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Many Neocate babies and children receive their formula through a feeding tube. Enteral tube feeding provides nourishment to individuals who are unable to consume adequate nutrition by mouth. If your child uses a feeding tube, you know that there may be some occasional tube feeding complications. This blog will provide some general troubleshooting tips for the most common tube-feeding problems.

Clogging of the Feeding Tube:

Sometimes a feeding tube will become blocked so that no food can go through.

How to fix:

• First, using a syringe to gently remove the liquid on top of the blockage, if possible (throw away the fluid removed).
• Next, gently flush the tube using lukewarm water, using at least a 30 ml syringe. Gently plunge the water back and forth to clear the blockage.
• Unless directed by a health care professional, do not use acidic solutions such as fruit juices or cola as they may curdle the tube feed.
• If the tube is still clogged, clamp the tube for around 10 minutes and then try flushing it again.
• If the tube the clog remains, gently squeeze the tube between your fingers along the length of the tube as far as possible.
• If you are still unable to clear the blockage, contact your health care professional for advice. Sometimes, the physician will prescribe a special enzyme which can dissolve the clog. If the clog cannot be cleared, the tube will have to be replaced.

How to Avoid:

• Tube Flushing is the most important factor for preventing the feeding tube from clogging. Use a syringe to flush 20 mL or warm water through the feeding tube before and after feedings and medications (or as directed by your health care professional). If your child receives a continuous feed, your health care provider may recommend flushing with water during the feed to prevent clogging.
• Use liquid medications whenever possible. If pills are necessary, crush them well and mix them with a small amount of warm water. Use a syringe to draw up the solution and insert it into the feeding tube. If pills are coated or time-released, discuss this with the physician because these types of pills are typically not meant to be crushed.
• Do not mix medications together and do not mix medications in formula unless instructed to do so by your health care provider.

Tube Site Irritation or Infection:

Redness, pain, swelling or unusual/excessive drainage, as well as fever, can all be signs of an infection at the stoma site (the surgical opening through which a gastrostomy tube (g-tube) or jejunostomy tube (j-tube) enters the stomach or small intestine).

How to Avoid:

To avoid infection, it’s important to keep the stoma site clean and dry. Your health care provider should give you specific recommendations for how to clean the stoma site each day. For more information on keeping the stoma site clean (from a parent’s point of view), check out this informative article from Complex Child E-Magazine.

A Dislodged Feeding Tube:

If the feeding tube comes out, call the doctor and go to the hospital right away. The stoma can close up very quickly so the tube needs to be replaced promptly. Cover the site with clean dressing or bandage to prevent leakage and immediately seek medical attention.

Sometimes the health care provider will train you to replace the feeding tube yourself (temporarily or permanently) but you should ONLY do this if directed and properly trained by your child’s physician.

How to Avoid:

Young children occasionally pull the tube out themselves. Keep the tube covered with clothing to prevent this. Onesies work well for infants and toddlers. It’s also important to secure the tube during activities so that it doesn’t get pulled out. You can use various methods to secure the tube. Some companies make special wraps and clothing for protecting and accessing the feeding tube:

• Gus Gear
• Bundie Baby
• Tummy Tunnels

Do you have any troubleshooting tips to share with other tube-feeding families? What problems have you encountered and what tricks have you learned?

- Mallory

Although most Neocate-users drink their formula, many patients receive Neocate through a feeding tube. This is referred to as “enteral nutrition”. Those of you with tube-fed little ones are already experts on the subject, however, I hope this post will be useful for those of you who are new to tube-feeding or for those of you who are just interested in learning how it works.

Tube-feeding provides nutrition to someone with a medical condition that impairs his/her ability to eat or drink (or impairs their ability to consume enough to sustain his/her nutritional needs). Nutrition is provided by a special liquid food that is given through the tube.

The liquid food contains all components of nutrition (protein, fat, carbs, vitamins and minerals) so it provides everything a person needs to live and be healthy. Some people are exclusively tube-fed while others continue to eat food while supplementing with tube-feeds. Fluids and medications (most of them) can also be given through the tube (which is a nice perk for kids who require some bad-tasting meds!).

