If a child is unable to eat after surgery, a gastrostomy tube may be inserted directly into the stomach so the child to continue to receive nutrition.
Use our guide in reference to:
The information contained in this material should not be used as a substitute for the medical care and advice of your physician. There may be individual circumstances of your child's healthcare that cause a variation in treatment.
For more additional information and patient testimonials, view our guide, Supporting Nutrition: Understanding Tube Feeding .
Gastroesophageal reflux (GER): Movement of stomach contents into the esophagus
Gastrostomy: An opening or “hole” between the abdominal wall and the stomach for the purpose of giving stomach feedings (done in the operating room)
Nissen fundoplication: An operation to prevent food and liquids from going from the stomach up into the esophagus
Gastrostomy tube (GT or G-tube): A tube placed through the gastrostomy opening to give feedings and keep the hole open
Low profile gastrostomy tube or “button”: A small type of gastrostomy tube with a separate piece that attaches for feedings (some tubes referred to as buttons include MIC-Key and Bard button)
Bolus feeding: A feeding given over 30 to 45 minutes, by gravity or on a feeding pump, one to five times per day, depending on how much the child eats or drinks by mouth
Continuous feeding: A feeding given over 12 to 24 hours, that is usually easier to give with a pump that controls the rate at which the feedings are given
At the end of each feeding and after every medication, the tube must be flushed or rinsed with 5 to 10 ml of water to prevent the tube from becoming clogged with formula or medication.
Note: When possible, have your physician order a liquid form of the medications that you will be giving through the tube. Some pills can be crushed, mixed with water and given through the tube. However, when capsules are opened, they will clump together in the tube and may clog it.
Children with reflux who have a fundoplication may have difficulty with gas pain. To relieve this, attach a 30 cc or 60 cc syringe, without the plunger, to the tube for 10 to 15 minutes after each feeding to allow air to escape. Children that receive continuous feedings may have their feeding interrupted for 10 minutes every 3 to 4 hours for venting.
Children can take a bath 4 days after the operation. Change the dressing after the bath if it is wet or loose and no longer stabilizes the tube.
After gastrostomy surgery, avoid placing your child on their stomach for at least 2 weeks. It is okay if the child rolls unassisted onto their stomach and seems to tolerate the position. Your child may resume physical therapy one week after the operation but should not be placed on their stomach or on a ball during therapy for three weeks.
Several dressing types may be used to secure the gastrostomy after surgery. The dressing is very important because it:
A 2x2-inch gauze or split gauze pad and tape should be used.
If your child has a Malecot tube with a drain tube attachment device, the first visit will be one week after the operation, where you will learn how to change the dressing. Call the surgeon's office to schedule the appointment. The second appointment is eight weeks after the operation. At that visit, the Malecot will be changed to a MIC-key.
Important note: The first tube change for patients with a Malecot is only done on Tuesdays at 1 or 1:30 p.m. This appointment may take 1 to 2 hours. After the tube is changed from the Malecot to the MIC-key, your child will have to go to radiology to check placement.
If your child has a MIC-key placed at the time of the operation, the first visit will be 2 weeks after the surgery to have the incision and GT site checked.
MIC-keys are changed every 4 to 6 months. You will be taught how to change the tube.
Small amounts of leakage from around the tube: You may use a dressing under the gastrostomy tube to keep clothes clean.
Granulation tissue: This is pink tissue that occurs as a reaction to the tube. It may bleed or produce an odor. This tissue is not of great concern but may lead to leakage around the tube. Make an appointment in the office; this tissue growth can be easily treated.
Redness around the tube: A small area of redness is normal. Infection around a gastrostomy tube is uncommon. If the area is bright red, increasing in size, or swollen and warm, schedule an appointment for evaluation. This is not an emergency but should be evaluated in the office within several days.
The tube is loose but not out (this applies only to “Buttons” or low profile tubes): Tape the edges of the “button” down. This will keep the tube in place and the gastrostomy hole open. You may continue to give feedings and medications through the tube. Schedule an appointment to have the tube replaced. As long as the tube is in the track, you do not have to be seen immediately.
The tube falls out or gets pulled out: If the operation to place the tube was done longer than 4 months ago and you have been taught how to replace the tube, insert replacement tube. If you are unsuccessful, you must seek medical attention within 6 hours.
All of the formula or feeding is leaking at the site: Small amounts of leakage or drainage around a GT are ALWAYS normal. If all or most of the formula is leaking, however, the tube may no longer be all the way in the stomach and should be evaluated to prevent damage to the tract.
These pages have been adapted from materials developed by Susan Luck, MD; Marleta Reynolds, MD; Srikumar Pillai, MD; Teri Coha, APN, CWON; and Kerri Keller, CNP.
