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Enteral Tube Nutrition

Enteral nutrition is any type of feeding or nutritional supplements given through a tube that goes directly into the stomach or intestine. Enteral feeding can be recommended for a child for a variety of reasons, including weight loss, severe lack of appetite, feeding and swallowing disorders or delays, or certain medical conditions or food allergies. The tube feedings provide protein, vitamins and other nutrients the body needs for energy. At CHOC, we monitor all children who have tube feedings for proper nutrition, growth and weight gain, as well as for any complications such as infection, leaking or dislodgement.

The types of special tubes are:

  • Nasogastric tube (NG-tube). An NG-tube goes from the nose down the esophagus to the stomach.
  • Gastrostomy tube (G-tube). A G-tube is placed by a surgeon or gastroenterologist into the stomach through a small hole outside the stomach wall (also called a PEG tube, or a percutaneous endoscopic gastrostomy tube).
  • Jejunostomy tube (J-tube). A J-tube is placed into the upper part of the intestine (jejunum), just beyond the stomach. The tube is placed by the surgeon through a small hole in the abdomen.

Ways to Feed Using a Tube

Children receiving enteral feeding are usually put on a schedule that best fits their needs for care and the amount of calories required. At CHOC, patients work with our specially trained gastroenterologists, dietitians and nurses to develop the best schedule for their child’s and family’s needs. The choices of schedules are as follows:

  • Intermittent or bolus. The amount of tube feeding for the day will be divided up into smaller portions to be given at set times during the day over short periods. This may be done by gravity or syringe.
  • Continuous tube feeding. The amount of tube feeding for the day will be given slowly over the 24-hour period. It is usually given by a pump to keep the rate steady.

Parents who feel that feedings are not working well should speak with their child’s gastroenterologist or dietitian about changing the rate of feeding or method of feeding.

Warning Signs for When it is Time to Call the Doctor

If the tube becomes dislodged or falls out, apply a dressing over the opening if the tube is in the child’s stomach or intestine, and call the doctor immediately.

It is also important to contact the child’s doctor right away if they have any of the following:

  • Temperature of 100.5°F (38.1°C) or higher
  • Diarrhea for more than one day
  • Nausea or vomiting
  • Constipation
  • Abdominal distention (swelling)
  • Tube dislodgement
  • Clogging of the tube
  • Shortness of breath
  • Coughing
  • Unusual sleepiness, disorientation or confusion.

Gastronomy Tube Placement

A PEG tube (percutaneous endoscopic gastrostomy tube or G-tube) is a feeding tube that is placed surgically into the stomach during an endoscopic procedure. At CHOC, this surgical procedure takes place at our state-of-the-art Tidwell Procedure Center. Learn more about PEG tube placement at CHOC.

Caring for a Child with a Feeding Tube

Feeding tubes are inserted surgically by your child’s gastroenterologist or surgeon. It is important to learn as much as possible about caring for the tube prior to your child being discharged to go home. If at all possible, we recommend leaving other children in the care of a friend or family member the day of the surgery so that you can concentrate on the child having the tube placed and learn about how to care for your child’s tube. Many common problems can be avoided when care is taken to use and clean the tube properly. Here are some of the more common problems and what you can do to try to prevent them:

Aspsiration

Aspiration happens when the tube feeding is inhaled into the lungs. Tips for avoiding aspiration include:
  • Children should sit up while receiving their feeding and should remain upright for one hour afterward.
  • If feeding is continuous, keep the child’s head elevated on two or three pillows.
  • Check for residual food before giving a bolus feeding.
  • If using a nasogastric tube, check placement of the tube before the beginning of each feeding.
  • Do not begin the feeding if the child says he or she feels full or bloated.

Diarrhea

  • Do not use a feeding solution that has been opened and at room temperature for more than six hours.
  • Do not use a feeding solution left open in the refrigerator longer than 24 hours.
  • Wash your hands before handling the tube or feeding solution.
  • Keep the feeding container and tubing or syringes clean.

