What challenges will my loved one face with nutrition and eating after severe TBI?
Right after a brain injury, the body often needs lots of calories and protein. Individuals lose muscle mass because their brain is not working like it used to and because they aren’t moving and using their muscles. Many people with brain injuries lose weight after their injury.
Severe brain injury can impair your loved one’s ability to recognize when they have food or drink in their mouth — and their ability to chew and swallow. This can put your loved one at risk for food and drink going into their lungs instead of their stomach.
They may need a different way to get the nutrition they need to recover. Meeting the caloric and nutritional needs of a recovering brain requires a different approach, and it can take time to get the right kinds of nutrition.
What do I do if my loved one cannot eat by mouth?
When a person is not able to eat enough food, they can be fed by a tube placed into the stomach or small bowel. Shortly after their injury, the feeding tube may be put into the stomach through their nose. This is called a naso-gastric tube. If your loved one needs supplemental feeding for a longer period of time, your doctors may recommend a feeding tube that is placed directly into the stomach. This is called a gastric tube. It is through these feeding tubes that liquid nutrition or nutrition formulas can be provided to give your loved one the calories they need to support recovery.
There are many types and brands of tube-feeding formulas to make sure the person is getting everything their body needs to get better. The best one will be determined by your doctor or a dietician. Early on, it is sometimes hard to find the one that is going to work the best; and the process is often trial and error based on how your loved one is tolerating the feeding.
How will I know if my loved is not tolerating tube feeding?
For about 50% of severe brain injury patients, it has been shown that they have trouble tolerating any type of tube feeding. If this is the case, the patient may have signs of:
- Vomiting
- Abdominal/stomach distension
- Slowed ability to empty the stomach
- Reflux
Studies show that there is a link between the central nervous system and the stomach not functioning well from severe brain injury. Your doctors will monitor these issues and provide appropriate medical interventions.
When will my loved one receive their tube feeding?
There are many ways that tube feeding is given; and, again, your doctor will make that decision based on your loved one’s medical needs and ability to tolerate the feedings. Below are the different ways that tube feeding can be given. This is done mostly by a feeding pump or by gravity (like with an IV drip).
- Continuous feedings are given hourly over a 24-hour time frame.
- Cyclic feedings are given over a period of less than 24 hours, for example, hourly for eight hours and then again the next day at the same time in the same cycle.
- Intermittent feedings are given over 20-60 minutes, every 4-6 hours with gravity.
- Bolus feedings (larger volume of formula at once) are given in a 4- to 10-minute period using a syringe or gravity drip.
As your loved one can eat more on their own, the tube feedings are slowly reduced. They may be used on top of what the person is eating on their own to make sure their body is getting everything it needs.
More Information About Tube Feeding and Nutrition
Tube Feeding (PDF)
From Shepherd Center
Basic information and how to operate a feeding tube
Troubleshooting Feeding Tubes (PDF)
From Shepherd Center
Nutrition information and tips on troubleshooting potential feeding tube issues
From Shepherd Center