Changing Colors: The Blog of Spectrum Pediatrics

March 4, 2015

The Truth about Tube Feeding: The (Physical) Downsides

By: Jennifer Berry, MS, OTR/L  &  Heidi Liefer Moreland, MS, CCC-SLP, BRS-S, CLC

As discussed in our previous blog post, the feeding tube can be a vital part of the medical care for children who need them.

What happens, though, when a child no longer has the medical need for the tube but remains tube dependent?  Many families discover that the tube becomes a part of their routine care, making it easy for the medical team to forget that there are downsides to the tube as well.  Why, then, is it so important to wean children off of the feeding tube once they have the underlying ability to eat by mouth?  Here are 8 often overlooked physical risks associated with tube use that every family and medical team should consider when weighing the decision to wean a child off a tube or to continue with tube feedings:

  1. Infection – The feeding tube forms a pathway from the outside world into the body, which brings an increased risk of infection.  Studies have shown that a large percentage of children that are tube fed experience systemic and site specific infections.  (Craig, 2005) (Sullivan, 2005)
  2. Retching and Vomiting – Tube feeding is known to be associated with increases in vomiting and correlated to high rates of retching.  Vomiting is a negative experience for a child and family, but it has physical implications as well.  Vomiting can cause complications with the esophagus and dentition, as well as increase the risk of aspiration and other respiratory complications.   (Craig, 2005) (Sullivan, 2005) (Orenstein, 1988) (Gomes, 2003)
  3. Reflux – Gastroesophageal reflux (often called “heartburn”) is an uncomfortable condition for adults and children alike.  According to the National Institutes of Health (NIH), this occurs when stomach contents spill up into the esophagus.  It is known that tube feeding is linked to an increased risk of reflux, which can be “silent” without any actual spit-ups or vomiting.  Anyone who suffers from heartburn can tell you that it hurts and can lead to avoidance of specific foods or mealtimes.  Reflux is also associated with complicated movement patterns, dental problems, and feeding refusal.   (Craig, 2005) (Sullivan, 2005) (Kabuakus, 2006) (Hyman, 1994) (Gomes, 2003)
  4. Pain – We know that pain in general has a negative impact on brain development.  Not all children experience pain with feeding tubes, but the associated reflux, site irritation and discomfort with movement can cause momentary or chronic pain in some children.  Pain relief is always a goal for medical providers, but it is easy to overlook chronic pain from reflux or tube-related complications.  Because children who are tube-fed are at increased risk for pain from reflux and other associated complications, pain relief should always be a consideration in order to improve their well-being and to protect their developing brains. (Grunau, 2009)
  5. Dental Problems –  Research suggests that tube feeding can compromise the dental health of the children who are tube dependent.    Dr. Melanie Allgeyer, a dentist from Alexandria, Virginia, tells us “children normally do not produce calculus (tartar) in abundance but tube-fed children do. They often can also have gastric reflux which can cause the enamel to wear away and can make their teeth very sensitive to temperature changes.”  Dr. Allgeyer points out that regular dental visits and vigilant dental care can be helpful managing these complications.  The dental complications associated with tube feeding should be among the factors considered when medical teams and families are making decisions about ceasing or continuing tube use.(Jawadi, 2004) (Gomes, 2003)  (Dyment, 1999)
  6. Skin – Most parents of tube fed children have had at least some experience with tube irritation.  For children with NG tubes, the adhesive that secures the tube to the face has been know to cause discomfort, redness, and rashes.  The site of a G-tube or a GJ tube is also at risk for skin problems.  At least half of children with these types of tubes experience granulation tissue or site infection.  Bleeding is not uncommon.  In addition to the risk of infection, the skin issue itself or the treatment for it can be painful.  As discussed above, we know that pain compromises the development of young brains. (Craig, 2005) (Sullivan, 2005)  (Grunau, 2009)
  7. Motor delays –It is possible for a child who needs a tube to gain appropriate motor skills, but there is no doubt that the presence of a feeding tube can and often does cause complications in motor development.  For children with G and J tubes, important developmental activities like tummy time and crawling are sometimes avoided due to discomfort, also complicating the acquisition of later milestones.  Children with reflux or discomfort associated with tube feedings often present with arching or extension, which can create atypical movement patterns.  Lastly, many children who are tube fed must be fed over long periods of time requiring them to stay in one place.  As any parent can tell you, it’s difficult to enforce sitting when kids would rather be “on the move.” Those children obviously miss out on the opportunity to explore their environment through movement as much as their peers that don’t have tubes.
  8. Feeding skills – Many children continue using the feeding tube until they seem “ready” to eat by mouth.  What many people overlook is that tube-feeding itself can delay the acquisition of important feeding skills.  (Mason, 2005)

 

For children that need to be tube fed for sound medical reasons the tube is a great solution.  Many of the complications mentioned can be monitored and managed to make tube-feeding a nurturing and healthy experience for children and their families.   However, for a child who no longer has a medical need for the tube, weaning from the tube should be considered as a viable medical option.  As the family and medical providers face this decision, they need to consider the downsides to continued tube use, not just the benefits.  Without considering the whole picture and all the factors, the team is only treating part of the child.  Stay tuned for our blog post: “The Truth About Tube Feeding:  The Downsides (Social/Emotional).

If you found this blog post helpful, you may also enjoy:  The Truth About Feeding – The Upsides,  Feeding Aversions: Skill vs. Dysfunction , and Finger Food Fun – How to Help Your Child Learn to Self-Feed.

References:

  • Melanie D. Allgeyer DMD, FAGD is a general dentist at Dental Care of Alexandria on Belle Haven Road. She is also an adjunct professor at Northern Virginia Community College in the Dental Hygiene Department at the Springfield Medical Campus.
  • Craig, G. M., et al. “Medical, surgical, and health outcomes of gastrostomy feeding.” Developmental Medicine & Child Neurology 48.05 (2006): 353-360.
  • Dyment, H. A. and Casas, M. J. (1999), Dental care for children fed by tube: a critical review. Special Care in Dentistry, 19: 220–224.
  • Gomes, Guilherme F., et al. “The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia.” Current Opinion in Clinical Nutrition & Metabolic Care 6.3 (2003): 327-333.
  • Grunau, Ruth E., et al. “Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18months in preterm infants.” Pain 143.1 (2009): 138-146
  • Hyman, Paul E. “Gastroesophageal reflux: one reason why baby won’t eat.”The Journal of pediatrics 125.6 (1994): S103-S109.
  • Jawadi, Amal H., et al. “Comparison of oral findings in special needs children with and without gastrostomy.” Pediatric dentistry 26.3 (2004): 283-288.
  • Kabakus, Nimet, and Abdullah Kurt. “Sandifer syndrome: a continuing problem of misdiagnosis.” Pediatrics international 48.6 (2006): 622-625.
  • Mason SJ, Harris G, Blissett J (2005) Tube feeding in infancy: Implications for the development of normal eating and drinking skills. Dysphagia 20: 46-61
  • Orenstein, Susan R., and David M. Orenstein. “Gastroesophageal reflux and respiratory disease in children.” The Journal of pediatrics 112.6 (1988): 847-858.
  • Sullivan, Peter B., et al. “Gastrostomy tube feeding in children with cerebral palsy: a prospective, longitudinal study.” Developmental Medicine & Child Neurology 47.2 (2005): 77-85.

 

 

Photo 1, Photo 2, Photo 3

Leave a Reply