Tube Feeding and Hydration: How Proper Fluids Can Improve Digestion and Health

Hilarie holding a tube feeding syringe

Handling fluid intake with tube feeding can be challenging! First, it’s hard to know how much fluid you need to give in addition to formula or blended food. And even when you know the amount, squeezing this into your daily routine can be tough.

But for many families I’ve worked with, understanding their child’s fluid needs and the best ways to stay hydrated with a feeding tube has been a game-changer in improving their child’s digestive issues.

This post explores the common challenges associated with hydration and tube feeding, offers guidance on determining your child’s fluid intake and practical tips for getting more water in if needed, and explains how this all plays a role in your child’s digestion and overall health.

HYDRATION Needs and Challenges with Tube Feeding

In my experience, many children who are tube-fed do not get enough fluids. I think there are a couple reasons for this.

To start, many do not tolerate their formula well, leading to long feeding times to get their nutrition in. This makes it tough to fit in fluids too.

And for many, giving fluids after a meal makes vomiting worse. Understandably, these fluids are often skipped to avoid losing those precious calories.

Hilarie preparing real food for tube feeding.

Also, maintaining hydration through feeding tube isn’t as simple as having a drink; it involves preparing and connecting tubes, which can be a hassle, especially with all the appointments and therapies you’re trying to juggle.

Can you relate to any of this?

The Importance of Fluids in Digestion

The thing is, we need enough fluids to help digest and break down food and to absorb nutrients and get rid of waste.

So if someone does not get enough fluids, digestive issues like constipation often occur, which often makes reflux and vomiting worse — especially for kids.

Just recently, a family started working with me inside Blended Tube Feeding Made Simple at the VIP level. Their daughter was really struggling with severe constipation, reflux, vomiting, and poor growth.

Understandably, the family was prioritizing formula intake over water to help with her growth, but because she was so constipated, she vomited all day long. The vomiting and loss of fluids just made constipation worse and her growth continued to suffer.

So instead, we took down the volume of formula to what she could tolerate and prioritized her fluid intake. She finally started pooping on her own, and then was able to tolerate more formula and she finally started gaining weight.

I know this seems like a backwards way to approach things, and it may not always be appropriate, but for many this approach has been VERY helpful.

We did all this before we started any home blending because it was important to get her pooping better first. In my experience, a severely constipated kid often does not tolerate anything, even nutritious home blended meals.

How Do You Know if You’re Giving Your Tube Fed Child Enough Fluids?

Squeazy bottle of water for tube feeding hydration

Here are some signs that might indicate your child needs more fluids:

  • Thirst
  • Headache
  • Fatigue
  • Constipation
  • Infrequent urination and/or dark urine
  • Dizziness
  • Dry skin
  • Dry mouth/less drooling

Even if you’re not noticing these symptoms and think you’re providing enough fluids, there’s a chance that optimizing fluid intake could make a difference.

You know those days when we don’t drink enough fluids and feel tired, foggy-minded, or even get a headache? This may be happening even if bathroom routines seem fine.

And it can be hard to know how your child is feeling, so it’s good to check what you’ve been giving and compare it to estimated needs.

How to Determine Estimated Fluid Needs for Tube Feeds

This chart provides general fluid guidelines for people based on weight. It’s important to consider other factors that impact hydration needs like climate, activity level and medical conditions, and to consult your practitioner or registered dietitian who can calculate your personal fluid needs.

WeightFluid NeedsWeightFluid NeedsWeightFluid NeedsWeightFluid Needs
10 lb455 ml31 lb1205 ml60 lb1645 ml165 lb2600 ml
11 lb500 ml32 lb1225 ml65 lb1690 ml170 lb2645 ml
12 lb545 ml33 lb1250 ml70 lb1735 ml175 lb2690 ml
13 lb590 ml34 lb1275 ml75 lb1780 ml180 lb2735 ml
14 lb635 ml35 lb1295 ml80 lb1825 ml185 lb2780 ml
15 lb680 ml36 lb1320 ml85 lb1875 ml190 lb2825 ml
16 lb725 ml37 lb1340 ml90 lb1920 ml195 lb2875 ml
17 lb775 ml38 lb1365 ml95 lb1965 ml200 lb2920 ml
18 lb820 ml39 lb1385 ml100 lb2010 ml205 lb2965 ml
19 lb865 ml40 lb1410 ml105 lb2055 ml210 lb3010 ml
20 lb910 mo41 lb1430 ml110 lb2100 ml215 lb3055 ml
21 lb955 ml42 lb1455 ml115 lb2145 ml220 lb3100 ml
22 lb1000 ml43 lb1475 ml120 lb2190 ml225 lb3145 ml
23 lb1025 ml44 lb1500 ml125 lb2235 ml230 lb3190 ml
24 lb1045 ml45 lb1510 ml130 lb2280 ml235 lb3235 ml
25 lb1070 ml46 lb1520 ml135 lb2325 ml240 lb3280 ml
26 lb1090 ml47 lb1525 ml140 lb2375 ml245 lb3325 ml
27 lb1115 ml48 lb1535 ml145 lb2420 ml250 lb3375 ml
28 lb1135 ml49 lb1545 ml150 lb2465 ml255 lb3420 ml
29 lb1160 ml50 lb1555 ml155 lb2510 ml260 lb3465 ml
30 lb1180 ml55 lb1600 ml160 lb2555 ml265 lb3510 ml

