Children with Long-Term Tube Feeding | Part 4 Bridging Research and Practice in Pediatric Nutrition

Feed Type and Administration Modalities in Pediatric Tube Feeding
This presentation will discuss the different ways to nourish tube fed pediatric patients, focusing on feed type and modality. The main talking points of this presentation will include the categorizations, and related shortcomings, of feed types for pediatric enteral nutrition, a review of the evidence for using commercial and homemade feed types, as well as provide an overview of adapting modes of enteral feeding that holistically consider patient and caregiver needs. This session will use case studies to highlight the concepts about feed type and modality discussed throughout the talk.

Inez Martincevic MSc, RD
Hospital for Sick Children

Inez Martincevic is a registered dietitian practicing within the Division of Gastroenterology, Hepatology and Nutrition at The Hospital for Sick Children. Inez completed her undergraduate and graduate studies at the University of Toronto working closely with leaders in clinical nutrition. Inez is a member of the Medical and Scientific Advisory Board and Registered Dietitian Working Group with Celiac Canada, as well works with the Allied Health Advisory Board with Mirum Pharma. In collaboration with her gastroenterology team, Inez helps provide medical nutrition therapy and support to pediatric patients with gastrointestinal or liver complexity, as well participates in research endeavours looking to improve aspects of medical nutrition therapy, nutritional status, and the quality of life of those affected by gastrointestinal or liver conditions.

Ensuring Nutritional Adequacy and Tolerance in Pediatric Long-Term Tube Feeding
This presentation will explore the intricacies of monitoring growth and nutritional status in children undergoing long-term tube feeding. We will delve into the critical evaluations that guide necessary adjustments in nutritional management. Key discussions will include the timing for feed modifications, strategies to prevent both overfeeding and underfeeding, assessment and management of feeding intolerance, and identifying indications for nutritional blood work. The session will be enriched with case studies to illustrate these concepts in practical scenarios.

Jessie M. Hulst, MD, PhD
Hospital for Sick Children

Dr. Jessie Hulst is a staff gastroenterologist at The Hospital for Sick Children (SickKids) and Associate Professor in both the Department of Pediatrics and Department of Nutritional Sciences at the University of Toronto. Previously, Dr. Hulst served as a Staff Gastroenterologist at Sophia Children's Hospital in Rotterdam, Netherlands (2011 to 2018). Her extensive academic background includes the completion of her PhD focusing on nutritional assessment in critically ill children in 2004.

Throughout her career, Dr. Hulst has been deeply involved in advancing the field of pediatric nutrition. She served as a member of the ESPGHAN committee on Nutrition (2014-2018), acted as the previous chair of the ESPGHAN Clinical Malnutrition Special Interest Group, is a current member of ASPEN malnutrition committee and NASPHAN Nutrition committee. Her research focuses on nutritional screening and assessment in children with medical conditions predisposed to malnutrition, with the goal of improving outcomes through individualized interventions. She has made significant contributions to the academic literature, with over 100 peer-reviewed manuscripts and more than 10 book chapters to her credit. 

She co-chairs the Pediatric Working Group of the Canadian Malnutrition Task Force and leads the implementation of a national pediatric Malnutrition Pathway in Canada. She serves as a Distinguished Fellow in Child Nutrition at the Joannah & Brian Lawson Centre for Child Nutrition, University of Toronto, with a mission to enhance physician competency in both clinical and public health nutrition through educational initiatives and resource development.

Clinically, Dr. Hulst specializes in complex nutrition and intestinal failure, serves as the hospital's Parenteral Nutrition medical lead and chairs the Nutritional Advisory Committee.

Tube Weaning: Strategies for Success
A review of the evidence as well as practical strategies for helping children wean off tube feeds. 

Sarah Howe McKenna, RD
Alberta Children's Hospital

Sarah is a registered dietitian in Calgary, AB.  She went to McGill University in Montreal,QC and worked in Montreal and California for a couple of years before returning home to Alberta to be closer to her family.  She has worked in a variety of different settings, including an adult hospital in Montreal and the WIC program in Salinas, CA, before deciding to focus exclusively on pediatrics. She began work at the Alberta Children’s Hospital in 2005 as a clinical dietitian and worked in a variety of areas such as short bowel syndrome, cardiology, general pediatrics, gastroenterology and the NICU.  In 2019, she left clinical practice to work as a manager of dietitians.  She enjoyed leadership but missed working directly with patients so, in 2022, she obtained her current position as a team lead for the outpatient dietitians at the Alberta Children’s Hospital.  She has a private practice, Howe Nutritious, where she helps people find joy in feeding and eating and is a faculty member of the Ellyn Satter Institute.