requirements. By contrast, reducing calorie intake by feeding diluted or lower volumes of standard formulas may result in suboptimal micronutrient provision.

¶ Commercial blenderized formulas may or may not be nutritionally complete (ie, they meet estimated needs for energy and all macro- and micronutrients, when provided in the appropriate volume for the patient's age group). When these formulas are used, an expert clinician should review the composition and determine if the diet meets the child's estimated needs for all nutrients and fluid.

Graphic 53184 Version 11.0

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Formula selection for children and adolescents