NUTRITION ORDER REQUIREMENTS:  INFANT AND PEDIATRIC 
                                   FORMULA  
                                    
                                   DOCUMENT TYPE:  STANDARD 
         
        Introduction  
            1.1.  Purpose  
                  The purpose of this standard is to establish a consistent ordering practice for infant and pediatric 
                  formula.  This ensures providers write orders safe and clear orders that can be filled without requiring 
                  clarification thereby reducing the potential for preventable errors or adverse events.  It applies to all 
                  inpatient services. 
            1.2.  Scope 
                  This standard applies to orders for infant formula and pediatric formula orders written by physicians, 
                  nurse practitioners and dietitians.  
         
        Definitions 
                  Infant formula is defined as a formula intended for use in children less than or equal to one year of 
                  age. 
                  Pediatric formula is defined as formula intended for use in children greater than one year of age.  
         
        Standard 
            Infant and pediatric feed orders must minimally contain core order components consistent with Medication 
            Order Requirements Policy PTN.01.001   
                   
                  All orders must include: 
                         Formula name  (see Infant and Enteral Formulary)  
                         Feeding product concentration (See Table 1 for standard available concentrations): 
                              o  For Infant feeds in kcal/100mL  
                              o  For Pediatric feeds in kcal/mL 
                         Feed route 
                   
                  Continuous Feeds must include: 
                         Feed rate (mL/hr) 
                         Total Feed duration (hours) 
                   
                  Bolus feeds (oral or tube) must include: 
                         Feed volume (mL) 
                         Feed frequency (common orders include Q2h, Q3h, Q4h) 
                         Time to infuse each bolus 
                  
                 Orders must use standard available infant or enteral formula concentrations.  See Table 1 – Standard 
                 Concentration of Formula Products.  Sample orders are available in Table 2 and 3.   
                 An infant formula order without a concentration will be interpreted as standard concentration 
                 (68kcal/100mL) 
         
         
        Table 1 – Standard Concentration of Formula Products  
         
        Product Type                                       Order Concentration as           Concentration available 
        Infant formula                                     kcal/100mL                              68 kcal/100mL 
        Standard infant formula concentration is 68                                                74 kcal/100mL 
        kcal/100mL for patients <1 year.                                                           81 kcal/100mL 
                                                                                                   91 kcal/100mL 
        C-0506-15-60421  | PTN.01.017B                                                                                                                                            Published Date: 28-Nov-2019 
         Page 1 of 3                                                                                                                                                                                   Review Date: 28-Nov-2022                                                                                                                                                                                             
          This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current. 
                                         NUTRITION ORDER REQUIREMENTS:  INFANT AND PEDIATRIC 
                                         FORMULA  
                                          
                                         DOCUMENT TYPE:  STANDARD 
           
          Pre-Term Infant formula                                      kcal/100mL                                     74 kcal/100mL 
          Pre-term infant formula concentration is                                                                    81 kcal/100mL 
          variable; see Infant and Enteral Formulary                                                                  91 kcal/100mL 
          for product specific details.  
          Pediatric enteral (tube feed) formula                        kcal/mL                                        1-2kcal/mL 
          Product specific; see Infant and Enteral 
          Formulary 
          Clinical notes: 
                   When required, feed concentration should be increased incrementally to support clinical needs  
                   Only one change should be made at any given time to evaluate tolerance 
                   Confirm patient tolerance to current feed prior to increasing concentration 
           
           
          Table 2 – Sample Orders – Infant Formula 
          Table 2 provides sample orders that meet standards for infant formula orders.    
           
          Infant Formula Feed Type               Sample Order (formula name, calorie concentration, volume) 
          Infant Formula, Oral feed              Enfamil 68 kcal/100mL, 120mL q3h PO  
                                                 Enfamil 81 kcal/100mL,PO, ad lib; total volume of 1200 mL/day 
                                                 Nutramigen 81 kcal/100mL, PO, ad lib; total volume 800 mL/day  
          Infant Formula, Tube Feed              Enfamil 68 kcal/100mL, 50mL/hr x 24 hours via NG tube 
          (CONTINUOUS)                           Enfamil 91 kcal/100mL, 20mL/hr x 18 hours  via NG tube  
          Infant Formula, Tube Feed              Enfamil 81 kcal/100mL, 60 mL q2h, via NJ tube over 30 minutes  
          (BOLUS)                                Enfamil 91 kcal/100mL, 150 mL q4h, via NG tube over 60 minutes 
           
          Table 3 – Sample Orders – Pediatric Formula  
          Table 3 provides sample orders that meet standards for pediatric formula orders.    
           
          Pediatric Formula Feed Type              Sample Order 
          Oral feed                                Pediasure, 1 container PO, three times daily with meal 
                                                     
          Tube Feed (CONTINUOUS)                   Nutren Jr, 75mL/hr x 22 hours via NG tube 
                                                    
          Tube Feed (BOLUS)                        Isosource Fibre 1.2,  210 mLs plus 75 mL water, via gastrostomy tube, 4 times daily 
                                                   (gravity)  
                                                   Neocate Jr 1.5 kcal/mL, 250 mL q4h 100L/hr, via gastrojejunostomy tube 
           
           
          Supporting Documents  
                     
                    Related Policies 
                              PTN.01.001  Medication Order Requirements Policy  
                              PTN.01.012  Nutrition Orders by Dietitians  
                              PTN.01.017  Nutrition Order Requirements  
           
          C-0506-15-60421  | PTN.01.017B                                                                                                                                            Published Date: 28-Nov-2019 
           Page 2 of 3                                                                                                                                                                                   Review Date: 28-Nov-2022                                                                                                                                                                                             
            This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current. 
                                    NUTRITION ORDER REQUIREMENTS:  INFANT AND PEDIATRIC 
                                    FORMULA  
                                     
                                    DOCUMENT TYPE:  STANDARD 
          
                 Guidelines/Procedures/Forms 
                          C-0506-14-60394 Infant and Enteral Formulary  
                          CC.01.012  Nutrition Order Procedures:  Ordering infant formula, tube feed (enteral) formula 
                           and oral diets   
         References 
         Pediatric Nutrition Practice Group; Caroline Steele, MS, RD, CSP, IBCLC, FAND and Emily Collins, MHA, RD, 
            CNSC, Editors.  Infant and Pediatric Feedings: Guidelines for Preparation of Human Milk and Formula in 
            Health Care Facilities, 3rd Ed.  Chicago:  Academy of Nutrition and Dietetics.  2018.  
              
              
              
              
              
              
              
              
              
              
              
              
              
              
              
              
              
              
              
              
              
              
              
              
              
         Developed By  
                  Professional Practice Leader, Nutrition 
          
         Version History 
         DATE             DOCUMENT NUMBER and TITLE                                   ACTION TAKEN 
         12-NOV-          C-0506-15-60421Nutrition Order Requirements:                Approved at: Pharmacy, Therapeutics & 
         2019             Infant And Pediatric Formula                                Nutrition Committee 
          
         DISCLAIMER 
         This document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or 
         reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical 
         advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this 
         document. This document is protected by copyright and may only be reprinted in whole or in part with the prior 
         written approval of PHSA.  
         C-0506-15-60421  | PTN.01.017B                                                                                                                                            Published Date: 28-Nov-2019 
         Page 3 of 3                                                                                                                                                                                   Review Date: 28-Nov-2022                                                                                                                                                                                             
          This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.