Types of Feeding Tubes

There are various types of feeding tubes. A nasogastric or nasoenteral tube is inserted through the nose into the stomach or small intestine[1]. Alternatively, a tube may be surgically inserted through the skin and directly into the stomach or the small intestine in a procedure called a gastrostomy or jejunostomy, respectively. You may hear these refered to as a “g-tube” (short for gastrostomy tube) or a “j-tube” (short for jejunostomy tube). Patients with g-tubes may get a feeding port (commonly known as a MIC-KEY button or a mickey tube), so that the outside feeding tube only needs to be attached during feedings.

Methods of Tube-feeding

There are 3 ways that tube-feeds are administered:

• Gravity: With gravity feeds, a bag of formula hangs above the patient so that the formula flows down the tube.
• Syringe: With syringe feeds, formula is administered by hand using a syringe to push the formula through the tube.
• Feeding pump: An electronic pump moves formula through the feeding tube at a controlled rate. Common brands of feeding pumps include the Kangaroo pump and the Infinity pump.

Feeding Rates

• Bolus feedings: Bolus feedings are relatively large in volume and given over a relatively short period of time. Feedings are given several times a day and the schedule more closely resembles “mealtimes” in comparison to a continuous feed.
• Continuous/drip feedings: Feedings that are given at a slow rate, over a relatively long period of time. Continuous feeds may be indicated for patients who are unable to tolerate large volumes.
• Combination: Some people may do a combination of both types. For example, they may receive bolus feeds during the day and a continuous feed overnight.

Enteral nutrition is such an amazing example of the impact that medical technology has on our lives. Before there was enteral nutrition, the inability to eat was a life-threatening situation. Although nobody wants to rely on a feeding tube unnecessarily, it is such a blessing for those who could not live without it.

My younger sister Caroline got her G-tube about 2 years ago (she was 11). We tried to avoid it for so many years but once she got it, it turned out to be such a blessing in disguise! She has never looked healthier; she gained some much-needed weight, her hair and skin look so much healthier, and she’s so much stronger. Our family is so thankful for it! If you have come across this post because your little one is getting a feeding tube, I hope this gives you a new and optimistic perspective!

Do any of you have experience with a feeding tube? What impact did it have on your child’s life? What are the biggest obstacles you experience with a feeding tube?

-Mallory

[1] American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). http://www.nutritioncare.org/wcontent.aspx?id=266>

Did you know that Feeding Tube Awareness Week is happening right now? It is! This year Feeding Tube Awareness Week falls on February 5-11. You can help the Oley Foundation  and Feeding Tube Awareness Foundation  (FTAF) spread the word.

We know, many children who benefit from Neocate products have to use a feeding tube to get their nutrition.  If you’re new to tube feeding and are looking for folks who share similar stories, try the Oley Foundation’s support community or the FTAF’s inspiring stories. You can also visit the Oley Foundation’s facebook page and FTAF’s facebook page. 

The FTAF launched Feeding Tube Awareness Week last year with great success! Both organizations’ websites have some great tips for how you can help spread the word. Ideas include contacting local media outlets as well as using social media platforms. This is a great opportunity to help raise awareness of feeding tubes in your community to promote greater acceptance and understanding. 

To someone who isn’t familiar with feeding tubes, they can be strange and confusing. On one hand, parents can have a tough time adjusting to tube feeding. On another, people in the community don’t always know how to react to feeding tubes. You can help inform others about how many precious little ones’ lives have been improved and saved with the help of feeding tubes.

Is there something you’ve done to help promote feeding tube awareness?

- Rob 

[Image name: Feeding Tube Awareness Week - Image link: http://www.oley.org/Tube_Feeding_Awareness_2012.htm]

[Image name: Feeding Tube Awareness Logo - Image link: http://www.feedingtubeawareness.org/raising-awareness.html]