Constipation

  • Provide your child enough water as discussed with the doctor.
  • Ask about adding fiber to your child’s diet.
  • Talk to your child’s doctor about using a stool softener or laxative.
  • Increase your child’s physical activity as it is allowed.

Skin Irritation

  • Keep skin around the tube clean and dry.
  • Check for leakage around the tube and report this to your child’s doctor right away.
  • Tape tube securely to prevent pulling.
  • Change the dressing daily.
  • Apply skin protectant as needed.

Dehydration

Dehydration is the loss of too many body fluids. Be sure to:
  • Ask your child’s doctor or nurse if you need to increase the amount of water given in the tube between feedings.
  • Watch your child for increased urination or for signs of thirst or fever.

Tube Clogging

  • Make sure there are no kinks in the tube.
  • Flush the tube after meals and after medications.
  • Rinse the tube before and after giving medications.

Feeding Tubes and the Trend to Blend

Children with feeding tubes traditionally receive their nutrients from commercial formulas. Recently, dietitians at CHOC have begun working with families who prefer to feed their children blenderized tube feedings (BTF), which are real foods that are blended into a consistency similar to formula.

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Registered dietitian Katherine Bennett

Understanding Blenderized Tube Feeding Diets

Sometimes, children who are tube-fed with commercial formulas suffer from reflux, constipation and general feeding intolerance. It may be recommended by your child’s gastroenterologist to try a blenderized tube feeding (BTF) diet. Other times, families may want to provide something more natural for their child and ask about putting real food through their child’s feeding tube. Our gastroenterologists and dietitians at CHOC can help you provide your child a real-food-based diet through a feeding tube in a safe and nutritious way.

What are blenderized tube feeds (BTF)?

Blenderized tube feeds are pureed/blended food and liquids used as a nutrition source for a feeding tube. Blenderized tube feeding is not using juices or blending up meals but rather calculated recipes consisting of the right amount of foods from each food group to ensure a child is meeting all his or her nutritional needs.

Can BTF be used through all feeding tubes?

No. BTF can only be used in a feeding tube that is in the stomach. A 14-French-diameter feeding tube or greater is preferred.

How can I start my child on a blenderized tube feeding diet?

Your gastroenterologist will refer you to our specially trained registered dietitian. At your appointment with the registered dietitian, you will learn more about your child’s individual nutrition needs and concerns, how to prepare recipes to meet your child’s nutrition needs, what equipment and supplies will be needed, how to ensure safe food handling and storage, and troubleshooting tips. Other topics that will be discussed include the child’s:
  • Medical history
  • Whether the child has ever had real food
  • Allergies
  • Volume intolerance
  • Preferred foods
  • Religious or cultural beliefs
Patients and their families will work closely with the dietitian while on the BTF, especially in the first few months, to ensure that the child is tolerating the diet and maintaining (and gaining) weight.

My child has allergies. Can I still try the BTF?

Yes. The BTF can be individualized to avoid any food allergies or intolerances your child may have.

What can I expect with the BTF compared to using commercial formula?

You will find that the BTF may take more time at first to prepare, blend and give to your child instead of just opening a can of formula. However, many families report it gets easier and faster over time. Think of it like preparing a meal for your child and expect a similar amount of dirty dishes.

Will the food in the BTF be covered by insurance?

No. You will have to purchase all the food to blend.

Are there any real-food-based formulas on the market?

Yes. Compleat Pediatric is a commercial tube-feeding product that is made with real food. This formula is typically covered by insurance. Other products that may be covered by insurance include Real Food Blends and Function Formularies. (Learn more about insurance coverage on their websites.)

Learn More about G-tube Home Care

There is a lot to know about taking care of your child’s G-tube at home. This handy guide provides families with great reminders and information on caring for a child using a G-tube for nutrition.

Download our G-tube Home Care Guide in English.
Download our G-tube Home Care Guide in Spanish.