Sometimes babies and children
with GERD begin to learn that when they eat, they hurt.
They begin to become difficult feeders and many will down
right refuse to eat just trying to stop their pain. Severe
oral and feeding aversions can result as the baby begins to
associate bad things with their mouth. Some people believe
that babies will eat no matter what if they get hungry
enough, and that may well be true for most babies,
refluxers; however, are completely different and need to be
treated as such. Some babies or children may vomit so much
they are unable to gain sufficient weight on their own. In
some cases the oral/feeding aversions and excessive vomiting
become so severe the baby requires tube feeding to survive.
There are several types of feeding tubes that can be used,
as listed below.
Temporary Feeding Tubes
- NG-tube (N-Naso, G-Gastric)
This is a long thin tube that is inserted through the
child's nose, throat and esophagus down into the stomach.
The tube is attached to the side of the child's f ace
using a hospital grade tape. A pump or gravity feed may
be used to supply the food through the tube. Feeds can be
given in bolus or continuous amounts. Bolus meaning large
amounts over a short period of time. For example,
mealtimes can be mimicked by giving three large meals a
day through the tube. Continuous feeds are smaller
amounts given over longer periods of time, for example the
food would pumped slowly all night long long, or for over
a period of several hours. NG tubes are only temporary
solutions, and although literally a life safer for many
kids, they also have their drawbacks. They can cause
irritation and damage to the skin on the face, from the
tape used, as well as irritation and damage to the
esophagus and throat if left long term. NG tubes have
also been known to actually make oral and feeding
aversions worse because they cause even more negative
associations to the mouth, and nose area for the child.
They can also actually increase the amount of reflux
activity because they can hold the LES opened slightly.
- NJ-tube (N-Naso, J-Jejunum)
This is similar to the NG tube except once in the stomach
it continues through the pyloric valve, duodenum (first
part of the small
bowel) and into the jejunum (second part of the small
bowel). NJ tubes have the same drawbacks of the NG tube
but because the end of the tube is in the jejunum instead
of the stomach, NJ tubes can help reduce vomiting
associated with reflux. They can also help decrease
aspiration and apnea episodes for the same reason.
Because the jejunum (bowel) can't handle large volumes of
food bolus feeds are not possible with an NJ tube. NJ
tubes must be placed using fluoroscopic guidance with the
help of a radiologist.
Surgically Inserted Tubes
- G tubes (Gastronomy tubes)
 G-tubes
are surgically inserted through the side of the abdominal
wall. A small hole is created on the left side of the
abdomen, leading directly into the stomach. A foley
catheter will likely be placed until the incision heals,
at which time a more permanent and convenient button will
be placed.
- J-tubes (Jejunostomy tubes)
J-tubes are surgically inserted through the side of the
abdominal wall. Similar to the
gastronomy a jejunostomy is performed by creating a small
hole on the right side of the abdomen leading into the
jejunum.
*J-tube pictured to the left. Pictured in
the photo, zinc is used on the abdomen to protect the skin
surrounding the stoma (hole) from acidic stomach contents
that leak out.
Photos and drawing by and © 2001-2005
RMacLean.
All rights reserved.
Reviewed By Dave Olson, MD
Fellow, American Academy of Pediatrics
Graduate University of Michigan School of Medicine |
