Whether your child is on bolus feeds, partial oral feeds, a blended diet, continuous feeds, or a combination of these, it can be really difficult to keep track of what he or she has consumed over the course of the day. To help solve this problem, Karen Prante, mom to Nathan, began to develop what has now become Nathan's Chart
, a free online meal-planning application for tube feeding. This application allows you to plan feedings in advance or as they are given throughout the day to ensure that your child meets his daily caloric amount or tube feeding volume.How It Works
When you open the application
, there are three sections to complete in order to create your feeding plan. These include general settings on the left, and a Menu Planner and Daily Menu on the right.
In the settings section on the left, you are able to first choose your unit of measure, which can be milliliters (mL), fluid ounces, or calories. Next, you input the total amount of food/formula your child needs to consume in the chosen unit of measure. If your child receives any excess water, you are able to enter that quantity in milliliters, as well as how much water you flush the tube with after each feeding.
The second section then allows you to plan meals or feedings. First you choose your meal type (tube fed meal, water, or oral meal), and then you use a slider to set the pump rate for the meal (if applicable). You are then able to enter the amount of food in the unit of your choice, as well as the amount of any water flush. Once done, the meal can be added to the Daily Menu by selecting a time to administer the meal. The Daily Menu planner then calculates how much more your child still needs to consume of both food and water. When done, you are able to print out a daily schedule.
In general, the application is very easy to use. I was able to figure it out and enter my daughter's old feeding schedule within about five minutes. It calculated the length of the feeds and the total amount consumed easily and accurately. For people who are not tech-savvy, there are detailed instructions provided on a separate page.
I found two small issues that will hopefully be corrected as the application is developed further. One was that the slider used to indicate the pump rate often does not allow you to choose typical round numbers like 250 or 300. For accuracy, this needs to be improved. Also, the water flush defaults to 40mL in the menu planner, no matter what default amount you entered in the settings section.Future Directions
The creator of the application has indicated that she hopes to make some improvements to it in the near future if people find it helpful and are using it. These include the ability to email the results, the creation of an iPhone App, the ability to store a history of meals, and improving the printed form of the Daily Menu.
While this application already works really well, I could envision it working even better for families who tube feed with a few minor improvements. For example, if you choose to use "calories" as your unit of measure, you are allowed to indicate if you use 30-calorie formula or 45-calorie formula. While this choice has no bearing on the meal planning and quantification, I would like to see other common concentrations, such as 20-calorie or 24-calorie formula, as options.
Another helpful addition would be to allow meals to be planned by length of time instead of pump rate. I know many parents who have difficulty calculating pump rates but know their child needs to be fed over 60 minutes. Other families give gravity feeds over a set period of time without using a rate. Allowing the option of entering the length of feeding instead of the pump rate (which would then be calculated) would be very helpful to these families.Check It Out!
Overall, Nathan's Chart
is a fabulous website and application which will likely prove extremely helpful to many families managing tube feeds. It is simple to use, practical, and a great tool for managing what is sometimes a challenging and overwhelming process.