Clinical UM Guideline

This document addresses “medical food” or commercially available processed enteral products (please see the Definitions section for further information regarding medical food) when used in the home to meet basic metabolic needs in a variety of conditions affecting either the mechanical or metabolic process of digestion. Enteral nutrition consists of nutritional support given via the gastrointestinal (GI) tract, either directly or through any of a variety of tubes used in specific medical circumstances. This includes oral feeding, sip feeding, and tube feeding using nasogastric, gastrostomy, jejunostomy, or other tubes. This document does not address standard food (not for medical purposes), although it is technically an enteral nutritional product.

Note: Some benefit plans exclude products available without prescription, sometimes referred to as ‘over the counter’, even when prescribed by a physician or other healthcare provider. Enteral food products are often available without prescription. Please see the text in the footnote of this document regarding Federal and State mandates and contract language, as these documents often specifically address the topic of enteral nutrition.

Note: For criteria related to RELiZORB^® (Alcresta Therapeutics, Inc., Waltham, MA), refer to applicable guidelines used by the plan.

Note: Please see the following related document for additional information:

• CG-MED-37 Intensive Programs for Pediatric Feeding Disorders

Note: For a high-level overview of this document, please see “Summary for Members and Families” below.

I.       Oral Enteral Nutrition

Medically Necessary:

Oral enteral nutrition (oral feeding) is considered medically necessary when all of the following criteria are met:

1. The product constitutes more than 50 percent of the individual’s caloric intake; and
2. The product must be a medical food for oral feeding; and
3. The product must be labeled and used for the dietary management of a specific medical disorder, disease, or condition for which there are distinctive nutritional requirements to avert the development of serious physical or mental disabilities or to promote normal development or function as listed in 1. or 2. below:
   1. Conditions associated with an inborn error of metabolism that interfere with the metabolism of specific nutrients, including, but not limited to:
      1. Phenylketonuria (PKU); or
      2. Homocystinuria; or
      3. Methylmalonic acidemia;
         or
   2. Conditions that interfere with nutrient absorption and assimilation, including, but not limited to:
      1. Allergy or hypersensitivity to cow or soy milk diagnosed through a formal food challenge; or
      2. Allergy to specific foods including food-induced anaphylaxis; or
      3. Allergic or eosinophilic enteritis (colitis/proctitis, esophagitis, gastroenteritis); or
      4. Cystic fibrosis with malabsorption; or
      5. Diarrhea or vomiting resulting in clinically significant dehydration requiring treatment by a medical provider; or
      6. Malabsorption unresponsive to standard age-appropriate interventions when associated with failure to gain weight or meet established growth expectations; or
      7. Failure to thrive unresponsive to standard age-appropriate interventions (for example, nutritionally complete liquid meal supplements) when associated with weight loss, failure to gain weight or to meet established growth expectations, including but not limited to:
         1. Premature infants who have not achieved the 25^th percentile for weight based on their corrected age; or
         2. Individuals with end-stage renal disease and an albumin less than 4 g/dL;
            and
4. The product must be used under the supervision of a physician or nurse practitioner, or ordered by a registered dietician upon referral by a health care provider authorized to prescribe dietary treatments.

Oral enteral nutrition is considered medically necessary when the product constitutes less than 50 percent of the individual’s caloric intake and either of the following (A or B) is met:

1. The enteral product is used as part of a defined and limited plan of care in transition from a diet of more than 50 percent enteral products to standard diet for age; or
2. Medical records document a medical basis for the inability to maintain appropriate body weight and nutritional status prior to initiating or after discontinuing use of an enteral supplement as well as ongoing evidence of response to the enteral nutrition.

Not Medically Necessary:

Oral enteral nutrition is considered not medically necessary when the criteria above have not been met.

Oral enteral nutrition is considered not medically necessary when use of a product is based on the convenience or preference of the individual or provider.

