Some children cannot meet their nutritional needs by oral feedings alone. Due to medical complications or growth difficulties, these children are unable to take in enough calories by mouth for proper growth, nutrition, and development. Tube feeding supplements are often required.
There are several types of tube feedings that can be used to supplement nutrition. A doctor will recommend one that is specific to the child’s needs.
The nasogastric tube or NG tube is a soft tube that runs through the nose and into the stomach. Surgery is not required for placement. This tube is designed to be used for several months to provide the child with extra nutrition and calories. The NG tube still allows the child to eat by mouth. Therefore, oral eating skills can continue to develop and prepare the child to eventually eat without the tube.
The NG tube is considered a short-term help for babies with poor growth. It is generally not used when babies have long-term feeding difficulties.
The orogastric or gavage tube is run from the mouth to the stomach using a tube similar to a NG tube. Surgery is not required for placement. The orogastric tube is usually pulled out immediately after each feeding and replaced before the next one. This irritates the throat and makes swallowing difficult. It is only used, therefore, on a short-term basis in very young infants as it is difficult to eat by mouth with the tube in place.
A gastronomy tube infuses food directly into the stomach. A surgical procedure or a special procedure called endoscopy (PEG) is required for placement and daily skin care is necessary. Children are at risk of developing reflux of stomach contents with this tube.
Some advantages to this tube are that it is placed directly through the abdominal wall and is not seen most of the time as is the NG tube. When the tube is no longer necessary, it can easily be removed. Because the tube bypasses the mouth completely, irritation to the throat does not occur and food can be taken orally if the child is medically able to eat. This type of tube can be used on a long-term basis and due to its larger size, thicker formulas can be used.
The jejunostomy tube is placed surgically through the abdominal wall into the jejunum (the beginning of the small intestine past the duodenum). It bypasses the stomach and helps stop the risk of reflux feedings. If permitted by the doctor, the child may still eat by mouth. Care for this tube is similar to the gastronomy tube. This tube requires a continuous drip feeding, meaning the child is connected to a feeding pump most of the time. Special predigested formulas may also be required.
How is it diagnosed or detected?
Children that require tube feedings usually have a pre-existing condition or disability such as Failure to Thrive, Down Syndrome, Cleft Palate, Cancer and/or other disabilities that may present the child with severe oral-motor difficulties.
In infants and young children, common signs that tube feedings are necessary are:
- lack of, or very little, weight gain
- weight loss
- slow growth
- severe crying during feedings/refusing to feed
- inability to swallow
- evidence of aspiration
The goals of nutritional intervention are to prevent or reverse nutritional deficits, to promote normal growth and development, and to maximize quality of life.
The information on the specific types of tubes has been adapted from, Therapy Skill Builders, a Division of Communication Skill Builders; Feeding and Nutrition for the Child with Special Needs, Klein and Delany.
THE HOSPITAL FOR SICK CHILDREN www.sickkids.ca/dietitians/
The Department of Clinical Dieticians is composed of 33 registered dieticians and four breastfeeding Support Nurses. Each dietitian works within their respective program to assess the nutritional status and needs of paediatric patients at risk of less than optimal nutrition to support their growth and well-being. They develop, implement, monitor and adjust nutritional care plans based on this assessment and each child’s on-going medical condition.
THE OLEY FOUNDATION www.oley.org
The Oley Foundation is a national, independent, non-profit organization that provides up-to-date information, outreach services, conference activities, and emotional support for consumers, their families, caregivers and professionals.