Table 1.

G-tubes: Background information for clinicians

When to initiate discussion? Mention the potential benefits of G-tube feeding early, preferably when neurologic impairment is first diagnosed or feeding difficulties are recognized. Key clinical opportunities for initiating discussion include: poor oral intake and weight gain despite calorie boosting of oral feeds; recurrent aspiration or prolonged feeding times; gastroesophageal reflux disease (GERD), if it leads to insufficient oral intake; dysmotility despite medical treatment; if long-term G-tube feeding (e.g., >3 to 6 months) is anticipated.

How are G-tubes inserted? The procedure is centre-dependent but a G-tube is usually inserted by a radiologist (using ultrasound and fluoroscopy), a gastroenterologist (using endoscopic guidance) or a general surgeon (using open or laparoscopic surgery or endoscopic guidance).

What types of G-tubes are inserted? Two types are commonly used: a low profile or ‘button’ tube that sits flush to the skin, or a tube with a long external portion. Most children’s G-tubes go directly into the stomach, but children with severe GERD (for example) may require a gastrojejunal (GJ)-tube.

What are the risks of G-tube feeding? Short-term risks relate to the insertion procedure and include peritonitis (in ~2% of cases), bleeding, infection, anesthesia-related problems, abdominal organ puncture and (rarely) perioperative death. Tube feeding over the longer term poses risks caused by tube malfunction (blockage, dislodgement, breakage) and issues with the stoma (infections, bleeding, irritation). Some children experience worsening of GERD, which can be managed medically, surgically, or by placement of a GJ-tube.