*On mobile, you may need to scroll to the right to see the whole chart

If you want to compare that estimated fluid goal (or the one you got from your team) with how much fluid your child is getting daily, here are the steps to figure it out. You can also ask your team to help you determine your child’s fluid intake.

  1. Write out the current meal/fluid schedule
  2. What is the total volume of formula/blended food received on average daily in mL? This is the total mL of all meals added up. Don’t worry about how much is water, we will figure out that next.
  3. Multiply this total volume by 0.75 (formula and blended food ranges from ~70-80% fluid on average). This will give you an estimate of how much water is coming from the formula or blended food. If you need to be more specific, you can look up how much water is your specific formula on the companies website.
  4. Next, total the amount of water/fluid received in addition to formula. This is any fluid mixed into the formula/blended food at meal time or given separate from meals as a flush or with meds.
  5. Add the amount of water from formula/blended food (number from step 3) with total water given in addition (number from step 4) to get total fluid intake for the day.  

Common Mistake: Counting every mL of formula or blended food as fluid. This often leaves kids short on fluids, because not ALL of the formula/blended food is water. It’s important to only count the true water in the formula/blended food towards fluid intake.

Finding you’re a little short on fluids, but not sure how to get more in? Let’s consider the timing of your water flush next.

Consider Water Flush Timing with Tube Feeds

Hilarie holding a PEG tube for tube feeding.

It is often suggested to give water after a tube feed or mixed in with the feed. When we do this, we’re asking the stomach to digest and absorb a larger volume at one time.

If I could only have water when I was eating or after meals, I’d have a hard time getting enough too!

This also makes the meal a lot thinner, which we know can make reflux worse for many kids. You can learn more about that HERE next.

That’s why it can be better to give water before or in between tube feeds, rather than after or mixed in! When water is given on its own, it quickly passes through our system. It doesn’t need to be broken down like food does.

By doing this, we’re giving the stomach a bit of a break. It can handle the water easily without extra work. Then, when it’s time for the actual tube feed, the stomach has less to handle!

Here’s a few ways families I’ve worked with have been able to successfully give their child more water throughout the day.

  • Give water BEFORE meals, this is typically tolerated better!
  • Split into smaller water flushes, some before and after each meal
  • Give some water as a large bolus first thing in the morning and/or before bed
  • Give additional water between meal
  • Give additional water with meds (if appropriate)
  • Give water overnight via pump

Pro Tip: Measure and fill a bottle with the daily water goal in the morning, pour from this throughout the day. This is especially helpful when there are multiple caregivers as it makes tracking fluid intake a lot easier.

These simple tweaks have made a huge difference for many families I’ve worked with, especially giving water BEFORE a meal rather than all of it after or mixed in.

Importance of Fluid Intake When Starting a Blended Diet

Hilarie placing food into a Blendtec blender to create a blended meal for tube feeding.

One last important note about fluids, especially if you’ve been considering trying some real food.

It is SO important to make sure fluids are in a good spot before you start testing things out. This is especially important if real, fiber-containing foods are new to your child.

Like we discussed earlier, we need fluids to help move food through our body. So even if hydration seem okay now, it may not be enough when you introduce real food.

To avoid things like constipation, which can be SO defeating when you’re getting started, get those fluids in a good spot first.

I hope you these tips make tube feeding a little easier for your family! For more support and guidance, check out my top 10 tips for your child’s feeding tube journey, beyond the basics.

You can also learn more and connect with me on my Instagram. I’d love to hear if you tried anything you’ve learned today. Send me a DM with how it went!

Hilarie, RD, CSP

*Disclaimer: The information and education provided here is not intended or implied to supplement or replace professional medical advice. Always check with your own medical professional before trying to implement any information provided here

Similar Posts