Enteral Nutrition, Part One: When a Child Needs to Get Meals by Tube

Article excerpt

Enteral" is an adjective defined as "having to do with the intestine." "Enteral nutrition" usually refers to liquid nutrition, delivered by tube directly into the stomach or small intestine.

Enteral nutrition, or "tube-feeding," is often used when a child cannot receive adequate nutrition orally--perhaps due to an obstruction of the esophagus (the tube that carries food from the throat to the stomach) or swallowing difficulties that increase the risk of choking and aspiration (breathing food or liquid into the lungs, which can result in pneumonia). In such cases, the only alternative to enteral nutrition is "total parenteral nutrition," or intravenous nourishment. This is not usually a good long-term solution because the intravenous solution, with its amino acids and vitamins, provides a rich medium in which bacteria can grow and dangerously infect the bloodstream. Enteral feeding is usually the best long-term solution unless the child has a problem with nutrient absorption, severe chronic diarrhea, severe inflammatory bowel disease or another condition that makes enteral feeding impractical.

To the parents of a child who has undergone a long period of illness and inadequate nutrition, enteral nutrition may seem like a blessing--and it is. Finding an answer to the question of how to provide good nutrition in difficult circumstances is a relief to everyone.

ABOUT THIS SERIES:

This is the first of several articles on enteral nutrition. Further articles will cover topics such as care of the stoma and tube, formulas and nutritional needs, positioning, oral motor difficulties and making the transition to oral eating.

Types of feeding tubes

Three types of feeding tubes are used to provide enteral nutrition:

* A nasogastric tube is threaded into one nostril, down the throat and esophagus, and into the stomach. This is a temporary tube--it blocks one nostril and is usually taped in place rather than anchored with stitches. Nasogastric tubes often hold open the muscle at the top of the stomach, allowing stomach contents to flow backwards into the esophagus, a condition known as gastroesophageal reflux (see sidebar below). This problem has been partially solved by new materials that have made it possible to use smaller nasogastric tubes.

* A gastrostomy tube, or "g-tube," goes into the stomach through a surgical opening in the abdominal wall. The g-tube is a flexible rubber catheter that remains in place at all fumes and is clamped between feedings to prevent leakage of stomach contents. A gastrostomy button is often inserted either initially or after a g-tube has been used for a while. The button, a small plastic device placed surgically in the stomach wall, allows the g-tube to be removed between feedings.

Children receiving enteral nutrition through a nasogastric tube or g-tube are given a specified amount of formula daily. Portions of the daily formula allotment may be delivered through the tube at regular "mealtimes"--each lasting 20 to 30 minutes. This is known as "bolus feeding." Or feedings may be given slowly, over a period of several hours, using the "drip method." Sometimes the formula is delivered at night, regulated by a feeding pump.

* A jejunosotomy tube, or "j-tube," may be used to bypass the stomach when a child with a g-tube has problems with vomiting and/or gastroesophageal reflux that cannot be resolved through medications or changes in feeding methods, formulas or positioning. A j-tube is inserted through a surgical opening in the abdominal wall and threaded into the upper small intestine--either directly or through the stomach.

Jejunostomy tube feedings are infused continuously because the small intestine is pressure sensitive. Food pushed into the small intestine with too much force or in too large an amount can trigger vomiting, cramps or diarrhea.

Preserving family mealtimes

An important issue for families has to do with finding ways to preserve regular mealtimes as an opportunity for family members to socialize, converse and eat together. …