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Tube Feeding Your Child

Sometimes feeding tubes are needed to provide proper nutrition to maintain health and normal growth and development.  They may be required because the child does not eat enough or because he or she is unable to swallow safely.

There are many reasons why a child may need a feeding tube.  Some of the most common are prematurity, central nervous system problems, gastrointestinal diseases (like GERD), failure to thrive, metabolic disorders, allergies, and abnormalities of the GI tract.

Types of Feeding Tubes

ￏ         Nasogastric Tube Feeding

ￏ         Gastrostomy Tube Feeding

ￏ         Jejunal Tube Feeding

Nasogastric Tube Feeding (NG)

A NG tube is inserted into the nose, down the esophagus and into the stomach. NG feedings are for short term, usually for less than 3 months, but may be used longer in some cases.  Placement does not require surgery and can be started quickly.  It can be used intermittently and for short periods with very little risk.  The disadvantages of the NG feedings are nasal and esophageal irritation and discomfort.  NG tubes can cause a child to not want to eat by mouth at all because of the discomfort.  In infants, it can decrease the suck/swallow mechanism. NG feedings can contribute to increased ear infections and sinusitis.  There is also a risk of the NG tube being inserted incorrectly and food entering the lungs.  Learning to check tube placement is important. The tube can be easily pulled out by an active child and will require taping to the cheek, which can be very irritating to the skin.  Finding the right tape and technique will be important to keep the tube in place.

Gastrostomy Tube Feeding (G-tube)

G-tubes are for long term feeding.   The G-tube is a tube that is inserted by a small incision in the abdomen into the stomach.  There are several types of tubes that can be used.  Your surgeon will choose what will best meet your child's needs.  Some of the advantages of a G-tube are that it can be hidden by clothing, it causes less irritation to the nasal passages and esophagus (eating by mouth is more comfortable), and it interferes less with a child's activities.  The major disadvantage is that placement requires surgery.  Skin irritation or infection is possible.

Jejunal Tube Feeding (J-tube)

A J-tube is placed into the jejunum (middle portion of the small intestine) bypassing the upper GI tract.  It can be placed nasally (NJ-tube) or it can be passed from a gastrostomy to the jejunum (J-tube).  They may be used if gastric motility is poor, for severe GERD, and for those with high risk of aspiration as well as for other physical anomalies.  Children fed through a J-tube will require continuous drip feedings - which means being attached to a pump for a majority of the day.  Most children that are J-tube fed will be on elemental formula, which is very expensive.

Feeding a Tube Fed Child

After your child's feeding tube is placed, you will be taught how to care for it and will be given an ideal feeding schedule and the calories or volume of food required for your child.  This is not written in stone and will most likely change once you get home.  You know your child best and spend the most time with him/her - parents are usually the ones who come up with the best feeding schedule.  You will work closely with a GI or dietitian to set up the best schedule for your child.  Some children tolerate tube feedings well and others take time to adjust and require many schedule modifications before the right one is found.

Bolus Feeds vs. Continuous Feeds

Bolus feeds are more like a regular eating schedule.  It is a set volume delivered over a short period of time.  For example, a child may get fed 4 times a day over a 20 min period.  Some children will not tolerate large volumes, so they may require smaller feedings more frequently during the day.  Bolus feeds are more convenient and less intrusive to your daily routine.  You may or may not need a pump to deliver bolus feeds.  In general, most children will not tolerate a super fast bolus, so a pump is useful to control the rate.  Pumps may also allow the parent some freedom - you do not need to hold syringes and tubes. 

Not all children tolerate bolus feeds.  Some require a slow, continuous drip of formula for a long period of time.  Continuous feeds work best with those children who are very sensitive to the volume of food in their stomach.  It is also better for those with a high risk for aspiration.  Continuous feeds are sometimes administered overnight.  For those children who eat orally as well, night feeds are generally utilized to make up for the calories not consumed during the day.  Because children receiving continuous feeds are so volume sensitive, it is best to use a pump to regulate the rate.

Sometimes a combination of bolus feeds and a continuous feed  is used.  For example, a child may receive 3 bolus feeds during the day as well as a continuous drip overnight.  This works well for those who do not tolerate much volume.  The  bolus feeds during the day can be well spaced out and whatever is not tolerated during the day is administered at night.

Written by: Sam's Mom, Amanda W.

Read more about Reflux Information:
Equipment and Supplies, Frequently Asked Questions (FAQs) About Tube Feeding »View all articles«

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