Every single child requires a well balanced diet in order to grow and develop properly. But not all children are the same and there are many cases in which they might need special care, attention and nutrition. Children who have certain medical conditions often need assistance to eat since consuming foods via the mouth might become a hindrance, making it difficult to obtain an appropriate nourishment or nutrition.
It is in these types of cases when a gastrostomy tube or a G-tube is required. This is a special tube which is introduced via the abdomen and provides nourishment straightway to the stomach. By performing this procedure, specialists can rest assured that a child will obtain the right hydration and amount of calories/energy demanded by the body and needed for growth and development.
A gastrostomy is a standard procedure which normally lasts between 30-45 minutes. Children who undergo this procedure only need to be hospitalized for a couple of days. Once the wound has healed they can resume their everyday activities like playing and attending school.
In order to make this process more bearable both for the child and the parents, it is important to be aware of all the aspects this procedure carries with it. Being knowledgeable about what the anesthesia and overall surgery entails will allow the parent to feel more certain as to what to expect and how to encourage the child during this process.
Reasons as to why a gastrostomy tube may be needed include the following:
- Complications in the early stages of development which may cause neurological and respiratory conditions that hinder the ability to suck, swallow and breathe. These conditions make it difficult to obtain an appropriate feeding.
- Anomalous conditions in the stomach, oral or facial area, the trachea, esophagus, stomach and intestines.
- Problems with weight gain and growth which most of the the times may be a consequence of a subjacent medical diseases like cancer, intestinal problems, extreme allergies to certain foods, problems with the metabolism and cystic fibrosis.
- Having a hard time taking medicines
- Experiencing difficulties in burping after undergoing a surgical intervention to control reflux.
A child who is about to undergo gastrostomy may need to have some exams done such as x-rays of the upper part of the gastrointestinal system. Doctors normally request this radiography in order to have a better view of a section of the digestive system.
It is important to be aware that in order to prepare for the gastrostomy, a child is required to remain in the hospital for 1 or 2 days. Normally, the gastrostomy procedure in a child is performed under general anesthesia- the patient feels as if he/she is sleeping deeply and is not aware of what is going on- or under a deep sedation- the patient is not aware of what is going on but the sedation level is not as deep as with general anesthesia.
Drugs administered before the procedure can have an impact on the regular reflexes of the body. They can cause vomit and might lead to the patient inhaling food by the lungs during the procedure. This is why the stomach to should be empty before the gastrostomy. Specialists strongly recommend parents to stop giving food and drinks to toddlers and older kids around 8 hours before the procedure and 2 hours before for breastfed babies. Feel free to ask the doctor or nurse any question before, during or after the procedure.
Specialists currently use three different methods to introduce the gastrostomy tube:
- Percutaneous Endoscopic Gastrostomy
- Open Surgical Intervention
These three methods are not complicated and can take approximately between 30-45 minutes. A surgeon or gastroenterologist will decide which one is the best for the child.
Right after the procedure is finished, the child is carried to a post-operative room where specialists will constantly check on him or her to make sure that everything is going as expected. Parents should not worry if after the surgery the child experiences feelings such as: sadness, confusion, coldness and grogginess. According to experts this is completely normal and should disappear minutes later. If the child experiences pain in the incision surroundings, parents should immediately inform the doctor or nurse so that the right medication can be administered to the child. Generally, doctors prescribe antibiotics to avoid possible infections.
A specialized nurse will educate the parents on how to treat the g-tube so as to avoid infections and other complications. Parents will also be taught how to react in specific situations where immediate assistance is needed, for example, the g-tube detaching from its position. Knowing what to do in these types of situations will prevent further issues such as infection and closing of the incision.
Specialists will also teach the parents or the person taking care of the child, how to feed the patient via the g-tube and what to feed the child with. A nutritionist is normally the person in charged of explaining frequency of feeding and the two specific terms which will help parents or carers have a better understanding of the description of feedings given to the patients. The following are the two terms applied:
- Bolus: This term refers to a type of feeding method.This kind of feeding is given with more frequency, similar to a normal meal and is often given in large quantities.
- Continuous: This type of feeding is normally given at night and is provided through a pump. This method is constantly used on children who need less amounts of feeding at a slower pace.
Children who have undergone other surgical procedures might experience burping or vomiting. The parents will be instructed on how to release air and fluids from the stomach, if needed. Carers must follow this process if they notice the child makes efforts to vomit once the gastrostomy tube is inserted.
