2.3 Describe conditions where feeding may be undertaken by extended methods

This guide will help you answer 2.3 Describe conditions where feeding may be undertaken by extended methods.

Some people cannot eat or drink enough by mouth because of illness, injury, or other factors. In these situations, feeding by mouth is not safe, not possible, or not effective. Extended feeding methods are used to provide nutrition and fluids. These are called “enteral feeding” or “parenteral feeding,” depending on how the food and fluids are given.

In this guide, we cover why extended feeding may be needed, the different conditions that lead to this, and offer practical information to help you understand your role in supporting individuals receiving this kind of care.

What Are Extended Feeding Methods?

Extended feeding methods involve delivering nutrition and fluids in ways other than normal eating and drinking by mouth. The two main types are:

• Enteral feeding: Nutritional support is given directly into the stomach or bowel using a feeding tube.
• Parenteral feeding: Nutrition is given directly into the bloodstream using a drip (intravenous line).

Both methods are used when normal eating is not possible or would not give enough nutrients to keep a person healthy.

Examples of Extended Feeding Methods

• Nasogastric (NG) tube: A thin tube passed through the nose, down the throat and into the stomach.
• Percutaneous endoscopic gastrostomy (PEG) tube: A tube put through the skin of the abdomen straight into the stomach.
• Jejunostomy (JEJ) tube: A tube which enters the small bowel.
• Total parenteral nutrition (TPN): Fluid nutrition given by large intravenous line into a vein, usually in the chest.

Each method has risks and benefits. The choice will depend on why a person cannot eat normally. Some people may need long-term tube feeding, while others may need it only for a short period.

Why Are Extended Feeding Methods Needed?

There are several reasons a person may need extended feeding, including problems with swallowing, digestion, or the ability to absorb nutrients. The aim is to give enough fluids and nutrition to prevent dehydration, malnutrition, weight loss, or more serious complications.

Here are some of the most common conditions where these methods are used:

Neurological Conditions Affecting Swallowing

Some illnesses can affect the brain or nerves supplying the muscles used in swallowing. This creates a risk of swallowing food or fluids into the lungs (aspiration), which can cause pneumonia and other complications.

Examples include:

• Stroke: Damage to the brain may leave a person unable to control swallowing muscles.
• Motor neurone disease (MND): Muscles become weaker over time, including those for swallowing.
• Multiple sclerosis (MS): Nerve damage can disrupt the swallowing process.
• Parkinson’s disease: Muscle stiffness and tremor can make safe eating difficult.
• Other brain injuries or tumours that affect swallowing control.

In these cases, healthcare staff may recommend temporary or permanent tube feeding.

Head, Neck, and Oesophageal Cancers

Cancers in the mouth, throat, oesophagus (food pipe), or nearby areas can block the passage of food or make swallowing very painful. Surgery or radiotherapy may worsen swallowing in the short term. Tube feeding helps the person get enough food and drink while the main condition is treated.

Examples include:

• Mouth or jaw cancer
• Throat (laryngeal or pharyngeal) cancer
• Oesophageal cancer
• After surgery, such as removal of part of the tongue or jaw

Severe Eating Disorders

People with severe anorexia nervosa or other eating disorders may refuse or be unable to eat enough food. When nutritional status is dangerously low, tube feeding may be considered, sometimes with mental health support and oversight.

Digestive System Problems

In some conditions, the digestive tract is blocked, damaged, or removed, making it impossible for food to reach or be absorbed from the gut. Extended feeding supports life and recovery.

Examples include:

• Short bowel syndrome (after major bowel surgery)
• Chronic bowel obstruction from tumours or scar tissue
• Severe Crohn’s disease, where inflammation stops the gut working effectively

People with these disorders may need tube feeding or parenteral nutrition, depending on the site and extent of the problem.

Head or Facial Injuries

Accidents or trauma can damage the mouth, jaw, or throat, preventing eating or drinking safely. Surgery to repair bones or tissues may also make normal eating impossible for a period. Tube feeding supports healing until the person is safe to try swallowing again.

Common causes:

• Severe facial fractures
• Burns inside the mouth or throat
• After surgery for injuries or tumours

Critical Illness or Severe Surgery

Some people in intensive care cannot eat or drink because they are unconscious or need special breathing support (e.g., ventilators). Others have major surgery and cannot use their gut while it heals. Tube feeding or intravenous nutrition is used until full recovery.

Situations can include:

• Major abdominal or bowel surgery
• Intensive care stays for shock, infection, or after major trauma
• After organ transplants

Severe Swallowing Disorders

Conditions called “dysphagia” make swallowing difficult, unsafe, or impossible. These may be long-term (because of disability) or short-term (due to illness or infection).

Common causes include:

• Stroke or neurological disease (as above)
• Severe throat infections or abscesses
• Congenital (from birth) conditions affecting the mouth or throat

Failure to Thrive in Babies and Children

Some infants and children cannot gain weight or grow, often because of birth disorders, congenital conditions, or severe feeding difficulties. Extended feeding gives extra support before or during treatment.

Examples:

• Premature babies who cannot suck or swallow
• Babies with cleft palate or severe reflux
• Failure to thrive from genetic conditions or chronic illness

Conditions Affecting the Oesophagus or Stomach

Some people have narrowed, scarred, or blocked oesophagus or stomach. This may be due to acid reflux, strictures, tumours, or swallowing toxic substances. Extended feeding bypasses the problem and provides safe nutrition.

Conditions Needing Parenteral Nutrition

If the gut cannot absorb nutrients, feeding directly into the veins can support life. This is rare but used when all other options do not work or are not available.

Examples include:

• Short bowel syndrome
• Severe Crohn’s disease, if too much bowel has been removed
• Some rare, inherited digestive disorders

Practical and Emotional Considerations

Feeding by tube or intravenously can be distressing. People may worry about body image, comfort, or loss of independence. Some may grieve the loss of normal eating. Clear, sensitive support and information are very important. Staff must always respect preferences, involve the person as much as possible, and watch for signs of distress or discomfort.

Risks Linked to Extended Feeding

All extended feeding methods carry risks, such as:

• Infections at tube or line sites
• Tube blockages or misplacement
• Sore skin or irritation
• Vomiting, diarrhoea, or bloating
• Under or over feeding

Staff must be trained to spot and report complications quickly.

Role of Health and Social Care Workers

Your role may include:

• Supporting the person during feeds
• Helping with personal care and dignity
• Monitoring for signs of distress, discomfort or complications
• Keeping careful records of feeding plans and amounts taken
• Communicating clearly with families, nurses, and dietitians

You must not attempt to insert or change a tube unless specifically trained and asked. Some care tasks may only be done by nurses or specialists.

Final Thoughts

Extended feeding methods, including tube and intravenous feeding, are used when normal eating and drinking is not safe or suitable. Many different medical conditions and situations can make this necessary, from problems with swallowing after a stroke, to cancers, digestive diseases, or severe illness. These carefully managed methods help individuals get the nutrients and fluids needed for life, healing, and comfort when food by mouth is not possible. Staff play a key part in providing support, observing for problems, and helping individuals maintain dignity and emotional wellbeing during a challenging time.