II.     Enteral Nutrition Via Tube

Medically Necessary:

Enteral nutrition via tube feeding is considered medically necessary when either of the following criteria (A or B) is met:

1. The product is the primary source of nutrition (that is, it comprises more than 50 percent of the individual’s daily caloric intake) and both of the following are met (1 and 2):
   1. The product is used under the supervision of a physician or nurse practitioner, or ordered by a registered dietician upon referral by a health care provider authorized to prescribe dietary treatments; and
   2. Nutrients cannot be ingested orally due to a medical condition which either:
      1. Interferes with swallowing (for example, dysphagia from a neurological condition, severe chronic anorexia nervosa unable to maintain weight and nutritional status with oral nutrition); or
      2. Is associated with obstruction of the proximal gastrointestinal (GI) tract (for example, tumor of the esophagus);
         or
2. The product constitutes less than 50 percent of the individual’s daily caloric intake and all of the following criteria (a and b) are met:
   1. The product is used under the supervision of a physician or nurse practitioner, or ordered by a registered dietician upon referral by a health care provider authorized to prescribe dietary treatments; and
   2. Medical records document a medical basis for the inability to maintain appropriate body weight and nutritional status prior to initiating or after discontinuing use of an enteral supplement as well as ongoing evidence of response to the enteral nutrition.

Not Medically Necessary:

Enteral nutrition via tube is considered not medically necessary when the criteria above have not been met.

III.       Other Considerations

Not Medically Necessary:

The use of formulas and other food products is considered not medically necessary when the criteria above have not been met, including, but not limited to:

1. Used primarily for convenience or for features which exceed that which is medically necessary (for example, pre-packaged, liquid vs. powder, etc.).
2. When used for individuals with disorders of swallowing where non-medical food is tolerated.

Continuation of home enteral nutrition, regardless of route of administration, is considered not medically necessary when documentation demonstrates the applicable medical necessity criteria above are no longer met.

This document describes clinical studies and expert recommendations, and explains when use of home enteral nutrition is clinically appropriate. The following summary does not replace the not medically necessary statements or other information in this document. The summary may not contain all relevant criteria or information. This summary is not medical advice. Please check with your healthcare provider for any advice about your health.

Key Information

Home enteral nutrition is nutrition support given by mouth using special medical foods or through a feeding tube passed through the nose to the stomach. It is used when a person cannot meet their nutrition needs because of medical conditions that affect digestion, absorption of nutrients, or the body's ability to use specific nutrients. Enteral nutrition may help support growth, maintain body weight, and prevent nutrition-related health problems. The type of nutrition support used depends on the person's medical condition, nutritional needs, and ability to eat safely. Studies and expert recommendations support its use for some conditions while also noting possible risks such as pneumonia, diarrhea, stomach discomfort, pressure sores, and complications related to feeding tubes.

What the Studies Show

Enteral nutrition provides nutrients through the digestive tract. This can be done by drinking special medical foods or by using a feeding tube. Research and expert recommendations support the use of enteral nutrition for people who cannot get enough nutrition because of certain digestive, metabolic, or swallowing disorders. Studies and clinical recommendations support specialized medical foods for inherited metabolic conditions such as phenylketonuria (PKU), homocystinuria, and methylmalonic acidemia. These medical foods help provide the nutrients needed while limiting substances the body cannot process properly. Research and expert guidance also support specialized formulas for confirmed food allergies and for some people with cystic fibrosis or kidney disease who cannot meet nutrition needs through diet alone.

Studies show that feeding tubes can help some people meet nutrition goals when eating by mouth is not possible. However, feeding tubes also have risks. These risks can include pneumonia caused by food or liquid entering the lungs, diarrhea, stomach discomfort, pressure sores, and complications from tube placement. Studies in people with severe dementia found that feeding tubes did not help people live longer and may increase the risk of some harms, including pneumonia and pressure sores. Healthcare providers should consider both benefits and risks when deciding whether enteral nutrition is appropriate.

When is Home Enteral Nutrition Clinically Appropriate?

