Articles and Updates from Phoenix Children's
Tube feeding is used to provide partial or full nutrition when your child is unable to take enough nutrition by mouth. For example, children with chewing and/or swallowing difficulty, poor growth, high nutrition needs, multiple diet restrictions, severe selective eating or alterations of the gastrointestinal tract may benefit from a feeding tube.
A feeding tube can be placed through the nose and down into the stomach or lower parts of the small intestine such as the duodenum and jejunum. A feeding tube that is placed through the nose down into the stomach is called a naso-gastric tube (NG tube) while a tube that is placed down the nose into the jejunum is called a naso-jejunal tube (NJ tube). If a feeding tube will be needed for an extended amount of time it can be placed surgically at the stomach and provide nutrition to the stomach or lower to the duodenum or jejunum. Surgically placed feeding tubes are called gastrostomy tubes (G tube) if they end in the stomach and gastrostomy-jejunostomy tube (GJ tube) if it ends in the jejunum.
If it’s decided that a feeding tube will be placed, you and your team will work together to form a tube feeding nutrition plan. Tube feeds can be provided as bolus feeds, continuous feeds or a combination of the two. Bolus feeds are like eating a meal. During a bolus feed more amount is given over a shorter period of time and multiple times per day. Bolus feeds can be given if the patient has a tube that ends in the stomach (NG or G tube). During a continuous feed a formula pump is used to provide liquid food every hour. For example, if a patient can eat some food by mouth during the day, a continuous feed could be provided overnight while the patient sleeps to supplement nutrition. Continuous feeds can be given if the patient has a tube that ends in the stomach or lower intestine (NG, NJ, G tube, GJ tube). However, a patient with a feeding tube that ends in the duodenum (ND tube) or jejunum must receive continuous feeds because the small intestine is not capable of handling as much volume as the stomach.
Another component of the tube feeding nutrition plan is to determine the type of liquid food that will be provided through the feeding tube. Feeding tubes that are placed through the nose are smaller than feeding tubes that are placed surgically so they often require a commercial formula to be used. Infants with a feeding tube will receive their infant formula through the tube. A commercial tube feeding formula is one that comes premade as a liquid that is ready to feed or as a powder that is mixed with water. These formulas can have a variety of features, such as easier to digest proteins, a hypoallergenic formulation and/or higher calorie.
In recent years, there has been an increase in ‘whole food’ formulas that are available. These formulas contain whole food ingredients and can be organic, non-GMO and/or free of allergens such as dairy and soy. A ‘whole food’ formula might have a thicker consistency than a traditional commercial formula and might not be appropriate for use through a NG or NJ tube.
Home blended tube feeding formula is another option that can be provided, but it’s recommended that home blends be given through surgically inserted tubes and must be given as a bolus feed. Home blended formula is prepared at home using whole foods and recipes specific to the needs of that patient. A commercial or ‘whole food’ formula could also be used as a base for home blends.
At Phoenix Children’s, our Gastroenterology team of doctors, nurse practitioners and dietitians are here to assist with any tube feeding questions or needs you may have. Dietitians in our General Nutrition Clinic are also available to assist with forming nutrition plans tailored to your child and family.