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Nutritional Support for Children with an Inadequate Appetite 211
The routes of tube feeding can be via: not appropriate when the natural reservoir of the
stomach is bypassed. The pump flow rate will
●● a nasogastric tube or much less commonly an depend on what the child can tolerate.
orogastric tube
Feeds available for tube feeding
●● a nasojejunal tube when the stomach needs to be
bypassed Several companies make a variety of sterile tube
feeds that are ‘ready to feed’. They can provide
●● a tube connected to a gastrostomy or jejunostomy either complete nutrition or partial nutrition.
button – used for longer term feeding. Standard feeds have an energy content of 1 kcal/
mL and are designed for different age groups to
Nasogastric tube feeding provide adequate energy, nutrients and fibre
within a suitable fluid load for that age range: 0–1
This route is used when a child initially requires year, 1–6 years and 7–12 years. Children over
tube feeding or requires it for a short time. A thin 12 years are usually given feeds formulated for
tube is passed through the child’s nose down into adults.
the stomach so that liquids can be slowly pumped
into the stomach. The tube is usually held in place Non-standard feeds include those providing
by being taped to the child’s cheek. They are easily complete nutrition:
pulled out and can be repassed quite easily if the
child is cooperative. ●● in lower volumes
Orogastric tube feeding ●● with lower or higher energy content
In orogastric tube feeding the tube is passed via the ●● with varying levels of fibre
mouth down into the stomach.
●● with varying fat content such as different
Gastrostomy feeding combinations of long and medium chain
triglycerides
If tube feeding continues to be necessary for a
longer period of time (about 6 weeks or more) a ●● with varying protein type such as complete
gastrostomy is formed which requires a minor protein, hydrolysed protein or simple amino
surgical procedure: a short tube is passed directly acids.
through the child’s skin and stomach wall and into
the stomach. It is held in position with a plastic Although there is a choice of brands, commonly an
clamp or a button with a small inflatable balloon NHS Hospital Trust will have a contract with one
that sits inside the stomach. The feeding tube can of the companies and use their products exclusively,
then be connected directly to the gastrostomy where possible, at a lower cost. Feeds for children at
device without having to go via the nose/mouth. home are prescribed by their GP usually on the
When this form of feeding is no longer needed, the advice of a paediatric dietitian or paediatrician.
gastrostomy device can be removed and the small
hole in the skin and stomach wall will close over Selecting a feed and feeding
and heal. A tiny scar may be the only indication regimen
that this route of feeding was ever used.
A paediatric dietitian can assess a child’s
Jejunostomy feeding is either via a nutritional needs and advise on the type of feed
nasojejunostomy tube or a jejunostomy button. and feeding regimen that meets their nutritional
Jejunostomy feeding must be slow and continuous requirements. The assessment will include an
using a pump so that the jejunum does not receive estimation of their:
large volumes of feed over a short period of time;
this can result in malabsorption. Bolus feeding is ●● energy requirements, taking into account
mobility, activity level, body temperature and
