🧒💉 Parenteral Nutrition (TPN) in Children: The Complete Parent-Friendly Guide

(IV nutrition through a central line)

✅ Parenteral Nutrition (PN)—sometimes called TPN—is a carefully designed mix of calories, protein, fats, fluids, vitamins, and minerals given into a vein when the intestines cannot be used enough.
PN can be temporary (while the gut heals) or long-term (intestinal failure).
The biggest day-to-day safety focus is central line infection prevention.

1) 🧾 Quick “At-a-glance” box (top of page)

✅ Condition/Topic name + common names:
Parenteral Nutrition (PN) / TPN / IV nutrition

2–3 line plain-language summary (“what it is / why it happens / what it usually means”):
PN provides nutrition directly into the bloodstream when a child’s gut cannot digest or absorb enough. It often supports children after bowel surgery or with intestinal failure and may be reduced as gut function improves.

Who it affects (typical ages):
Newborns, infants, children, and teens with severe intestinal disease or after major surgery.

✅ What parents should do today:

• Know your child’s central line type and daily PN schedule
• Follow sterile technique exactly (hub cleaning, dressing care)
• Check temperature daily and inspect line site
• Keep emergency contacts and supplies ready

⚠️ Red flags that need urgent/ER care:

• Fever ≥38°C (100.4°F) or chills/shaking
• Red, painful, oozing line site
• Sudden breathing trouble, chest pain, or fainting
• Swollen arm/neck/face on the line side (possible clot)

🟡 When to see the family doctor/clinic:

• Poor growth despite PN plan
• Repeated pump/line alarms
• New or worsening jaundice
• Ongoing vomiting or swelling

2) 🧠 What it is (plain language)

PN bypasses the gut and is delivered through:

• a central venous catheter (most common): PICC line, tunneled line, port (less common for PN)

PN typically contains:

• dextrose (carbohydrates for energy)
• amino acids (protein)
• lipids (fat calories)
• electrolytes (salt balance)
• vitamins and trace minerals
• fluids

Many children receive PN:

• overnight (so daytime is free)
• cycled over fewer hours to support liver health (team decision)

What part of the body is involved? (small diagram required)

Common myths vs facts

• Myth: “PN is only for end-of-life care.”
  Fact: PN is often used to support healing and growth and can be temporary.
• Myth: “If my child is on PN, eating by mouth doesn’t matter.”
  Fact: If safe, even small amounts of oral/enteral nutrition help keep the gut healthy.
• Myth: “Home PN means constant hospital-level danger.”
  Fact: With training, monitoring, and strict line care, many families manage PN safely at home.

3) ?? Why it happens (causes & triggers)

Common causes

• short bowel syndrome after surgery
• severe intestinal inflammation or injury
• bowel obstruction or ileus
• intestinal failure / malabsorption

Less common but important causes

• congenital intestinal disorders
• severe motility disorders
• complex neonatal gut conditions

Triggers that worsen nutrition (and increase PN dependence)

• inability to tolerate tube feeds
• high-output stoma or severe diarrhea
• dehydration and electrolyte losses
• repeated infections disrupting feeding progress

4) 👀 What parents might notice (symptoms and day-to-day patterns)

• child may look more energetic when nutrition is stable
• appetite may be reduced during PN hours
• sleep can be affected by pump alarms
• routine becomes structured around line care

What’s normal vs what’s not normal

🟢 Often expected:

• mild fatigue after infusion nights
• appetite variability

⚠️ Concerning:

• fever or chills
• new jaundice (yellow eyes/skin)
• swelling on the line side
• breathing trouble, chest pain
• line leaking or cracked tubing

Symptom trackers (simple)

• daily temperature
• line site appearance
• PN completed yes/no
• stool output/diarrhea
• weight trend (as advised)

5) 🏠 Home care and what helps (step-by-step)

✅ The #1 goal is preventing bloodstream infections.

Daily routine (family-friendly checklist)

✅ Do this now:

• Wash hands well
• Prepare a clean area for PN setup
• Scrub the hub exactly as taught (every time)
• Check:
  • PN bag label (name/date/composition)
  • bag clarity (no cloudiness/particles)
  • tubing connections
• Start infusion at the prescribed rate
• Keep dressing clean and dry
• After infusion:
  • flush line as prescribed
  • clamp correctly (if applicable)

Infection prevention habits

• no line handling unless necessary
• keep pets away from setup area
• avoid touching catheter hubs
• cover line for bathing (no soaking)
• swimming only if team approves (often restricted)

What usually makes it worse

• skipping hub scrub steps
• letting dressing get wet or loose
• “just this once” shortcuts when tired
• missing routine labs

6) ⛔ What NOT to do (common mistakes)

• Don’t ignore any fever.
• Don’t force flush resistance.
• Don’t change PN rate, hours, or additives yourself.
• Don’t use the PN line for non-prescribed purposes.

