The most common type of feeding tube is the gastrostomy (G) tube. G-tubes are placed through the abdominal wall into the stomach. This sounds scarier than it is. The G-tube surgery can be performed in three ways: surgically through small incisions using a laparoscope, surgically using a larger open incision, or endoscopically using a scope into the stomach to create the stoma from the inside. The endoscopic method has become the method of choice at many hospitals; however, some institutions still place tubes surgically, and children with anatomic abnormalities or who need other procedures may require a surgical placement. For more information on surgical placement, see our page on G-Tube Surgery.
There are a number of types of G-tubes. Any kind of G-tube can be placed initially. Often it is the surgeon or the gastroenterologist who determines the first type of G-tube placed.
Best thing ever. My two daughters had NG-tubes for 9 months or so and they pulled them out up to 8 times a day. Complete nightmare having to rethread them. G-tube is amazing.
Best thing we could have done for our son! He was on an NG for about 6 months before we switched. I’m so glad we did. G-tube has been in since October and we love it!!
It was a good choice for us. The G-tube went in during another abdominal surgery. Changing the G-tube takes a few seconds every few months, and isn’t traumatic for my child. My son was a ninja when it came to pulling out his NG-tube. I did get good enough at placing NG-tubes that I could do it by myself on a squirmy infant, but I hated having to do so. It also lets him be a more typical little boy since his feeding issue isn’t out in public all the time. The G-tube isn’t much more difficult to manage than a piercing.
We were so nervous about the transition. Overall though it has been the best choice we have made!!! Our son has made so much progress since we switched him to a G-button! We are to the point now where they think we may be able to get rid of the button within the next 6 months & he’s only had the tube since November!!
I hated the idea at first, but it seriously was the best choice. My son wouldn’t be where he is now developmentally without his.
Best thing we ever did! No more tape bothering my babies little cheeks & much easier for parents to handle than an NG.
I wish I would’ve had my sons placed so much sooner. Took away the stress of trying to get formula or extra calories into him. It has been a positive experience for us and so glad we did it.
I was definitely nervous at first, but for us the G-tube was easier and less stress. I was constantly worrying about her pulling the NG-tube out. It’s easier to protect the G-tube. All in all, I can tell a huge difference in her personality. The G-tube doesn’t bother her at all like the NG-tube did.
We just made the switch a month ago. It has been AMAZING. The NG-tube was filling me with stress and dread–it was pulled out almost daily, she wasn’t getting enough calories, and she was developing an oral aversion. A month later she’s gained weight, we are all much happier and less anxious, and she just recently started to let herself be spoon fed again.
Fact: No feeding tube is permanent. A G-tube can be removed easily when it is no longer needed. Kids can just as easily wean from a G-tube as an NG-tube. In fact, G-tubes may make it more comfortable for a child to eat orally.
Fact: Many kids with G-tubes actually eat some of their diet orally. In fact, sometimes kids eat more with a G-tube because they no longer feel as pressured to eat, and the G-tube is much easier to eat orally with.
Fact: There is no reason your child cannot eat orally with a G-tube, as long as he or she is safe to swallow. Kids with G-tubes who used to eat orally typically continue to eat orally after they receive their G-tubes.
PEG and Long Tubes
These are one-piece tubes held in place either by a retention balloon or by a bumper. They are often used as the initial G-tube for the first 8-12 weeks post-surgery. PEG specifically describes a long G-tube placed by endoscopy, and stands for percutaneous endoscopic gastrostomy. Sometimes the term PEG is used to describe all G-tubes. Surgeons may place other styles of long tubes.
Low Profile Tubes or Buttons
These tubes do not have a long tube permanently attached outside the stomach. Instead, they have a tube called an extension set that is attached for feeding or medication administration and then disconnected when not in use. When an extension set is not attached to the button, it lies fairly flat against the body. There are two types: balloon and non-balloon.
