Exclusive Enteral Nutrition (EEN)

Children with inflammatory bowel disease (IBD) often have trouble gaining weight. Intestinal inflammation often makes it difficult for their bodies to absorb the nutrients needed to help them grow. In addition, impaired bone growth and delayed puberty may also occur in children managing IBD.

Exclusive enteral nutrition (EEN) is the recommended first-line therapy to treat active Crohn’s disease. The formula-based (no solid foods) diet is designed to induce remission in patients. It is a short-term program and may extend six to 12 weeks.

Why is exclusive enteral nutrition needed?

EEN provides a constant flow of formula, which prompts better absorption of nutrients and less distention, stomach pain, and vomiting — all symptoms associated with Crohn’s disease. It is important to note that EEN is not a treatment for all IBD patients. Please discuss this option with your physician.

What are the benefits of exclusive enteral nutrition?

The benefits of EEN include:

• increased remission rates
• healing of the lining of the gastrointestinal tract
• nutritional improvements
• weight gain
• increased muscle mass
• enhanced bone health

How is exclusive enteral nutrition administered?

Exclusive enteral nutrition is administered via nasogastric (NG) tube, which is inserted through your child’s nostril and into the stomach. The length of therapy typically lasts six to 12 weeks.

At Boston Children’s Hospital, your child will have the support of a team of EEN experts — a gastroenterologist, nurse, and dietitian. Additional social work or psychological support is also available.

How is my child weaned off exclusive enteral nutrition?

It is important for young patients to meet with their gastroenterologist and dietitian on a regular basis. At Boston Children’s Inflammatory Bowel Disease Center, we have two IBD nutritionists on staff ready to carry your child through their EEN journey.

Solid foods

When weaning a patient off EEN, we begin by adding solid foods back into their diet. The choice of solid foods depends upon your child. Initially, we recommend adding one solid meal a day for the first three to seven days then advance as tolerated. Quick reintroduction of solid food will often result in return of symptoms.

Diet

Moving forward, we recommend an anti-inflammatory diet, which may include a carbohydrate-free diet or a “clean” non-processed food diet. Once the weaning process begins, we suggest maintaining a 50 percent, formula-based diet for four to six months, then slowly wean based on test results.

Follow-up visits

Appointments with a dietitian will be determined based on adequacy of nutritional intake. Children on EEN may use an online food diary, called a chronometer. This tool allows our patient to share dietary information with a nutritionist in real time. The chronometer is the only online food diary that will show the nutrition analysis based on children’s requirements. Your child’s dietitian will monitor nutritional activity and quickly determine whether all dietary needs are being met.

During the visit, we also discuss the psychological impact the diet is having on the patient and family in an attempt to determine whether they can be added back or find suitable alternatives that meet a healthier profile.