7) 🚦 When to worry: triage guidance

🔴 Call 911 / Emergency now

• trouble breathing or chest pain
• fainting/collapse
• severe shaking chills with fever

🟠 Same-day urgent visit

• fever ≥38°C (100.4°F) even if your child looks okay
• red, painful, oozing line site
• swelling of face/arm/neck on line side
• line break, leak, or you cannot flush

🟡 Book a routine appointment

• poor growth despite PN plan
• repeated pump alarms and incomplete infusions
• ongoing nausea or swelling
• new mild jaundice (still needs prompt review)

🟢 Watch at home

• mild fatigue after infusion nights with no fever and stable vitals

8) 🩺 How doctors diagnose and monitor PN therapy (what to expect)

What the clinician will ask

• infusion schedule and missed doses
• line care routine and any breaches
• fevers or ER visits
• stool output and hydration
• oral/enteral intake (if any)

Physical exam basics

• growth and hydration
• line site exam
• abdominal exam
• signs of liver issues (jaundice, itching)

Possible tests (and why)

• bloodwork (electrolytes, liver enzymes, minerals)
• line cultures if fever
• ultrasound if liver concerns
• clot assessment if swelling suggests thrombosis

What tests are usually not needed

• frequent imaging if labs are stable and symptoms are absent

9) 🧰 Treatment options (how teams adjust PN)

First-line treatment

• customize PN calories, protein, fluids, and electrolytes
• encourage safe gut use (oral or tube feeds) when possible
• cycle PN to fewer hours/day to support lifestyle and liver health (if appropriate)

If not improving (next steps)

• adjust lipid type/dose (team decision)
• treat bacterial overgrowth or diarrhea causes (if present)
• refer to intestinal rehabilitation team (if long-term)

Severe cases (hospital care)

• bloodstream infection
• severe dehydration/electrolyte instability
• line complications requiring replacement

Medications/treatments used alongside PN (when applicable)

• Antibiotics for line infection
  • common side effects: diarrhea, rash
  • urgent: breathing trouble, severe rash
• Anticoagulation if clot develops (specialist-managed)
  • bleeding risk: seek urgent help for heavy bleeding/bruising

10) ⏳ Expected course & prognosis

• some children wean from PN as gut adapts (weeks to months)
• others need long-term PN with close monitoring
• long-term outcomes improve with:
  • excellent line care
  • regular labs
  • appropriate use of enteral nutrition when possible

What “getting better” looks like

• stable growth
• fewer dehydration episodes
• increasing enteral/oral tolerance
• stable liver tests

What “getting worse” looks like

• repeated fevers/line infections
• worsening jaundice or itching
• swelling suggesting clot
• poor growth despite PN

11) ⚠️ Complications (brief but clear)

Common

• line infections
• electrolyte/mineral imbalance

Rare serious complications

• PN-associated liver disease
• blood clots
• bone disease (long-term)

12) 🛡️ Prevention and reducing future episodes

• strict sterile technique every single time
• routine labs and appointments
• cycle PN when appropriate
• use gut feeds when safe
• protect the line during daily life (bathing, play)

13) 🌟 Special situations

Infants

Higher risk of liver complications; close follow-up and careful PN tailoring.

Teens

Teach independence safely: supervised line care training.

Kids with chronic conditions

Coordinate all medications and nutrition changes with one team.

Neurodevelopmental differences/autism

Use consistent routines, visual schedules, and sensory-friendly setup.

Travel considerations

Bring:

• extra supplies (more than you think)
• backup pump/batteries if provided
• a medical letter explaining PN and line care
• emergency contact numbers

School/daycare notes

• PN is usually overnight; daytime plan focuses on line protection and emergency steps.

14) 📅 Follow-up plan

• routine labs (weekly → monthly depending on stability)
• scheduled clinic reviews
• earlier follow-up if:
  • fever occurs
  • labs worsen
  • infusion completion becomes inconsistent

15) ❓ Parent FAQs (PN-specific)

“TPN vs PN — what’s the difference?”

People say “TPN” when PN provides all nutrition needs. “PN” is the broader term and can be partial or total.

“Why must I treat every fever like an emergency?”

Because a central line can allow germs directly into the bloodstream, and infections can worsen quickly.

“Can PN cause liver problems?”

It can over time in some children. Cycling PN, adjusting lipids, and using enteral feeds when possible can help reduce risk.

“Will my child become dependent on PN?”

Many children wean off as the gut adapts. Some need long-term support; the team reassesses regularly.

“What should I do if the line won’t flush?”

Stop and seek urgent advice—do not force it. Resistance can indicate clot or line malfunction.

16) 🧾 Printable tools (high-value add-ons)

🧾 Printable: One-Page PN Action Plan

Daily

• Temp check
• Line site check
• Hub scrub every access
• Correct PN bag confirmed
• Infusion completed

Urgent

• Fever ≥38°C (100.4°F)
• Chills/shaking
• Red/painful/oozing line site
• Line leak/break
• Swelling on line side

🧾 Printable: Pump Alarm Troubleshooting (Basic)

• Check power/battery
• Check tubing not kinked
• Check clamps open
• If unsure or line issue: call your PN team

🧾 Printable: Lab Tracking Sheet

Date: ______
Key labs (as directed): __________________
Notes: ________________________________

17) 📚 Credible sources + last updated date

Trusted references:

• Pediatric intestinal rehabilitation programs
• Children’s hospital PN education pages
• Pediatric nutrition support resources

Last reviewed/updated on: 2025-12-31
Local protocols differ—follow your child’s PN team instructions.

🧡 Safety disclaimer

This guide supports—not replaces—medical care. If you are worried about your child, trust your instincts and seek urgent medical assessment.

This guide was fully developed & reviewed by Dr. Mohammad Hussein, MD, FRCPC ROYAL COLLEGE–CERTIFIED PEDIATRICIAN & PEDIATRIC GASTROENTEROLOGIST Board-certified pediatrician and pediatric gastroenterologist (Royal College of Physicians and Surgeons of Canada) with expertise in inflammatory bowel disease, eosinophilic gastrointestinal disorders, motility and functional testing, and complex nutrition across diverse international practice settings.

To book an online assessment Email Dr. Hussein’s Assistant Elizabeth Gray at: Elizabeth.Gray@pedsgimind.ca
In the email subject, please write: New Assessment Appointment with Dr. Hussein

Important: This appointment is completely online as Dr. Hussein is currently working overseas. This service is not covered by OHIP