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A G-tube is a tube, which is inserted through the abdomen to deliver nutrition directly into the stomach by bypassing the child´s mouth. Therefore doctors and parents can control fluids and the nutrition which a child needs for its growth, development and health. There are temporary and permanent tubes depending on the child´s underlying medical condition. Common conditions to need a G-tube are:
Common conditions to need a G-tube are:
- congenital abnormalities of mouth, esophagus, stomach, intestines
- extreme prematurity
- severe brain injury
- cardiac anomalies
- global developmental delays
- neuromuscular disorders
- failure to thrive
- gastro-esophageal acid reflux
Before tube placement (Pre-PEG-assessment)
The child´s medical team should include professionals who preferably are involved in the indication for tube placement and will be responsible for the whole period during tube feeding. Usually this is the child´s pediatrician, a gastroenterologist/surgeon who will place the G-tube and a professional who takes care of a maintenance and tube exit plan with the parents. It will be necessary to regularly check the efficiency of tube feeding monthly on a medical, nutritional and growth related level.
Before the procedure it may be necessary to perform diagnostic investigations of the abdomen of the child (X-ray, sonographie).
On the day of the gastrostomy the child is not allowed to drink or eat anything in the morning (overnight fast). In some cases it will be necessary by a child´s surgeon or gastroenterologist to support the child with an intravenous infusion of glucose and electrolytes. Usually the gastrostomy is performed under anesthesia or deep sedation.
PEG (=percutaneous endoscopic gastrostomy)
This is the most common method and is done in most of the countries by a gastroenterologist who will also prescribe the enteral nutrition, which will be followed up by a nutritionist. The G-tube is placed endoscopically through the stomach. A „button“ (a device that is flatter and lies against the skin of the stomach) can be given afterwards, if insecurity whether the child will be able to sustain its food requirements itself (like in swallowing problems, or severe reflux) exists. The button can be opened for feedings and closed in between feedings or medications.
The reasons for using a laparoscopic technique or an open surgical procedure are limited and depend on the underlying medical condition of the child.
After spending 1 or 2 days in the hospital the child can return to normal activities after the incision has healed. Much of the time spending in the hospital will be spent for the parents learning about the care of a G-tube and to learn how to give a feeding through the G-tube. The efficiency of tube feeding will be checked on a weekly or monthly basis. If there are any side effects like vomiting, gagging, skin irritation or pain the child should be taken to the responsible doctor as soon as possible.If there are any side effects like vomiting, gagging, skin irritation or pain the child should be taken to the responsible doctor as soon as possible.
By this point the decision should be made by the involved medical professionals about the question of permanent placement of the G-Tube or intended temporary placement including a recommended period and goals to be achieved.
Now the tube maintenance team should be headed by the child´s pediatrician and should also include a speech therapist, occupational therapist, psychologist or nutritionist who will focus on developmental matters of the child and makes an individual support plan for the child.
Children who have a G-tube are usually able to eat/drink by mouth. Some children may be able to receive small amounts of fluids or taste stimulation orally during the period of tube feeding. This can help later on when the tube weaning process gets started, but should be discussed with the doctor and depends on the underlying diagnosis of the child. Keeping up oral activity and making the tube fed child a link to feel satiated even though being mainly tube fed can be recommended during the whole period of tube feeding.