One of the difficulties parents with premature babies face is feeding difficulties. As the babies struggle with muscle strength and coordination needed to suckle, they will have to be put on a feeding tube to receive adequate nutrition. While the decision to tube feed is not an easy one, they are the safest way to give your baby the essential nutrition it requires to develop. Continue reading to know all about tube feeding baby, how it is done, and whether your baby can benefit from it.
What Is a Feeding Tube?
The feeding tube, also known as a gavage tube is a flexible pipe-like device used to give nutrition to infants who cannot feed on their own. It is typically used for premature babies and infants with other conditions such as oral inversion, failure to thrive, and a number of neurological problems. The tube can be inserted and removed for each feeding or left in place as an indwelling for multiple feedings.
Types of Feeding Tubes
There are three main types of feeding tubes for infants and children:
1. Gastrostomy tubes
The gastrostomy tube is a feeding tube that goes through the abdominal directly into the stomach. They are short and also called G-tubes or PEG tubes.
2. Nasogastric tubes
The nasogastric tube, or NG tubes they are also called, are thin and flexible tubes that are inserted through the nose to go into the oesophagus (food pipe) and the stomach.
3. Orogastric tubes
The orogastric tubes are basically the same as NG tubes, except that they are inserted through the mouth instead of the nostrils. They can also be used to remove air bubbles from the baby’s stomach.
When Does an Infant Need Feeding Tube?
There are a number of reasons why a baby would need a feeding tube. They are as follows:
- Lack of strength or muscle coordination to breastfeed or drink from a bottle
- Weak ability to suck or weak swallowing reflex
- Irregular weight patterns or lack of weight gain
- Gastrointestinal defects or abdominal defects
- Respiratory problems
- Electrolyte imbalance or elimination problems
Deciding the Best Feeding Tube Type for Your Baby
Your doctor will consult with you before deciding the type of gavage tube to be used on your baby. The decision is based on multiple factors such as the nature of the problem and the length of time the tube needs to stay.
NG tubes are often the first option babies will be given as it is easier to use and effective. The tube also comes in variations inserted through the nasal passage that reach different parts of the gastrointestinal tract such as the jejunum or small intestine.
- NG tubes are easy to insert and can be done at the hospital or your home.
- They don’t require any kind of surgery and can be removed easily too.
- They are ideal to address short-term feeding problems.
- Feeding tube in the nose can irritate the nasal walls when used over a long period of time.
- They have to be replaced every week or two.
- NG tubes can cause reflux problem.
- Since they are taped to the skin on the face, the tape can irritate the skin.
G–tubes are preferred when the baby has to be tube-fed for a long period of time. They need to be placed in position by a pediatric surgeon directly into the stomach through the abdomen.
- G tubes stay in place without needing tapes.
- They need to be replaced only once in three months.
- The tube is private and hides well under the clothes.
- The insertion of the tube is a surgical procedure.
- It can have complications such as infection and stomach irritation.
- The tube has to be replaced quickly if it comes out else the hole begins to close.
- The tube leaves a small long-term scar in the abdomen.
The Procedure for Inserting a Feeding Tube in the Infant’s Nose or Mouth
The procedure of insertion is mostly done by nurses, except in special cases when it is performed by a doctor. The nurse begins by measuring the ng tube length from the baby’s nose to the stomach to get the right-sized tube to go inside. Sterile water or a water-based lubricant is used to lubricate the tip of the tube. Carefully the tube is inserted into the baby’s nose or mouth so that it will pass into the food pipe.
Once inside the tube is checked for correct placement by injecting a small amount of air into the pipe and listening to it as it enters the stomach. The purpose is to check whether the tube has entered the stomach or the lungs. For further confirmation, a small amount of liquid is drawn from the tube to check for the pH value with a sample testing strip. For an exact confirmation, an x-ray imaging might be done to check for the position of the pipe.
The inserted tube is secured to the baby’s nose with a sticky tape for feeding. If the baby is allergic to the tape or has a skin condition, a pectin barrier is used to help with the adhesion without damaging the skin. The tube may also be secured internally using a special cloth tape that goes behind the nasal bone.
If the tube is securely inserted, the baby can be fed breast milk, infant formula, or even medicine by using a syringe to inject the contents in or using an infusion pump. The gavage feeding will be capped off or removed once the feeding is complete.
Gastric residual refers to leftover food from a previous feeding that remains in the stomach at the start of the next feeding. In preemies who have a G-tube or an NG tube, gastric residuals are occasionally checked, it is done more frequently if the doctor suspects that the feeds are not well tolerated by the baby or is not going as expected.
In such a case, the doctor or the nurse will use a syringe to gently pull out some of the stomach’s contents for analysis. If the residuals look healthy visually, it will be injected back into the stomach after the air is discarded. Bloody or green colored residuals are often a sign of infection and will be reported to the doctor.
Risks Associated With the Usage of Feeding Tube
There are very few risks associated with ng tube feeding. The major factor is that the procedure is uncomfortable for the baby no matter how well it is done. Here are the risks that were commonly seen in hospitals:
- Since the tube can be displaced with the baby’s movement, it could lead to minute tears and slight nasal bleeding.
- The tube obstructs a significant part of the nasal passageway and causes nasal congestion.
- The presence of the tube can cause nasal infections.
Feeding through an orogastric tube at home brings a few other risks such as:
- Tube misplacement and the associated damage is more likely at home than at the hospital.
- A misplaced tube can lead to pneumonia and breathing difficulties.
- Lung infections and respiratory arrest with wrongly placed tubes.
- Breathlessness or even cardiac arrest with wrong tube positioning.
It is common for new parents to feel a sense of anxiety to watch their premature baby being fed through a tube. However, it is quite a safe and very effective way of ensuring the baby gets all the nutrients. The doctor would decide removing ng tube date once the baby is strong enough to feed by themselves. Feeding should be continued as long as it is prescribed by the doctor and care should be taken to insert the tube properly when feeding at home.