Balloon buttons are held in place by a water-filled balloon. Balloon buttons are the most common G-tube for children once the stoma (G-tube site) is fully healed, usually in 2-3 months. The use of balloon buttons as a first G-tube is increasing among medical professionals. Balloon buttons can be replaced at home after caregiver training.
Some surgeons and gastroenterologists prefer the first G-tube to be a non-balloon button. Non-balloon buttons are harder to pull out than balloon buttons. Non-balloon buttons cannot be replaced at home. They are placed in the doctor’s office or at the hospital, sometimes with sedation or a topical pain reliever.
Gastric Tube Considerations
G-tubes can be more comfortable than nasal tubes and are a safer option for longer-term tube feeding.
There are low profile, button-style G-tubes that aren’t as noticeable under clothing.
The balloon button G-tubes can be replaced at home by a trained parent or caregiver.
Balloon buttons and tubes typically need to be replaced every 3 months, while non-balloon buttons need to changed less often, between every 6 months to a year.
G-tubes need to be placed surgically or endoscopically, and there is a recovery period after.
Little hands may also pull out G-tubes.
A common complication of G-tubes is the formation of granulation tissue (which looks like red, overgrown tissue around the tube site) during the healing process. It isn’t dangerous but it can be painful and irritating. It may also bleed easily. For more information, see the Granulation Tissue page.
Sizing for G-tubes
All G-tubes are sized by the width of the tube, which is measured using the French scale, across the diameter of the tube. G-tube buttons require a second measurement, in centimeters, based on the length of the tube’s stem (the part of the tube that is placed in the stoma or tube site). For example, a 16Fr 1.5cm tube has a French size (diameter) of 16 and a stem length of 1.5cm. The size is listed on MIC-KEY and AMT button G-tubes. G-tubes should have enough room between the tube and the skin to allow one or two coins to slide under. If the tube is pressing tightly against the skin or has much more room, your child may need a different stem size.
Caring for the New Stoma
Less is more with tube site care, particularly in the beginning.
New stomas often ooze cream-colored secretions. Initially, you may use gauze or another dressing around the site. You should change the gauze as often as needed to keep the site dry. Keeping the site dry is important to healing.
The dressing usually can be removed after a few days. Keeping the site open to the air is good for healing. You may continue to see leakage that is clear or tan in color, which may become crusty as it dries. There may be small amounts of blood. You can gently wash the site with warm water and gauze or cotton swabs as needed throughout the day. Dry the site with clean gauze or a towel after.
New tube sites should not be submerged in water for at least a week or two unless otherwise directed by your doctor. Ask your doctor about any restrictions your child may have.
Think of the G-tube like an earring. In order to form the stoma, the new G-tube needs to be spun daily.
See our Tube Sites pages for more help with stoma care.
Venting a G-Tube
Some children get uncomfortable when there is air in the stomach. You can vent air out of the stomach every few hours as needed. You may want to vent before each feeding, around the time of each diaper change, or after feeding. Children who receive fundoplication surgery may need to be vented more often. You will learn how often your child needs to be vented.
In order to vent, you need a large syringe with the plunger removed, a cup, and towel because sometimes stomach contents comes out with the air. If your child has a button-style tube, you will need an extension set (preferably a straight/bolus extension). Note that the Bard Button has a special extension set for venting called a decompression tube.
Insert the open syringe into the end of the long tube or into the extension set, then unclamp the tube. Gently pushing on the stomach (or raising your child’s legs to the chest) will help to move the air towards the tube and allow it to move out. Food may also come out. You should let it slowly run back in when finished. This is often referred to as re-feeding. For more continuous venting, even while feeding, you can use a Farrell valve bag.
Securing the PEG or Extension Set
Other than the daily spinning of the G-tube, movement and pulling on the site should be minimized to prevent trauma and leakage.
Many parents use medical tape, such as Micropore (paper tape) or Hypafix, or a securement device, such as a Grip-Lok, to secure tubes and extension sets, especially for continuous feeders. You can secure the tube to the stomach with tape. Or you can form a tab to pin to the child’s clothing or diaper by wrapping tape around the tubing and folding it back onto itself.