Home enteral nutrition may be appropriate in these situations:

Oral enteral nutrition

The special nutrition product may be appropriate when all of the following apply:

• The product provides more than 50% of daily calories; and
• The product is a medical food designed for oral use; and
• The product is used for a specific medical condition with special nutrition needs, such as:
  • Phenylketonuria (PKU); or
  • Homocystinuria; or
  • Methylmalonic acidemia; or
  • Confirmed allergy or hypersensitivity to cow's milk, soy, or other foods; or
  • Allergic or eosinophilic digestive tract disorders; or
  • Cystic fibrosis with poor nutrient absorption; or
  • Severe diarrhea or vomiting causing dehydration that requires treatment; or
  • Poor nutrient absorption that has not improved with standard treatment and is linked to poor growth or weight gain; or
  • Failure to thrive that has not improved with standard treatment and is linked to poor growth or weight gain; and
• The product is used under the supervision of a physician, nurse practitioner, or registered dietitian working with an authorized healthcare provider.

Oral enteral nutrition that provides less than 50% of daily calories may be appropriate when:

• It is part of a planned transition from enteral nutrition to a regular age-appropriate diet; or
• Medical records show difficulty maintaining a healthy weight or nutrition status without the product and show ongoing benefit from the product.

Enteral nutrition through a feeding tube

Tube feeding may be appropriate when:

• The product provides more than 50% of daily calories; and
• It is supervised by a physician, nurse practitioner, or registered dietitian working with an authorized healthcare provider; and
• The person cannot take in nutrients by mouth because of:
  • Difficulty swallowing; or
  • A blockage in the upper digestive tract.

Tube feeding that provides less than 50% of daily calories may be appropriate when:

• It is supervised by a physician, nurse practitioner, or registered dietitian working with an authorized healthcare provider; and
• Medical records show difficulty maintaining a healthy weight or nutrition status without the product and show ongoing benefit from the nutrition support.

When is this not Clinically Appropriate?

Home enteral nutrition is not clinically appropriate when the criteria listed above are not met.

Oral enteral nutrition or tube feeding is not clinically appropriate when it is used mainly for convenience or personal preference rather than a medical need. It is also not clinically appropriate when regular foods can be safely used in people with swallowing disorders. Continuation of enteral nutrition is not clinically appropriate when the person no longer meets the criteria above or is no longer benefiting from treatment.

Studies in people with severe dementia found that feeding tubes did not improve survival and were linked to increased risks such as pneumonia and pressure sores. Because studies have not shown a clear health benefit in this situation, experts recommend careful hand feeding instead of feeding tube placement for many people with advanced dementia. 

(Return to Description)

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services may be Medically Necessary when criteria are met:

When services are Not Medically Necessary:
For the procedure codes listed above when criteria are not met or for situations designated in the Clinical Indications section as not medically necessary.

Summary

The discussion below summarizes evidence and recommendations supporting home enteral nutrition for individuals who are unable to meet their nutritional needs due to disorders affecting the gastrointestinal tract or distinctive metabolic and physiologic nutritional requirements. Clinical guidelines emphasize selecting feeding routes based on anticipated duration, recommending multidisciplinary team management, and cautioning against home-prepared formulas. Condition-specific guidance supports enteral tube feeding in cystic fibrosis when nutritional goals cannot be met despite appropriate intervention, nutrition support in Chronic Kidney Disease or End-Stage Renal Disease (ESRD) when dietary counseling alone is insufficient, and specialized formula or medical food use for confirmed food allergy and inborn errors of metabolism. Enteral tube placement methods vary according to individual needs, prioritizing less invasive options when appropriate and discouraging tube feeding in advanced dementia cases due to limited clinical benefit and potential harm. Lastly, the discussion addresses the variability in defining ‘failure to thrive’ and criteria for cessation of therapy when clinical benefits no longer outweigh associated risks.

Discussion

Enteral nutrition is indicated to support optimal health status for individuals with diseases or structural defects of the gastrointestinal (GI) tract that interfere with transport, digestion, or absorption of nutrients. Such conditions may include anatomic obstructions due to cancer, motility disorders such as gastroparesis, or metabolic absorptive disorders such as phenylketonuria (PKU).

