Are bowel sounds/evidence of bowel function needed prior to initiation of enteral nutrition?

• A. Yes
• B. No
• C. Only if the patient is awake
• D. Only in pediatric patients

Answer: (B)

No—bowel sounds are not required before starting enteral nutrition. Bowel sounds are an unreliable marker of gut function and do not predict tolerance to feeding. You can initiate EN when there is no mechanical GI obstruction or other contraindication and the patient is hemodynamically stable with adequate gut perfusion. Start early if feasible (often within 24–48 hours in appropriate patients) and advance as tolerated, monitoring for signs of intolerance such as abdominal distension, vomiting, high residuals (if your protocol uses them), diarrhea, or electrolyte disturbances rather than waiting for audible bowel sounds.