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
page for a more complete description of NG and NJ
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
- 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
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
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
*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
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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