The European Society for Clinical Nutrition and Metabolism (ESPEN) produced an evidence-based clinical practice guideline for the management of home enteral nutrition. The ESPEN guideline states that home enteral nutrition is appropriate for malnourished individuals with a functioning gastrointestinal tract who cannot meet their nutritional needs through normal dietary intake. Key recommendations from ESPEN include selecting the access device based on the anticipated duration of therapy (such as nasal tubes for short-term use of less than 4 to 6 weeks and percutaneous tubes for long-term use), preferring fiber-containing formulas for individuals with diarrhea or constipation, and coordinating care by a multidisciplinary Nutrition Support Team to reduce complications and improve outcomes. The ESPEN guideline also advises against the use of home-made formulas made via a blender due to risks of microbial contamination and nutritional inadequacy (Bischoff, 2020).

Condition-specific society guidance is consistent with this approach. The Cystic Fibrosis Foundation recommends enteral tube feeding for individuals with cystic fibrosis (CF) who are unable to consume adequate calories and protein to meet growth or weight maintenance goals despite appropriate evaluation and intervention by a multidisciplinary team. The guideline also addresses pre-placement evaluation, patient and family education, short-term nasoenteral feeding, formula and supply considerations, monitoring, and tube removal planning (Schwarzenberg, 2016).

A registry-based study of children with CF reported that gastrostomy tube placement was associated with different degrees of improvement in body mass index (BMI) z-scores and pulmonary outcomes depending on age and malnutrition severity at placement, supporting continued individualized assessment rather than a uniform timing rule (Wall, 2026). For individuals with chronic kidney disease (CKD) or end-stage renal disease (ESRD) and protein-energy wasting or chronically inadequate intake, Kidney Disease Outcomes Quality Initiative recommends registered dietitian nutritionist-supervised nutrition care, a trial of oral nutritional supplements when dietary counseling alone is insufficient, and consideration of enteral tube feeding when protein and energy requirements cannot be met through counseling and oral supplementation (Ikizler, 2020).

The optimal route of enteral intake is swallowing by mouth. In conditions where this is not possible, a tube may be placed to facilitate transport of nutrition to the digestive/absorptive sites of the GI tract. Tube placement and types are governed by individual needs, with the least invasive approach being the placement of a nasogastric tube. Enteral tubes may also be placed percutaneously through an abdominal approach; this is most appropriate for long-term needs because it reduces the risk of aspiration and reflux (CMS NCD for Enteral Nutrition, 2023; Simon, 2000). The American Medical Dietary Association ([AMDA], 2015), the American Academy of Hospice and Palliative Medicine ([AAHPM], 2013), and the American Geriatrics Society ([AGS], 2015) recommend against placement of percutaneous feeding tubes in individuals with advanced dementia; instead, oral assisted feedings should be offered. This position is further supported by the 2024 ESPEN guideline on nutrition in dementia, which explicitly recommends that “Enteral and parenteral nutrition and parenteral fluids shall not be initiated in persons with severe dementia in the terminal phase of life” (Good Practice Point grade of recommendation: Strong Consensus).

Beyond the inherent risks associated with the placement procedures for enteral or parenteral access, enteral nutrition may also increase the likelihood of adverse events such as aspiration pneumonia, diarrhea, gastrointestinal discomfort, and the development of pressure ulcers. These recommendations are supported by a 2021 review in the Cochrane Database of Systematic Reviews, which specifically evaluated enteral tube feeding in people with severe dementia. The review, which analyzed data from over 49,000 individuals with this condition, found no evidence that the intervention prolongs survival. It also demonstrated with moderate certainty that percutaneous feeding tubes are associated with a significant increase in the risk of developing pressure ulcers in this population (Davies, 2021). A prospective propensity score-matched cohort study of individuals with advanced dementia and feeding problems similarly found no significant 1-year survival benefit with nasogastric tube feeding compared with careful hand feeding, while nasogastric tube feeding was associated with a higher adjusted risk of pneumonia (Yuen, 2025). Advanced dementia, as described in the landmark CASCADE (Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life) study, is defined as the following: (1) Cognitive Performance Score (CPS) equal to 5 or 6, (2) cognitive impairment due to dementia (any type), (3) Global Deterioration Scale (GDS) equal to 7 (Mitchell, 2006).

The term Total Enteral Nutrition (TEN) implies that the individual is receiving more than 50% of their daily caloric intake via enteral nutrition products. If fewer than 50% of daily calories are supplied by enteral nutrition products, they are considered supplemental.