Little hands can be persistent, so many families have had to come up with unique ways to secure the tube. The image is just one creative example.
Checking the Balloon
If your child has a button or tube held in with a balloon, you may need to periodically check the water level in the balloon. Some doctors like you to check the balloon on a regular basis, such as once a week, while others only suggest you check the balloon if the tube seems to be loosening up or tightening.
To check the balloon, insert a slip tip syringe into the balloon port. While holding the tube in place, withdraw back the water from the balloon into the syringe. Sometimes you will also withdraw some air. It can be difficult to get all of the water and air in one try, so you may need to pull back a few times.
Once you have emptied the balloon, note how much water is in the syringe. If there is more or less water in the syringe than there should be, add or remove water until the right amount remains in the syringe. If the water from the balloon is very discolored or looks contaminated, you may want to replace it entirely. Note that the stomach is not sterile, so regular tap water is fine unless your child has an immune system disorder.
Children with MicKey buttons tend to keep 5ml in the balloon, but your doctor may advise putting more or less water into the balloon, depending on your child’s size and needs. AMT MiniONE balloons should be filled according to the manufacturer’s guidelines. Insert the correct amount of water back into the balloon and remove the syringe.
If the balloon seems to be losing water continuously, or if more fluid is in the balloon than was initially inserted, the balloon may have a small hole. Replace the tube or button as soon as possible. Even if the balloon has burst, the tube or button can be taped in place until it can be replaced.
Changing the Tube
Depending on the type of tube or button your child has, it may be possible for you to learn to change it at home. Do not change a tube or button at home until your doctor or nurse has said you may do so and instructed you on the proper method. New tubes should not be changed at home, as the tube tract may not have fully developed yet.
Children with tubes held in by mushrooms, barriers, or collapsible barriers typically cannot be changed at home. Your doctor or nurse will need to change the tube in the office using special tools, such as an obturator.
If your child has a balloon button or tube and has had the device for at least two months, you may be able to change the tube at home. Ask your doctor or nurse for instructions on how to change the tube. In most cases, it is no more difficult than changing an earring.
The general method for changing a tube is as follows:
Place your child on a flat surface where there is a low risk of falling. If your child is grabby or wiggly, you may want to have a second person hold him or her, or wrap the arms up in a partial swaddle. Make sure you have clean hands, a towel for any messes, the new tube kit, water-based lubricant, and a small cup of fresh water.
The best time to change a button or tube is when the stomach is empty. Of course, this is not always possible. If the stomach is full, expect that some formula may leak out.
First, prepare to remove the old button or tube. You may want to place some gauze or a towel around the stoma in case there is any leakage. Attach a slip tip syringe to the balloon port and withdraw all of the water from the balloon port. Pull out the tube or button. If the tube will not come out, do not force it. Tape it in place and call your nurse or doctor for assistance.
Next, you may want to prepare the new tube by testing the balloon. Hold the new tube in the air and attach a a fresh slip tip syringe filled with the amount of water your doctor has recommended. Tap water is fine unless you have unsafe water or your child has immune system problems. Inflate the balloon by pushing the water in the syringe into the balloon port to test the balloon for leaks. If there are no leaks, deflate the balloon by drawing the water back into the syringe. Leave the syringe attached.
Coat the balloon and “stem” of the new tube with water-based lubricant, such as KY jelly, and slide it into the stoma. If you cannot get the tube in, call your doctor or nurse immediately. Sometimes it does take a bit of effort, but you should not feel like you are forcing it in.
Once the tube is in place, fill the balloon with the water by pushing the water in the syringe into the balloon port. Remove the syringe and save for later use. Clean the area around the stoma in case any leakage occurred. You may also want to turn the tube once or twice to make sure it fits well and moves easily.
Some doctors recommend that you verify the placement of the tube by withdrawing gastric contents through the new tube. If no gastric contents are seen, call your doctor or nurse before using the tube.