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So Your Child Needs To Be Tube Fed?

October 2006


NG (naso-gastric) and NJ (naso-jejunum) tubes are temporary fixes for a child who is not gaining enough weight or is unable to eat orally. It is a very narrow tube threaded through your child’s nose down to his stomach or jejunum. (Visit the tube feeding page for a more complete description of NG and NJ tubes.)

Formula or breast milk is delivered through the tube via pump, gravity, or syringe as bolus feeds (large amounts in a short time) or continuous feeds. Although an NG/J tube is generally put into place by a medical professional, I was trained to put an NG tube in our son, Daniel, by a home health nurse. A nurse should also show you how to check placement of an NG tube before each feeding.

Because he was born prematurely, Daniel used an NG tube for the first 12 weeks of his life. He hadn’t yet developed a suck reflex, and he didn’t have the strength to nurse or bottle feed. Later, when his reflux was in full swing and he’d learned that eating caused him pain, he simply refused to eat, and we used the NG tube to get us through the bad days and, later, the bad months.

The negative aspects – An NG/J tube is great because you know your child is getting the nutrition he needs with an NG/J tube, but you may encounter some of these problems:

  • Kids like to pull them out. We found that taping the tube to Daniel’s face all the way from the edge of his nose to his ear made the tube most secure.
  • Tape irritates the skin. We tried all types of tape – surgical tape, DuoDERM and Tagaderm, and anything else that looked promising at the pharmacy (and be sure to ask your doctor for samples!) – to secure the tube. But Daniel always had a rough red spot on his cheek. Using Uni-Solve adhesive remover pads seemed to help us take off old tape more gently. And whenever it was time to change tubes, we’d switch nostrils as well.
  • Tubes irritate the nose. Daniel always had a runny nose when he was using an NG tube. There was nothing we could do about it.
  • The tube gets in the way. We looped up the extra tubing, secured it with the end cap, and safety-pinned the whole thing to the shoulder of Daniel’s shirt.
  • The tube, at least in our experience, causes more vomiting. For the first few days with a new tube, Daniel always puked more than usual. My theory is that he would start to reflux, food would move up his esophagus, the tube would wiggle, he’d become even more irritated, and he’d throw up entire feeds. Eventually he would adjust to using the tube and the excessive vomiting would subside. The tube also holds the LES open slightly and therefore can exacerbate reflux.
  • The whole NG/J tube situation can cause greater oral and facial aversions for a child who is likely orally defensive in the first place.
  • Long-term use can cause damage. One of Daniel’s doctors told us that children can “tune out” the tube over time, leaving a spot on the tongue or throat without sensation. We definitely saw this with Daniel; he would panic and choke if food got far enough back into his mouth. We were told a child should use an NG tube for no more than three months before weaning him or considering a G or J tube.

After Daniel had been using an NG tube for an extended period and his attitude toward eating continued to worsen, we opted to have a G tube, or gastronomy tube, surgically placed. (A J tube or jejunostomy tube is similar, but it’s placed in the jejunum which is the second part of the small bowel, lower in the digestive tract. Visit tube feeding page for details.)

Why he needed a G tube – We worried that Daniel would lose the few oral feeding skills he had if he got a G tube, but finally a doctor put it to us bluntly – he had no feeding skills worth keeping. And the G tube would allow us to give Daniel the fluids, calories, and nutrition he needed without causing so much mealtime stress.

The surgery – Daniel’s G tube placement was an hour-long surgical procedure that included an endoscopy. He spent a few hours in recovery, then was transferred to the pediatrics ward for the night. The nurses began using the tube almost immediately – giving him Pedialyte for fluids and because it’s more easily digested. In the morning, we began giving him his regular formula through his new G tube, and, once it was clear he was able to tolerate it, we went home.

Caring for a G tube – As soon as we got home, Daniel seemed pain-free and was playing as usual, but we had to take some precautions to keep his G tube site healthy. We gently wiped the area with warm water and a clean gauze pad and put a split sponge around the site to collect any drainage.
We were lucky. Within a few days, it had stopped oozing, although the long tube (foley catheter) coming from the site sometimes pulled and irritated his skin. To combat that problem, we alternated between tucking his tube into the back of his diaper and putting it over his shoulder. Your doctor will give you complete instructions for caring for your child’s tube site before you leave the hospital.

Getting a G-tube?
Questions to ask...

*What kind of button will your child have?
 *When will it be placed?
 *How should you care for the site?
 * What happens if it becomes dislodged?
 *When is it OK to get the site wet?
 *Will you take home all of the equipment (gauze pads, syringes, etc.) that you’ll need? How do you order more?
 *What will you feed her through the tube? At what rate and how often? How will you know if that’s too fast or too slow?
 *Where will you get her formula? (Daniel’s, Nutren Jr. with Fiber, is supplied by Apria.)
 *What should you do if that formula isn’t working for her?
 *What kind of pump will you use? Who do you contact if you’re having problems with the pump?
 *Should you be venting the tube? When and how?
 *Will she remain on meds post-op? For how long?
 *What is the plan for feeding by mouth? Try to get feeding therapy involved ASAP.

The right clothes can help – During this time, Daniel wore onesies exclusively. This prevented his tube from falling out of his shirt and getting caught on a toy or kneeled on. Once his foley catheter was changed to a button, Daniel could no longer wear onesies, one-piece playsuits or pajamas, or overalls. Because he had five bolus feeds a day, it was too difficult to remove clothing to get access to his button. However, it may be easier to dress children who are on continuous feeds in one-piece outfits.

Changing to a button – The foley catheter is removed and a button is put in its place anywhere from three to eight or more weeks after surgery. The most common button type seems to be a Mic-key or Bard. Daniel, however, has a Genie button. It’s a small piece of hard plastic with a one-way valve. When we connect his extension tube for feeds, the valve opens. The button must be changed by the GI every three months, but I consider that a good opportunity to chat on a regular basis. Changing the button is fast and painless. Daniel sits on my lap, lifts his shirt, and watches the whole thing.

It was our GI who recommended a Genie over a Mic-key for Daniel – I think because of his age and where he was developmentally. A younger child who spends more time on his belly might be more comfortable in the Mic-key, which is made of a softer plastic. However, the Genie seems to be easier to care for – we simply wash the area like we wash the rest of his body every night.

About feeding pumps – Like most parents of new tube feeders, we were given a Kendall Kangaroo pump to dispense Daniel’s feeds. We rented it from Apria for a monthly fee, but a few months later we decided to purchase an Entralite Infinity pump from Zevex. (Depending on your insurance plan and medical supplies provider, you may be able to rent an Infinity, but that was not the case in our situation.)

The Infinity is lighter and more portable (since it can be carried in a tiny backpack); easier to use, in my opinion; and can deliver formula 50 percent faster, which is a real bonus since my three-year-old can handle fast bolus feeds.






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Site Last Modified: March 29, 2007
*Disclaimer: The information available on this website should not be used as a substitute for professional medical care for the prevention, diagnosis, or treatment of your child's reflux. Please consult with your child's doctor or pharmacist before trying any medication (prescription or OTC) or following any treatment plan mentioned. This information is provided only to help you be as informed as possible about your child's condition.
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