When Your Preemie Needs a Feeding Tube

Feeding difficulties are one of the most frustrating health problems new parents can face. Preemies, who often struggle with the muscle strength and coordination needed to eat on their own, may need help from a feeding tube to receive proper nutrition.

Feeding tubes can be used in both hospital and outpatient settings, with formula or breast milk. Babies who aren't premature may also require a feeding tube for other reasons, including oral aversion, failure to thrive, and neurological problems.

Although the decision to tube feed is never easy, feeding tubes are the safest and most efficient way to provide adequate nutrition for babies who need assistance. Feeding tubes allow babies to receive some or all of their feeding through the stomach, and can also be used to deliver oral medications.

Types of Feeding Tubes

There are three main types of feeding tubes that can be used in babies and children:

• Gastrostomy tubes, also called G-tubes or PEG tubes, are short tubes that go through the abdominal wall straight into the stomach.
• Nasogastric tubes, or NG tubes, are thin, flexible tubes inserted through the nose that travel down the esophagus into the stomach.
• Orogastric tube, or OG tube, is the same tube inserted into the mouth instead of the nose. These tubes may also be used to help remove air from your baby’s stomach.

Varieties

Both G-tubes and NG tubes can be used to give tube feedings in the hospital and at home. To use feeding tubes at home, parents will need to spend time in the hospital learning how to use the tubes. Hospital staff will spend plenty of time teaching families how to replace tubes, deliver feedings, fix tube problems, and get help when needed.

Reasons for NG or G-Tubes

Most premature babies outgrow feeding problems before they leave the hospital, and parents don't have to worry that they'll need to use feeding tubes at home. Other preemies have complications that cause oral aversions or long-term breathing, digestive, or neurological problems.

In the hospital, NG or OG tubes will be used for tube feedings while your baby is still growing and recovering. If your baby is ready for discharge but still having some trouble feeding, at-home NG tube feedings may be an option. For some babies, though, there comes a time when you or your baby's doctors and nurses realize that your baby is not going to be able to eat well for a very long time.

How to Determine the Right Tube

Doctors and parents will decide together which type of feeding tube is best by looking at the cause of the feeding problem and how long they think tube feedings will be needed.

NG Tubes

NG tubes are often the first tube a baby will receive in order to ensure tube feeding is effective. In addition to NG tubes, there are variations of feeding tubes inserted through the nasal passages that end at various points along with the digestive anatomy, such as the small intestine or the jejunum.

• Pros: NG tubes are easy to insert at home or in the hospital and don't require surgery. They are easy to remove too, making them perfect for short-term feeding problems.
• Cons: NG tubes can cause irritation inside the nose, especially over long periods of time. They need to be replaced about every week or two and can increase reflux symptoms. Because they're taped to the face they are always visible, and tape can irritate the skin.

G-Tubes

G-tubes are generally used for babies who will need tube feeding for a long period of time due to an inability to take food by mouth. They are placed by a pediatric surgeon directly through the abdomen and into the stomach.

• Pros: G-tubes are easy to hide under clothes, so tube feeds can stay private. They only need to be replaced about every 3 months and don't require any tape on the skin.
• Cons: G-tube placement is a surgical procedure that must be done in the hospital. There can be complications, including infection and problems with the stoma. If tubes come out and aren't replaced quickly, the hole can start to close. After the G-tube is removed, there will be a small scar.

Gastric Residuals

A gastric residual is when food from a previous feeding is left in the stomach at the start of the next feeding.

In premature babies who have an NG tube or a G-tube, residuals are sometimes checked routinely and sometimes only if there is a concern that feeds are not being tolerated by the baby as expected. The nurse or doctor checking the residual amount will attach a syringe to the end of the feeding tube and gently pull back on the plunger. Any air or food left in the stomach will flow into the syringe.

If the residual looks healthy, it will usually be returned to the stomach after discarding the air. Green or bloody residuals may be a sign of infection such as NEC and will be reported to the physician.

Although tube feeding should never be the first strategy for feeding problems, it is a good solution when other strategies haven't worked. And while it's hard to think about surgery for your baby, feeding tubes can be a wonderful thing for many families.