Eating help: feeding tubes
Swallowing and aspiration problems are common in children with a laryngeal cleft, and some patients need help to safely take in enough food and water for healthy growth. Sometimes a gastroenterologist will recommend using a feeding tube to provide a safe way for the child to receive nourishment, hydration, and medications. The following are common types of feeding tubes, though other tubes exist. There are risks and complications that can occur with any type of tube.
NG-tube or NJ-tube (naso-gastric tube or naso-jejunal tube)
These feeding tubes are inserted through the nose and end in the stomach (NG) or small intestine (NJ). Specific placement depends on the child’s individual gastrointestinal needs. They are meant for short-term tube feeding and can be connected to a syringe or feeding bag/pump that delivers breast milk, formula, water, or blended food.
Surgery is not needed to place the tube, but an x-ray will confirm initial placement. Unsurprisingly, the child may not like a tube sticking out of their nose. It may be uncomfortable to sneeze, cough, or vomit. There are fun tapes to secure the tube to the child’s face and various taping techniques and securement methods. However, the tape can still be uncomfortable or cause skin damage. It is very easy for the child to remove the tube, intentionally or accidentally. Getting trained by your team to place the tube at home may help minimize ER visits.
It’s important to note that while an NG tube may be beneficial for some children, the tube may aggravate reflux and dysphagia in some cases.
G-tube or PEG tube (gastrostomy tube)
This feeding tube is surgically inserted into the child’s stomach and is held inside by a plastic bumper. On the outside of the body, the tube is held against the skin with a tightener. The exterior tube typically dangles for several inches and has a port on the end. An extension tube connects the port to a syringe or feeding bag/pump that delivers breast milk, formula, water, or blended food.
While meant for long-term use, a G-tube may be removed when no longer needed. If the tube is removed, the stoma may heal on its own, or surgery may be necessary to close it. If a G-tube is needed again, another surgical placement would be necessary.
G-button (brand names include Mic-key and AMT Mini-ONE)
This is a lower-profile style of a long-term feeding tube and is commonly used in children. The button is held inside the stomach with a water-filled balloon. Outside the body, there is a port, but no dangling tube. If the button is pulled out or falls out (much less common than an NG tube coming out), it can quickly be replaced at home. If too much time passes, surgical placement may be necessary. Low profile buttons are also available for J-tubes and G/J-tubes.
J-tube (jejunostomy tube)
This feeding tube is similar to a G-tube, but is surgically-inserted into the child’s small intestine. It is not held inside the body by a bumper or balloon, so it can dislodge more easily.
G-J tube (gastrostomy-jejunostomy tube)
This tube has one port on the outside of the body, and two tubes inside the body. One tube empties in the stomach and the other tube extends into the small intestine. Surgical placement is required and changing the tube requires x-ray support, which may require anesthesia for some children to remain calm.