Different Types of Feeding Tubes
G (Gastric): G-tube is surgically placed directly into the stomach. Some hospitals will place a PEG or
Bard G tube initially to form the stoma (2-3 months) and then transition over to a button g-tube.
G tube Pros:
- It is more comfortable than the NG because it eliminates the tape on the face
- Buttons can last about 3 months or so
- If your child is not feeding, no one would know they are a Tubie. Low profile buttons do not stick out very far making it more comfortable for the child.
G tube Cons:
- It does involve a surgical procedure to place a G tube initially. However, we have found that our children have healed quickly from the procedure and resumed normal activity fairly quickly.
- Little hands can also pull out G tubes!
- G tubes need to be "vented" to release gas from the stomach. Think of it as belly burping. (See Video Tutorials)
- G tubes can clog. So be sure you "flush" medications with 7-8mls of water.
- Granulation tissue - it looks like little blisters and redness around the stoma. (see Troubleshooting)
- Some docs/surgeons will tell you that you need to have a Nissen Fundoplication at the same time - NOT TRUE!!!!! (See Nissen Fundoplication)
NJ (Naso Jejunal): Runs from the nose to the intestines
NJ tube Pros:
- Can serve as a trial run before moving to a more permanent tube, such as the GJ
NJ tube Cons:
- Because the tube is run to the intestines, it needs to be placed by Interventional Radiology using x-rays to insure correct placement. Many hospitals perform this procedure under sedation, some larger children's hospitals do not. You will need to check with your hospital.
- Your child will be continuously fed. There is no bolus feeding to the intestines. Your child can be off as many as 6 -8 hours. Feeding schedules vary based on nutrition and hydration needs.
- It is a bigger deal if your child pulls out the tube because you will need to get it placed by Interventional Radiology.
- You have all the tape cons like an NG
ND (Naso Duodenal): Runs from the nose to the entrance of the intestines
- Not a common Tubie. Has the similar pros and cons to the NJ.
GJ (Gastric Jejunal): Button is placed stomach and tubing runs to the intestines, using the existing G stoma.
GJs come in children’s and adult sizes. However, the adult size length (45 cm) can be used in very
young children. Longer lengths tend to stay in place better. Button GJs are much easier to work with in children.
GJ Tube Pros:
- Feeds directly to the intestines which is important for kids with delayed gastric emptying or dysmotility
- The G tube can be converted into a GJ easily (no new surgery)
- No more vomiting formula fed by Tubie!!!! (exception might be children with Chronic Intestinal Pseudo Obstruction and if tube has a complication)
- Tube is placed by Interventional Radiology using x-rays to insure correct placement. Like the NJ tube, some hospitals perform this procedure under anesthesia
- GJs need to be replaced about every 3 months
- Since GJ placement is key, more care needs to be taken to not to keep the button on the tummy as stationary as possible. The G tube is more like an earring - it should be turned. But, not GJs.
- GJs can coil up and migrate to the stomach if the J part isn't long enough - Seek medical attention immediately if you see formula in G output or venting.
- It is a bigger deal if a GJ tube clogs. It is recommended that a GJ be flushed every 4-6 hours with 20mls of water through a syringe. This should be done less quickly than a flush to the G. Water going through quickly can affect placement.
- Your child will be continuously fed. There is no bolus feeding to a GJ. Your child may be off as many as 6-8 hours. Feeding schedules vary based on nutrition and hydration needs, and if a child is able to eat or drink anything orally.
- It is likely you will still need to vent the G port
J (Jejunal): Button can be surgically placed directly into the intestines or into the stomach like a GJ
J Tube Pros:
J Tube Cons:
- J tubes without G ports cannot be vented. So if there is build up of gas in the stomach it cannot be released
- J tube sites can have more problems with leakage than G tube sites.
TPN: Total Parenteral Nutrition
This is a last resort for children who are unable to tolerate tube feeding into their stomachs or intestines. It involves the placement of a central line and nutrition is fed intravenously. In some cases it is used temporarily until a child is able to tube feed again. In other cases, TPN becomes the main nutritional support. TPN can be administered at home once a parent is trained.
Links to Resources:
Great Articles from Complex Child
The type of feeding tube used depends on how long a child will be tube fed and whether or not the stomach or intestines can tolerate the needed volume of food.
NG (Naso Gastric): Runs from the nose to the stomach
NG tube Pros
- Placed non-surgically and parents can be taught how to place an NG tube at home.
- It is a good Tubie for short-term tube feeding. If your child is going to be tube fed for longer than a few months, you should consider moving to a G-tube.
NG tube Cons
- NG tubes need to be changed every 1-3 weeks, rotating sides of the nose.
- Little hands pull the tube out.
- Taping the Tubie can be a challenge. Little hands pull at the tape. Sometimes there is a reaction on the skin from the tape. There is some trial and error to finding what works for your child. Moreover, some children are allergic to tapes used. (See Troubleshooting)
- There can be congestion in the nose and eye on the side where the NG tube is.
- The NG tube can make reflux worse because it holds the stomach open to the esophagus.
- It is the most visible of the Tubies and therefore it can draw attention in public. People may confuse it with oxygen.