Nutrition Interventions for Children with Special Health Care Needs

Appendix N
only when the child is being fed. These devices are easily hidden under a child’s
clothes without tubing that extends from stomach. They may be placed surgically
or endoscopically in the stomach wall or after a gastrostomy tube has been placed
and the stoma site well established. Some gastrostomy tubes have extensions that
“lock” into place, so the child is less likely to become disconnected while feeding,
e.g., MIC-KEY ® . Some parents prefer the flatter fitting tube such as the EndoVive ®
and Bard ® . There are many more gastrostomy tubes available and parents can ask
their physician or infusion company for more information. Families should check with
their home supply company to determine how many gastrostomy tubes are provided
every 6 months. If the child has the balloon gastrostomy tube, e.g., MIC-KEY ® or
EndoVive ® , the parents need to be instructed in what to do if the tube comes out or
how to replace with a back up gastrostomy tube.
Pumps
A pump can be helpful in providing a consistent amount of formula to the child,
which may improve tolerance. Pumps are designed to be accurate within 10% of the
set rate, so determining the accuracy that the patient is actually getting is important.
With small infants, a syringe bolus pump will provide more accuracy with a small
volume (8).
There are many different enteral infusion pumps, varying in complexity, flow rate,
and cost. Pumps can be rented or purchased from a medical supply company. For
long-term use, it may be less expensive to buy a pump. When a patient owns a
pump he will be responsible for its maintenance, while renting the pump makes the
medical supply company responsible for repair and maintenance.
When deciding which type of pump to use, there are various considerations:
availability, accuracy, cost, and ease of maintenance. A lightweight, battery operated
enteral feeding pump, such as the Zevex Infinity ® , will allow the child to attend
school or go on outings with formula and equipment fitting neatly into a small
backpack. If the child is feed at night only an ambulatory pump may not be needed.
For some families, pumps do not fit into their life. Syringe bolus feeds require less
equipment, alarms do not beep in the night, and the syringe bolus feeds may require
less instruction time.
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