Below you'll find answers to common nutritional questions, a glossary of tube-feeding terms as well as a link to more information about different types of feeding tubes.
What is feeding intolerance? How do we manage it?
Feeding intolerance is when an ingredient in a food irritates your child's digestive system or can't be digested properly. An allergic reaction is different from intolerance: It's when your child's immune system reacts to a food protein.
Symptoms of feeding intolerance may include:
When you suspect that your child is not tolerating a formula, you should work with your doctor or dietitian to find the cause of the intolerance. Sometimes it can be as simple as a change in formula. Certain formulas are specially designed to help improve tolerance, which can help relieve digestive symptoms. Your doctor or dietitian can recommend an alternative formula that is appropriate for your child's needs.
What is gastroesophageal reflux? How can we manage it?
Gastroesophageal reflux (GER) happens when stomach contents rise back up, or "reflux," into the esophagus and cause irritation. The liquid that comes back up can contain food, stomach acid, enzymes and bile. Stomach acid enzymes and bile can be harmful because it can damage the esophagus and cause pain and vomiting.
Occasional GER is fairly common, but it can be a problem if it happens frequently. If it happens too often, your child may not get all the nutrients from their feeding, which can affect growth. Some warning signs of GER are pain, irritability, crying, or trouble breathing after a feeding.
Talk to your HCP team about whether a change in formula that allows faster emptying from the stomach may help to resolve the condition. Formulas with whey protein have been shown to empty more quickly from a child's stomach. Your healthcare professional can advise you on an appropriate formula option.
What are "gastric residuals"? Why is this a problem, and how can we manage it?
Gastric residuals are food and/or liquid from a previous tube-feeding that remain in the stomach longer than normal, and may even be in the stomach at the start of the next feeding. Gastric residuals that remain in the stomach more than two hours after completing a feeding may mean that the formula is not emptying out of the stomach as quickly as it should.
If there are gastric residuals left in the stomach, the child may spit up or vomit. This is a problem if it happens often enough that the child is not receiving the full amount of their feed, and loses valuable nutrition as a result.
Gastric residuals can be managed by adjusting how the feeding is given, or by changing the formula. Another option is to change the amount of time between feedings. More time between feedings can give the stomach time to empty. If the feeding is by infusion, the rate of the infusion can be adjusted. Some formulas have been shown to empty from the stomach more quickly and this may be an option that you can discuss with your doctor or dietitian.
Identifying and managing a food allergy
A food allergy is an immune system response to one or more proteins in the diet. Common causes of food allergies include cow's milk protein, peanuts, tree nuts, fish, shellfish, eggs, soy, and wheat. Many tube-feeding formulas contain milk or soy protein, or may be made in the same manufacturing facility as other products that contain allergens such as wheat or nuts.
If a family member has a food allergy, the chances increase that your child may have an allergy.
Possible food allergy symptoms can range from mild to severe,
and include:
Symptoms of food allergy can be similar to symptoms of food intolerance, so it's important that if the reaction is allergic it is identified by your physician or by your healthcare team and managed with a change in formula.
Bolus feeding: A feeding method where children are given just enough formula to feel full for a few hours, similar to a traditional meal schedule. This type of feeding is usually provided with a syringe.
Continuous feeding: A feeding method that uses a pump to slowly and continuously deliver nutrients over the course of several hours.
Duodenostomy tube: A feeding tube that delivers nutrients to the top of the small intestine called the duodenum.
Dysphagia: A condition that causes difficulty swallowing as a result of the muscles and nerves used during the swallowing process becoming weak or malfunctioning.
Enteral nutrition (EN): Also called tube-feeding, enteral nutrition refers to bypassing the mouth and esophagus and delivering nutrients directly to the stomach or small intestine.
Gastrostomy tube: A feeding tube that delivers nutrients directly to the stomach.
Gastrostomy button: A low-profile feeding tube with a one-way valve placed in your child's stomach that allows feeding set tubes to be attached for feeding and removed when the tube-feed is complete.
Gravity feeding: A feeding method that uses gravity to let formula drip or flow into the body by placing an open syringe or feeding set above the height of the stomach.
Jejunostomy tube: A feeding tube that delivers nutrients to the second part of the small intestine called the jejunum.
Jejunostomy button: A low-profile device with a one-way valve placed in your child's small intestine.
Laparoscopic gastrostomy: A procedure used to place a feeding tube into the stomach involving small incisions in the abdomen and the use of a laparoscope, a tool to help the surgeon see inside the abdomen.
Nasogastric (NG) tube: A tube used in tube-feeding that is routed first through the nose and then down the esophagus into the stomach.
Nasojejunal (NJ) tube: A tube used in tube-feeding that is routed first through the nose and then down the esophagus through the stomach into the small intestine.
Oley Foundation: A foundation that offers tools, resources and support for people on home IV or tube-feeding.
Percutaneous: A tube that is placed through the skin directly into the stomach or small intestine using an endoscope.
Pump feeding: A feeding method using a special feeding pump to continuously deliver tube-feeding formula to the stomach or small intestine.
Radiological gastrostomy: A procedure using ultrasounds and X-rays to help guide the Interventional Radiologist to place the tube into the stomach.
Stoma: A hole in the skin to either the stomach or small intestine where a feeding tube is placed.
Stamm gastrostomy: An open surgery where the stomach is sewn to the abdominal wall to place a feeding tube.
Syringe feeding (bolus feeding): A feeding method using a catheter tip syringe to gently push food into the stomach.
For more information about different types of feeding tubes, specifically the MIC-KEY tube, visit the MIC-KEY website here.