Oral enteral formula is needed for individuals with inherited metabolic digestive disorders, such as:

• Tyrosinemia
• Homocystinuria
• Maple syrup urine disease
• Propionic acidemia
• Methylmalonic acidemia
• PKU

These diseases are characterized by inborn errors of amino acid metabolism and have distinctive nutritional requirements. Special formulas are used for the dietary management of these diseases. The American College of Medical Genetics and Genomics (ACMG) guideline for phenylalanine hydroxylase deficiency recommends lifelong treatment for individuals with untreated phenylalanine levels above the treatment threshold and supports maintaining phenylalanine levels within target range throughout life. The guideline specifically recognizes the use of medical foods and dietary compliance as part of management, including during pregnancy and postpartum care, supporting the role of specialized medical foods for PKU and related inborn errors of metabolism (IEM) (Smith, 2025).

The term "medical foods" does not pertain to all foods fed to ill individuals. Medical foods are foods that are specially formulated and processed (as opposed to a naturally occurring foodstuff used in a natural state) for the individual who is seriously ill or who requires the product as a major treatment modality. Medical foods are intended solely to meet the dietary needs of individuals who have specific metabolic or physiological limitations that restrict their ability to digest regular food. According to the U.S. Food and Drug Administration (FDA), a product must meet all of the following minimum criteria to be considered a medical food:

1. The product must be a food for oral or tube feeding.
2. The product must be labeled for the dietary management of a specific medical disorder, disease, or condition for which there are distinctive nutritional requirements.
3. The product must be used under the supervision of a physician.

For allergy-related indications, current society guidance supports medically supervised selection of suitable nutritional substitutes when allergy is confirmed. The World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guideline update conditionally suggests extensively hydrolyzed cow’s milk formula or hydrolyzed rice formula as first options for infants with IgE-mediated or non-IgE-mediated cow’s milk allergy who are not being breastfed, with amino acid formula as a second option and soy formula as a later option (Bognanni, 2024). EAACI guidance for IgE-mediated food allergy recommends avoidance of confirmed trigger foods, continued consumption of tolerated foods, individualized dietary advice, and suitable nutritional substitutes, including extensively hydrolyzed or amino acid formulas when cow’s milk allergy affects formula-fed infants (Santos, 2025). These recommendations support specialized formula use for confirmed allergy or hypersensitivity without broadening coverage to convenience-based or preference-based formula use.

The use of weight for a given age is a common metric used to determine if an individual meets criteria for failure to thrive (FTT). However, the threshold for weight for age is not standardized. Cole and colleagues (2011) use “weight less than 75 percent of median weight for age,” while the Agency for Healthcare Research and Quality (AHRQ) report states that the U.S. Social Security Administration (SSA) considers FTT to be present “when there is a fall in weight to below the 3rd percentile or to less than 75% of median weight-for-height or age in children under two years old” (Perrin, 2003). The current SSA language says growth retardation should be documented by 3 measurements over a 6-month period showing “less than the third percentile on the CDC’s [Center for Disease Control’s] most recent weight-for-length charts” for children under the age of 2, and “less than the 3rd percentile on the CDC’s most recent BMI for age growth charts” for children 2 years old and older (SSA, 105.08B1, 24598.002). Cole and colleagues (2011) further illustrate the lack of consensus on this issue by stating:

Other definitions are used commonly in the professional literature, such as height-for-weight <3rd percentile; weight-for-age less than 3rd or 5th percentile or less than 80 percent of the median for age; weight-for-height <10th percentile; and weight-for-age more than 2 standard deviations below the mean for age. 

Both the terms “corrected” age and “chronological” age appear frequently in the literature regarding the measurement of age in children diagnosed with FTT. The use of the term “corrected” allows for greater accuracy in the estimation of expected growth in children born prematurely who may have a significant discrepancy between their gestational and chronological ages. However, the use of this convention is not uniform in either the literature or guidelines addressing enteral nutrition. In accordance with Cole and colleagues (2011), this guideline uses the term “corrected” when referring to the age of premature infants.

