Nutrition Interventions for Children with Special Health Care Needs

Appendix N
Gastrostomy Tube Feeding
A gastrostomy tube places food directly into the stomach. Gastrostomy feedings are
preferred as they allow more flexibility with schedule and can mimic normal feeding
schedules. These feeding tubes are well suited for long-term enteral feeding. Patient
comfort with gastrostomy is an advantage over NG tubes. Gastrostomy tubes do not
irritate nasal passages, the esophagus, or the trachea, cause facial skin irritation,
or interfere with breathing. The mouth and throat are free for normal feeding if the
child is safe to feed orally. There are skin level gastrostomy tubes that are easily
hidden under a child’s clothing, require less daily care, and interfere less with the
child’s movement. A gastrostomy with a large-bore tube allows for a more viscous
formula and thus a lower risk of tube occlusion. The gastrostomy may be placed
surgically. Another alternative is the percutaneous endoscopic gastrostomy, which
may be done as an outpatient procedure.
Disadvantages of gastrostomy feeding include the surgery or endoscopy required to
place the tube, possible skin irritation or infection around the gastrostomy site, and
a slight risk of intra-abdominal leakage resulting in peritonitis. The child with poor
gastric emptying, severe reflux or vomiting, or at risk for aspiration may not be a
good candidate for a gastric placed tube (1,2,3).
Jejunal Tube Feeding
Jejunal tubes can be placed surgically or via percutaneous endoscopy. Feeding
directly into the jejunum (the middle section of the small intestine) is used for
children who cannot use their upper gastrointestinal tract because of congenital
anomalies, GI surgery, immature or inadequate gastric motility, severe gastric reflux,
or a high risk of aspiration. The jejunal tube bypasses the stomach decreasing the
risk of gastric reflux and aspiration. If safe to feed, the child can still eat by mouth.
However, even for children with gastric retention and a high risk of aspiration, there
are disadvantages to jejunal feeding. Jejunal tubes passed from a gastrostomy to
the jejunum and nasojejunal are difficult to position and may dislodge or relocate;
their position must be checked by X-ray. A jejunostomy reduces problems of tube
position. They usually require continuous drip feeding which results in limited patient
mobility and decreased ability to lead a “normal” life. Finally, when compared to
gastric feedings, they carry a greater risk of formula intolerance, which may lead to
nausea, diarrhea, and cramps. Standard formulas may be given in the small intestine
if tolerated, however, elemental or semi-elemental formulas may be required if the
child demonstrates formula intolerance (2,4). These elemental formulas are more
expensive.
346 Nutrition Interventions for Children With Special Health Care Needs