When you first enter the world of tube feeding, it feels like there is a whole new language to learn. Knowing more about the different types of tubes and understanding the lingo really helps you better navigate the most appropriate options for your child.
Terms to know:
Flush: Administering water into the feeding tube, usually with a syringe, to clear food, formula or medication, and to keep it from clogging. The amount of the flush is dependent on the length of the tube, but is usually between 10–20mL (about half an ounce) of water.
Bolus Feed: A tube feed that is given like a meal. Typically, a larger amount is given in a short period of time, usually less than 30 minutes. There is often a break, lasting hours between feeds. Bolus feeds can be administered by syringe, gravity bags or a feeding pump. They can be pushed in by syringe or the pump– or allowed to flow in at a comfortable rate by gravity.
Continuous Feed: A tube feed that is slowly dripped in using a feeding pump. It runs over longer periods of time, either overnight or for many hours per day.
Vent/Venting: Letting the air out of the stomach with a feeding tube, usually through an open 60mL syringe.
Feeding Tolerance and Intolerance: How a child reacts to tube feeds. If a child seems happy or content during and after feeding, he is tolerating feeds well. If there is discomfort, coughing, vomiting or retching during or after feedings, then there is feeding intolerance.
Motility/Dysmotility: Motility is how food and liquids move through the GI tract. If there is a motility issue, referred to as dysmotility, then food isn’t moving through as it should. There can be dysmotility at any point in the GI tract, from the esophagus all the way to the stomach, intestines and bowels.
Stoma: The stoma is the tube site itself (for G-, GJ- and J-tubes). It is the opening that connects the feeding tube on the outside of the body to the stomach or intestine on the inside.
PEG: PEG specifically describes a long G-tube placed by endoscopy, and stands for percutaneous endoscopic gastrostomy. Sometimes the term PEG is used to describe all G-tubes.
Types of feeding tubes:
Nasal tubes are non-surgical and temporary. The choice between nasogastric (NG), nasoduodenal (ND) and nasojejunal (NJ) depends on whether your child can tolerate feeding into the stomach or not.
- NG-tubes enter the body through the nose and run down the esophagus into the stomach.
- ND-tubes are similar to NG-tubes, but they go through the stomach and end in the first portion of the small intestine (duodenum).
- NJ-tubes extend even further to the second portion of the small intestine (jejunum). Bypassing the stomach can be beneficial for those whose stomachs don’t empty well, who have chronic vomiting, or who inhale or aspirate stomach contents into the lungs.
Gastric Tubes (or G-tubes):
The most common type of feeding tube is the gastrostomy (G) tube. G-tubes are surgically placed through the abdominal wall into the stomach.
There are a number of types of G-tubes. Any kind of G-tube can be placed initially. Often it is the surgeon or the gastroenterologist who determines the first type of G-tube placed. These are some of the most common types of G-tubes you may encounter.
- PEG and Long Tubes: These are one-piece tubes held in place either by a retention balloon or by a bumper. They are often used as the initial G-tube for the first 8-12 weeks post-surgery.
- Low Profile Tubes or Buttons: These tubes do not have a long tube permanently attached outside the stomach. Instead, they have a tube called an extension set that is attached for feeding or medication administration and then disconnected when not in use. When an extension set is not attached to the button, it lies fairly flat against the body. There are two types:
- Balloon buttons: These are held in place by a water filled balloon. These are the most common G-tubes used in children. They can be changed at home.
- Non-balloon buttons: Non-balloon buttons are harder to pull out than balloon buttons. Non-balloon buttons cannot be replaced at home. They are placed in the doctor’s office or at the hospital, sometimes with sedation or a topical pain reliever.
When you need to bypass the stomach for feeding, there is the Gastro-jejunal (GJ) tube. GJ-tubes are placed in the stomach just like G-tubes, but inside the stomach there is also a thin, long tube threaded into the jejunal (J) portion of the small intestine. The vast majority of children who get GJ feeding tubes begin with G-tubes; it is rare for a GJ-tube to be placed initially. Most GJ-tubes have separate ports to access both the stomach (G port) and the small intestine (J port), though some tubes, often called Transjejunal (TJ) tubes, only allow access to the small intestine. GJ-tubes are available both as buttons or long tubes.
Jejunal (J) Tubes:
It is sometimes necessary to place a separate J-tube that has a stoma (tube site) directly to the intestine. This is not usually an initial feeding tube placement for a child.
For more information on each type of tube, see the following resources:
Great articles from Complex Child E-Magazine:
All About NG Tubes: https://articles.complexchild.com/aug2009/00144.html
All About G Tubes: https://articles.complexchild.com/sept2009/00151.html
All About NJ, GJ and J Tubes: https://articles.complexchild.com/oct2009/00158.html
The Feeding Tube Awareness Foundation (www.feedingtubeawareness.org) is a 501(c)(3) nonprofit organization dedicated to raising positive awareness of tube feeding and providing parents with practical information. The organization’s Facebook page is the largest online support group for tube feeding in the world. (https://www.facebook.com/FeedingTubeAwareness).
Traci Nagy is the Founder of the Feeding Tube Awareness Foundation, and the author of this piece.