Introduction
For parents of children with Short Bowel Syndrome (SBS), one of the biggest concerns is nutrition and growth. SBS affects how the body absorbs nutrients, making it challenging for children to gain weight, grow, and develop properly.
Every child with SBS has a unique nutritional journey. Some rely on Total Parenteral Nutrition (TPN) for essential nutrients, while others transition to enteral or oral feeding. With the right dietary strategies, many children with SBS can thrive.
In this guide, GI specialists and dietitians share:
- How SBS affects digestion and nutrient absorption
- Best practices for balancing TPN, enteral feeding, and oral nutrition
- Key nutrients that support growth and development
- How to encourage oral feeding in children with feeding aversions
While feeding challenges can feel overwhelming, medical advancements and expert guidance can help your child grow and thrive.
Understanding Nutrient Absorption in Children with SBS
The Small Intestine’s Role in Digestion
The small intestine is responsible for absorbing:
- Carbohydrates → Energy from grains, fruits, and vegetables
- Proteins → Essential for muscle growth and development
- Fats → Needed for brain development and energy storage
- Vitamins & Minerals → Critical for immunity, bone health, and metabolism
When a child has SBS, part of the small intestine has been removed, reducing the body’s ability to absorb these essential nutrients.
Did You Know? The remaining intestine can adapt over time to improve absorption—a process called intestinal adaptation.
Intestinal Adaptation: What It Means for Your Child
The body is incredibly resilient, and the intestine has the ability to adapt by:
- Increasing the surface area of the remaining intestine
- Growing new villi (tiny finger-like structures that absorb nutrients)
- Becoming more efficient at absorbing key nutrients
Encouraging adaptation through the right nutrition plan is key to reducing dependence on IV nutrition over time.
Finding the Right Balance: TPN, Enteral Feeding & Oral Nutrition
Many children with SBS start with Total Parenteral Nutrition (TPN)—intravenous feeding that delivers essential nutrients directly into the bloodstream. Over time, they may transition to enteral (tube) feeding and eventually oral nutrition.
TPN: The Lifeline for Early Growth
TPN is often necessary after surgery to ensure proper hydration and nutrient intake. However, long-term use of TPN comes with risks, including liver complications and infection risks.
The Goal: Gradually reduce TPN dependence by introducing enteral nutrition when possible.
Enteral Feeding: Transitioning to the Gut
Enteral feeding delivers nutrients directly into the stomach or small intestine via a G-tube, NG tube, or J-tube.
Benefits of Enteral Feeding:
- Stimulates the intestine to promote growth and adaptation
- Reduces TPN dependency over time
- Mimics normal digestion, supporting gut function
Your dietitian will adjust enteral formulas based on your child’s tolerance and growth progress.
Encouraging Oral Feeding & Overcoming Aversions
Many children with SBS develop feeding aversions due to medical interventions, oral sensitivities, or early reliance on tube feeding.
Tips for Encouraging Oral Feeding:
- Start with small, frequent meals (avoid overwhelming the digestive system)
- Introduce sensory-friendly textures (purees, soft foods, and finger foods)
- Encourage self-feeding (allowing toddlers to explore food at their own pace)
- Make mealtime stress-free (avoid pressure and create positive associations)
Feeding therapy can be helpful for children struggling with oral intake.
Key Nutrients That Support Growth in SBS
Protein for Growth & Repair
Protein helps muscles, organs, and tissues develop.
- Sources: Eggs, chicken, fish, dairy, soy, and high-protein formulas.
Fats for Brain Development & Energy
Many children with SBS struggle to absorb fats, leading to malabsorption and poor weight gain.
- Sources: Avocado, coconut oil, MCT oil, and fat-modified formulas.
Carbohydrates for Energy
Some carbs (like simple sugars) may cause diarrhea in SBS.
- Best choices: Oatmeal, rice, bananas, and whole grains.
Essential Vitamins & Minerals
- Vitamin D & Calcium → Strong bones
- Iron & B12 → Prevent anemia
- Electrolytes (Sodium, Potassium, Magnesium) → Prevent dehydration
The Role of Medical Innovation in SBS Nutrition
Growth Factor Therapies (GLP-2 Analogues)
Medications like Teduglutide (Gattex®) stimulate intestinal growth, helping the intestine absorb more nutrients.
Regenerative Medicine & Intestinal Engineering
Innovations like Eclipse Regenesis focus on stimulating the intestine’s natural ability to regenerate tissue, offering a future where children with SBS rely less on TPN and feeding tubes.
Microbiome Research & Gut Health
The gut microbiome plays a huge role in digestion and absorption. Future therapies may use probiotics and gut bacteria modifications to improve nutrient absorption in SBS patients.
Parent Resources & Support Groups for SBS Nutrition
- The Oley Foundation – Support for families managing enteral & parenteral nutrition.
- Feeding Tube Awareness Foundation – Resources for families navigating tube feeding.
- Short Bowel Syndrome Foundation – Education, advocacy, and funding assistance for SBS families.
- American Society for Parenteral and Enteral Nutrition (ASPEN) – Information on TPN and enteral feeding.
Conclusion: Supporting Your Child’s Nutrition Journey
Managing nutrition and growth in children with SBS is a complex but achievable journey with the right support.
