Skin, Site, and Oral Careadmin2020-03-13T13:24:00+00:00
Depending on the type of tube a child has, specialized skin and site care may be needed. Children with feeding tubes also often need a little extra attention when it comes to oral care. This page provides general tips for oral, skin, and site care for children with any type of tube.
Most children with feeding tubes require no special skin care unless tape or a dressing is used, such as with an NG-tube or when a tube is first placed.
Children with NG-tubes often use tape to secure the tube, and this can be irritating to the face. The most important thing to remember is to rotate the placement of the tube from one nostril to the other. Not only does rotation protect the nostril and the inside of the nose, but it also allows the skin to heal where the tape had been. How often you rotate nostrils will depend on your child and your doctor’s recommendations. Many families rotate every 3-14 days.
Here are a few other tips that may help the skin:
Use a skin preparation agent before applying tape. These come in wipes, sprays, and applicators and help to protect the skin below a dressing. Ask your DME company to order it for you.
Use a more gentle tape on the skin, such as Duoderm, and secure the tube with a stronger tape on top of the Duoderm. See our page on Nasal Tubes for more information. Often, the Duoderm can be left in place even if the tube needs to be re-taped, avoiding irritation to the skin.
Secure the tube as well as possible to prevent the need to re-tape over and over.
Most children with other types of tubes do not use dressings that are taped in place. However, there may be skin irritation from leakage, movement of the tube, or rubbing of the tube.
If leakage is a concern, the best strategy is prevention. See our page on Granulation Tissue, Infections, and Leakage for more information on preventing leakage. You can also use a barrier cream around the site to help prevent damage. Some doctors also recommend a mixture of barrier cream and other creams to help heal the skin around a leaky site. If skin irritation is severe, see an ostomy or wound care nurse.
Irritation at the site may also occur from tugging on the tube or the tube rubbing on clothing or during activity. Securing the tube may be helpful to prevent injury or damage to the site. See our page on G-tubes for more information.
When your child first gets his or her tube, your medical team will likely instruct you on how to care for the site. Information on site care for new tubes is available on our G-tube page.
Once the site has healed, minimal care is required. Many children simply wash the site with soap and water while taking a bath. If the site is looking a little crusty, a washcloth or swab with warm water can be used to clean it between baths.
Unless the child has a problem with granulation tissue, leakage, or infection, there is no need for ointments, creams, or dressings. It is best to keep the site dry and open to the air as much as possible. A simple cloth G-tube pad or piece of split gauze can be used around the site if desired.
Visit our page on Granulation Tissue, Infection, and Leakage to resolve additional concerns.
Oral care is important, even if a child isn’t eating or drinking orally. In fact, children who don’t eat orally often need more oral care because they typically don’t produce as much teeth-cleansing saliva as children who eat.
We know that oral aversions and aspiration concerns can make oral care challenging. Children who are have limited oral diets should still see a dentist once they have teeth. Depending on your child’s condition, there are dentists that specialize in children with special needs and common dental issues that they face.
For infants and toddlers, you can try using the fingertip toothbrushes or wipe the mouth with a wet cloth. If your child has trouble accepting toothbrushes, talk to your feeding therapist or Speech Language Pathologist about incorporating the toothbrush into therapy sessions. It can help with both oral aversions for eating, as well as increase acceptance for oral care.
If your child aspirates and isn’t able to spit, you may want to consider brushing with a small amount of mouth rinse, or fluoride rinse. This may also be a solution for children who gag or react to having toothpaste foam in their mouth. For children with significant aspiration or respiratory issues, there are special toothbrushes that attach to a suction machine that suction the toothpaste and saliva as you brush. There are also a range of toothpaste flavors if your child has aversions to mint.
It is always important to check with your dentist to see what they recommend specifically for your child.
Things to consider:
Tube feeding itself doesn’t impact dental health, but medical conditions associated with tube feeding may.
Some medications can discolor teeth
Excessive acid may erode tooth enamel. Some children are impacted by this, and some are not.
Limited oral diets do not necessarily impact the timetable of when kids get teeth and loose baby teeth. Some kids who have limited oral diets get all their teeth early, some as expected, and some later. Medical conditions may factor in.
We hear from a number of parents who are concerned about their child having bad breath, even with good oral care. You should always tell your doctor about bad breath, as it can be a sign of a medical condition. Causes of bad breath include the following:
Bacterial overgrowth in the intestines is more common among those who have motility issues and can cause bad breath, excessive gas, and distention that is hard to vent out
Infection in the mouth, nose or throat
Metabolic conditions, GERD, and other medical conditions