Did you know that over 200,000 children in the United States require a feeding tube? What if I also told you that there are hundreds of conditions that can be a reason why a child may need a tube, most of which are not visible just by looking at someone? It’s the honest truth!
I remember back to when Bowen was first admitted to the hospital for Failure to Thrive and they talked about training Chris and I to put in a nasogastric (NG) tube. The nurses explained that it’s one of the first skills learned in nursing school because it’s easy. On another child who isn’t yours, YES, easy peasy lemon squeezy! Shoving a small rubber tube through your own child’s nose as they writhe and cry in discomfort, while watching it come back through their mouth because they’re crying so hard, then having to pull it back and re-position it so it goes into their stomach and not their airway… NO! THERES NO LEMONS HERE!!
It was the first moment in my motherhood journey where I remember thinking to myself “I don’t want to do this. But I have to…” it was the only time I every remember feeling sorry for myself knowing I was going to have a medically special needs child.
The fact is, having a child with a feeding tube is its own separate journey apart from the one under the umbrella of the diagnosis. In this blog, I aim to talk about the different types of feeding tubes to provide some basic education. The more you know…
An NG tube is a common “starter” tube. It is not permanent or surgically placed. It is a long rubber tube that goes through the nasal cavity down into the esophagus and then into the stomach. Placement into the stomach needs to either be confirmed through x-ray, or through testing stomach contents on PH paper. The paper method is somewhat “unofficial” as stomach contents can vary but generally speaking it is a reasonable way to check placement and the only way to check it outside of a hospital.
A G-tube (or gastric tube) is surgically placed into the stomach to deliver nutrition. Both an NG and a G-tube are considered pre-pyloric, which means they end in the stomach. (I’ll go into post-pyloric below).
A ND tube or NJ tube are 2 types of tubes that extend further into the intestinal tract, past the stomach. An ND goes into the duodenum and the NJ will go into the small intestine (jejunal). Reasons for these tubes vary widely, but the short answer is, children or adults who require one of these cannot tolerate nutrition directly into the stomach.
Post-pyloric tubes that are surgically placed include J-tubes, GJ-tubes. According to feedingtubeawareness.org, the J tube is less common in children. Again, these tubes bypass the stomach due to any sort of condition that would render the patient unable to tolerate gastric feeds. Feeds given through a GJ or J must be given very slowly and you may find kids with these tubes on continuous feeds.
Feeding through any type of tube can be done in 2 ways- through a feeding pump, or through a bolus or syringe. There are pros and cons to both. A feeding pump can be set at a certain speed or rate. It is beneficial for kiddos who need continuous feeds, or who cannot tolerate large amounts quickly, like a bolus. A feeding pump also doesn’t require continuous supervision and you can “plug and play” so-to-speak… as long as your Tubie can sit still! Bolus feeds are ideal for on the go. Feeding pumps can be bulky and not very travel friendly. By bolus feeding, all you need is a syringe (typically 60mL), the extension and your formula. Drawbacks include messes! Overfilling the syringe or feeding too quick can cause spillage or vomiting from your Tubie. We’ve made many mistakes by filling the syringe too full. This doesn’t leave room for burps, cries or laughs as any pressure coming from the stomach will push contents back out. As previously mentioned, if a faster rate is difficult for a Tubie to tolerate, then a bolus feed may come right back up. We always have to be careful with bolus feeds as Bowen does struggle to tolerate quick feeds that fill him up too quickly. Any Tubie caregiver is all too familiar with being vomited on- multiple…times…a…day…
Being a Tubie parent is it’s own unique badge of honor. Websites such as Feedingtubeawareness.org has been instrumental in my own journey to learn about life with a tube dependent kiddo. Facebook Groups have also been wonderful sources of education and help with troubleshooting or venting. Groups like Feeding Tube Families, G-Tube Families: The Road to Eating and Drinking, and Pediatric Feeding Disorders have been my go-to’s for the last several years.
The educational posts I do are rudimentary compared to the websites and sources I use. To a degree, the point of my educational posts is to be simple because there are a lot of resources to be utilized for more details and I do not need to reinvent the wheel. No one should replace their own doctors medical direction with that from a blog or website. My goal with any educational post is to give the basics, and then give the resources where to find more information and cite my sources.
Somewhere In Between 