The fact that the child has a g-tube does not mean that he or she cannot consume food via the mouth. There are many cases in which feeding through a tube just serves as a supplement for what is consumed through the mouth. If the specialist determines that the child is capable of consuming food through the mouth and opts to implement both methods, then he or she will provide the appropriate guidance on how to proceed with the feedings.
Once the child is ready to go home, there are some important points parents should have in mind:
- Parents must have well explained guidelines as how to care for their child once at home. Such guidelines should address how to get the child dressed, give him or her a shower, feed and provide medication through the g-tube, empty air from their stomach if needed and carry out regular physical activities.
- It is important to program regular visits from a specialized nurse in order to monitor the child’s health and to make sure that everything is going as expected.
- In order to ensure that the child is in the ideal weight scale and to be certain that the g-tube is still correctly positioned, parents should program regular visits to the doctor.
A gastrostomy tube may endure for approximately a year prior needing a replacement. The replacement of the tube becomes easier once the initial procedure has been done and can be replaced by the parent or a health professional without having to perform another endoscopic or operative intervention.
Children who have undergone a gastrostomy and whose incision has already healed have very few restrictions, if at all. Although some of them may experience a bit of concern towards the reactions of people around them and to the appearance of the g-tube. If parents notice some sort of uneasiness in their child they should seek the help from an expert such as a social worker or a person who specializes in feeding therapy. This therapist can help your child to better interact with family and friends during meal times which is a fundamental part of childhood.
Without taking into account the type of method used, doctors may advise exchanging the tube for a button (a flat device placed in contact with the stomach). This will offer both the child and the parent a more convenient and easier way of administrating food. Parents simply need to open the button when the time for medication or feeding arrives and then close it back.The procedure can be easily performed at a doctor’s facility without the need of a surgical intervention. The most popular choice among buttons is one that stays put with an inflated balloon.
When the doctor determines that there is no need for a g-tube or button since the child is already capable of consuming foods through the mouth, he or she will order the removal of any of these devices. A small hole will be left in the place where the tube or button was inserted. The doctor will instruct parents to take care of the hole by cleaning it and covering it appropriately with a gauze. This must be done until the hole completely closes by itself. There are times when an operative intervention may be needed to close the hole but this will be decided by the specialist.
Gastrostomy is not considered a threatening or dangerous procedure, nevertheless just as any medical intervention, it may carry some potential problems:
- There may be a loss of blood during the procedure, although it can be rapidly controlled.
- Anesthesia can sometimes generate problems in some children including arrhythmia, respiratory problems, allergic reactions and even death (in very rare cases). Keep in mind that these issues are highly unusual.
- An allergic reaction can be a side effect to anesthesia. There are some symptoms that parents need to look for in case this happens, such as vertigo, respiratory problems, skin eruptions, and swollen tongue and lips. An allergic reaction will normally occur right after the anesthesia is administered, therefore, parents should immediately inform the doctor in order to get the right medical attention.
- It is possible for a gastrostomy wound to become infected so parents or carers should be extremely careful when cleaning and drying the g-tube incision. Hands must always be carefully washed and kept clean whenever in contact with the wound.
- It is fundamental to be fully aware of any possible symptoms of infection such as:
- High fever
- The area around the incision becoming swollen, red or hot to the touch
- Oozing of different secretions or unpleasant smell originating from the wound.
Parents should also be careful if the any of these complications appear:
- Tube obstruction
- G-tube detachment
- Intensive abdominal pain
- Excessive blood loss and secretion of the incision
- Bowel problems (to defecate or pass out gas or diarrhea)
- Granulation tissue originating in the wound site
If any of these symptoms and/or complications arise, a doctor should immediately be contacted. By getting prompt help from a health professional these symptoms or problems can be easily controlled.
Parents often ask if there are any other options to a gastrostomy, but once a g-tube has been ordered by the doctor is because he or she has already exhausted all other alternatives (formula, feeding therapy, appetite stimulants and special diets). Although there are other types of tubes such as nasogastric and nasojejunal, the g-tube is ideal when needed for a long period of time.
It is normal for a parent to be afraid and nervous before, during and after an operative procedure. However, it is important for them to be aware that a gastrostomy is a quick and safe process which rarely brings problems. If the parent, at some point feels concerned or uncomfortable with the process, he or she can feel free to talk to the health professional and get the required assistance.