Cessation of home enteral nutrition therapy may be warranted if the individual is no longer deriving benefit from therapy or when, in the opinion of the treating provider, the risks of enteral treatment outweigh the benefits (Durfee, 2014). Such circumstances may be present when the condition for which the individual has been receiving therapy is no longer present, the individual has been transferred to the facility setting, the individual’s condition has changed such that other nutritional services are needed, and other such circumstances.

Cognitive Performance Score (CPS): A validated score that uses 5 variables from the Minimum Data Set (MDS) to group individuals into the following 7 hierarchical cognitive performance categories: 0=intact, 1=borderline intact, 2=mild impairment, 3=moderate impairment, 4=moderately severe impairment, 5=severe impairment, and 6=very severe impairment.

Dysphagia: The term that describes difficulty swallowing due to an abnormal swallowing reflex.

Food allergy or hypersensitivity: A clinically abnormal response believed to be caused by an immunologic reaction resulting from the ingestion of a food or food additive.

Food anaphylaxis: A classic allergic hypersensitivity reaction to food or food additives involving IgE antibody that occurs rapidly and may be life threatening.

Food challenge: This is an evaluation technique that may be used to assist in the diagnosis of food or eating-related disorders. After an adequate time with the exclusion of suspected foods (usually a week or two), the suspected food or foods are administered under close supervision in a dose escalation manner with proper observation periods between doses. Food challenges may be done in an open manner with the individual aware of what they are being given, with the individual unaware, or with both the individual and physician unaware.

Global Deterioration Scale (GDS): Classifies dementia into 7 stages (1 to 7) based on broad descriptions of the cognitive and functional deficits that typify each stage. Stage 7 of the GDS is distinguished by the following features: very severe cognitive decline with minimal to no verbal communication, assistance needed to eat and toilet, incontinence of urine and stool, and loss of basic psychomotor skills (for example, may have lost the ability to walk).

Medical food: Section 5(b) of the Orphan Drug Act (21 U.S.C. 360ee(b)(3)) defines a medical food as:

A food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.*

* U.S. Food and Drug Administration. Regulatory Information. Section 5 of the Orphan Drug Act. March 1, 2023. Available at: http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/MedicalFoods/default.htm. Accessed on August 14, 2026.

Proximal gastrointestinal tract: The section of the GI tract from the mouth to the small bowel.

Standard food: This refers to regular grocery products, including typical (not specially formulated) infant formulas.

Supplemental nutrition: Fewer than 50% of daily calories are supplied by enteral nutrition products.

Total enteral nutrition (TEN): The individual is receiving more than 50% of their daily caloric intake via enteral nutrition products.

Peer Reviewed Publications:

1. Wall B, Slaven JE, Bozic MA, et al. Registry-based study of gastrostomy tube placement and nutritional recovery in children with cystic fibrosis. BMJ Open Respir Res. 2026; 13:e003576.
2. Yuen JK, Bernacki R, Chan FHW, et al. Comparison of survival and pneumonia risk in advanced dementia patients on nasogastric tube feeding versus careful hand feeding. J Gerontol A Biol Sci Med Sci. 2025; 80(9):glaf165.

Government Agency, Medical Society, and Other Authoritative Publications:

