Tube Feeding or Enternal Nutrition

Most of us like to eat. Some of us "love" to eat--and of course, those who do often eat too much. But there are some who can't eat or can't eat enough to maintain their health. What happens then? Sometimes an appetite stimulant can be used or the foods can be changed to a different texture (a liquid diet, for example). But when that doesn't work, liquids can be dripped or pumped into the stomach or intestine to provide the necessary nutrition that person needs. They go through a tube (and so they are called tube feedings. In medical lingo, that's enteral nutrition.  

There are basically 3 types of feeding tubes:

  • Naso-gastric tubes (NG tubes). These go through the nose, down the esophagus and into the stomach. They are usually used for just a few days or a few weeks.
  • Gastrostomy tubes (G tubes)  go directly through the abdomen (with a hole made through the skin and muscle) going directly into the stomach. Obviously, they are not used unless the tube is going to be used for longer periods (months to years)
  • Intestinal tubes are simply extensions of the NG or G tubes that deliver the food into the intestine rather than the stomach. This is usually when the stomach doesn't empty well, or the patient has such severe reflux that it is likely the food will come back up into the esophagus (and perhaps spill into the lungs). So these tubes go down into the first part of the intestine, the duodenum; or the next part, the jejunum. The NG becomes an ND or NJ tube and the G tube becomes a GJ tube.

Buttons are similar to the tubes, but they are shorter versions, so that they don't have long "tails" always sticking out of the skin. Instead, a tube is attached when a feeding is going on and removed when the feeding is over.    

Enteral nutrition or tube feedings can be given in different ways.

They can be the only source of nutrition (this is called exclusive enteral nutrition or EEN) and is used for children who might aspirate their feedings, have problems with absorption or as the initial treatment for Crohn's disease, for example.   

Partial enteral nutrition is where the tube feedings are combined with normal meals. This might happen in situations where a premature infant or a child with heart disease, cystic fibrosis or cerebral palsy can't eat enough and the tube feedings are needed as supplemental nutrition.

In either case, the tube feedings may be pumped in as continuous feeds over several hours or all night or they may be dripped in over a short period of time (known as bolus feeds) so they are like having a regular meal.

Because these feedings have to replace what someone would normally eat, they have to be carefully balanced to make sure they meet all of that child's nutritional needs. It therefore essential to work with a qualified doctor or dietitian focused on pediatric nutrition.