Sometimes babies and children with GERD begin to learn that when they eat, they hurt.  They begin to become difficult feeders and many will down right refuse to eat just trying to stop their pain.  Severe oral and feeding aversions can result as the baby begins to associate bad things with their mouth.  Some people believe that babies will eat no matter what if they get hungry enough, and that may well be true for most babies, refluxers; however, are completely different and need to be treated as such.  Some babies or children may vomit so much they are unable to gain sufficient weight on their own.

In some cases the oral/feeding aversions and excessive vomiting become so severe the baby requires tube feeding to survive.  There are several types of feeding tubes that can be used, as listed below.

Temporary Feeding Tubes

• NG-tube (N-Naso, G-Gastric)
  This is a long thin tube that is inserted through the child's nose, throat and esophagus down into the stomach.  The tube is attached to the side of the child's face using a hospital grade tape.  A pump or gravity feed may be used to supply the food through the tube. Feeds can be given in bolus or continuous amounts.  Bolus meaning large amounts over a short period of time.  For example, mealtimes can be mimicked by giving three large meals a day through the tube.  Continuous feeds are smaller amounts given over longer periods of time, for example the food would pumped slowly all night long long, or for over a period of several hours.  NG tubes are only temporary solutions, and although literally a life safer for many kids, they also have their drawbacks.  They can cause irritation and damage to the skin on the face, from the tape used, as well as irritation and damage to the esophagus and throat if left long term.  NG tubes have also been known to actually make oral and feeding aversions worse because they cause even more negative associations to the mouth, and nose area for the child.  They can also actually increase the amount of reflux activity because they can hold the LES opened slightly.
• NJ-tube (N-Naso, J-Jejunum)
  This is similar to the NG tube except once in the stomach it continues through the pyloric valve, duodenum (first part of the small bowel) and into the jejunum (second part of the small bowel).  NJ tubes have the same drawbacks of the NG tube but because the end of the tube is in the jejunum instead of the stomach, NJ tubes can help reduce vomiting associated with reflux.  They can also help decrease aspiration and apnea episodes for the same reason.  Because the jejunum (bowel) can't handle large volumes of food bolus feeds are not possible with an NJ tube.  NJ tubes must be placed using fluoroscopic guidance with the help of a radiologist.

Surgically Inserted Tubes

• G tubes (Gastronomy tubes)
  G-tubes are surgically inserted through the side of the abdominal wall.  A small hole is created on the left side of the abdomen, leading directly into the stomach.  A foley catheter will likely be placed until the incision heals, at which time a more permanent and convenient button will be placed.

   

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• J-tubes (Jejunostomy tubes)
  J-tubes are surgically inserted through the side of the abdominal wall.  Similar to the gastronomy a jejunostomy is performed by creating a small hole on the right side of the abdomen leading into the jejunum.
  
  *J-tube pictured to the left.  Pictured in the photo, zinc is used on the abdomen to protect the skin surrounding the stoma (hole) from acidic stomach contents that leak out.

Photos and drawing by and © 2001-2005 RMacLean.
All rights reserved.

Reviewed By Dave Olson, MD
Fellow, American Academy of Pediatrics
Graduate University of Michigan School of Medicine