1. Bischoff SC, Austin P, Boeykens K, et al. ESPEN guideline on home enteral nutrition. Clin Nutr. 2020; 39(1):5-22.
2. Bognanni A, Fiocchi A, Arasi S, et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guideline update - XII - Recommendations on milk formula supplements with and without probiotics for infants and toddlers with CMA. World Allergy Organ J. 2024; 17:100888.
3. Centers for Medicare and Medicaid Services. National Coverage Determination: Enteral and Parenteral Nutritional Therapy. NCD #180.2. Effective April 10, 2023. Available at: https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=242&ncdver=3&=.  Accessed on August 14, 2026.
4. Cole SZ, Lanham JS. Failure to thrive: an update. Am Fam Physician. 2011; 83(7):829-834.
5. Davies N, Barrado-Martín Y, Vickerstaff V, et al. Enteral tube feeding for people with severe dementia. Cochrane Database Syst Rev. 2021; 8(8):CD013503.
6. Durfee SM, Adams SC, Arthur E, et al. ASPEN. Standards for nutrition support: home and alternate site care. Nutr Clin Pract. 2014; 29(4):542-555.
7. Good P, Richard R, Syrmis W, et al. Medically assisted nutrition for adult palliative care patients. Cochrane Database Syst Rev. 2014;(4):CD006274.
8. Høst A, Koletzko B, Dreborg S, et al. Dietary products used in infants for treatment & prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child. 1999; 81(1):80-84.
9. Ikizler TA, Burrowes JD, Byham-Gray LD, et al.  Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis. 2020; 76(3 Suppl 1):S1-S107.
10. Koretz RL, Avenell A, Lipman TO. Nutritional support for liver disease. Cochrane Database Syst Rev. 2012;(5):CD008344.
11. Langer G, Grossmann K, Fleischer S, et al. Nutritional interventions for liver-transplanted patients. Cochrane Database Syst Rev. 2012;(8):CD007605.
12. Marchand V, Motil KJ; NASPGHAN Committee on Nutrition. Nutrition support for neurologically impaired children: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2006; 43(1):123-135.
13. Mills RJ, Davies MW. Enteral iron supplementation in preterm and low birth weight infants. Cochrane Database Syst Rev. 2012;(3):CD005095.
14. Morgan J, Bombell S, McGuire W. Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants. Cochrane Database Syst Rev. 2013a;(3):CD000504.
15. Morgan J, Young L, McGuire W. Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev. 2013b;(5):CD001970.
16. Payne C, Wiffen PJ, Martin S. Interventions for fatigue and weight loss in adults with advanced progressive illness. Cochrane Database Syst Rev. 2012;(1):CD008427.
17. Perrin EC, Cole CH, Frank CH, et al. Criteria for determining disability in infants and children: failure to thrive. Evid Rep Technol Assess (Summ). 2003; (72):1-5.
18. Santos AF, Riggioni C, Agache I, et al. EAACI guidelines on the management of IgE-mediated food allergy. Allergy. 2025; 80(1):14-36.
19. Schwarzenberg SJ, Hempstead SE, McDonald CM, et al. Enteral tube feeding for individuals with cystic fibrosis: Cystic Fibrosis Foundation evidence-informed guidelines. J Cyst Fibros. 2016; 15(6):724-735.
20. Smith WE, Berry SA, Bloom K, et al. Phenylalanine hydroxylase deficiency diagnosis and management: a 2023 evidence-based clinical guideline of the American College of Medical Genetics and Genomics (ACMG). Genet Med. 2025; 27(1):101289.
21. Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2014;(4):CD002971.
22. Tan-Dy C, Ohlsson A. Lactase treated feeds to promote growth and feeding tolerance in preterm infants. Cochrane Database Syst Rev. 2013;(3):CD004591.
23. U.S. Food and Drug Administration (FDA). Center for Food Safety and Applied Nutrition. Office of Nutritional Products, Labeling, and Dietary Supplements. March 2023: Frequently Asked Questions about Medical Foods. Available at: https://www.fda.gov/media/97726/download. Accessed on August 14, 2026.
24. U.S. Food and Drug Administration (FDA). Regulatory Information. Section 5 of the Orphan Drug Act. March 1, 2023. Available at: http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/MedicalFoods/default.htm. Accessed on August 14, 2026.
25. U.S. Social Security Administration (SSA). Disability Evaluation under Social Security. 105.08 Digestive System - Childhood. Available at: https://www.ssa.gov/disability/professionals/bluebook/105.00-Digestive-Childhood.htm#105_08. Accessed on August 14, 2026.
26. U.S. Social Security Administration (SSA). Program Operations Manual System (POMS). DI 24598.002. Failure to Thrive. Revised February 6, 2025. Available at: https://secure.ssa.gov/poms.nsf/lnx/0424598002. Accessed on August 14, 2026.
27. Watson J, McGuire W. Nasal versus oral route for placing feeding tubes in preterm or low birth weight infants. Cochrane Database Syst Rev. 2013;(2):CD003952.
28. Watson J, McGuire W. Transpyloric versus gastric tube feeding for preterm infants. Cochrane Database Syst Rev. 2013;(2):CD003487.

Home Enteral Nutrition

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

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