Paeds · gastroenterology-hepatology-and-nutrition
Enteral feeding tubes and home enteral nutrition
Also known as Paediatric enteral feeding · Feeding tube management · Gastrostomy in children · Nasogastric feeding · Home enteral nutrition · Blenderised tube feeds
Fellowship guide to paediatric enteral feeding tubes and home enteral nutrition: the child with cerebral palsy who cannot swallow safely and needs a gastrostomy, the short-term nasogastric tube verified by gastric aspirate pH 5.5 or below, the percutaneous endoscopic gastrostomy and the low-profile balloon button, the post-pyloric jejunostomy for reflux and aspiration, the complications of granulation tissue, buried bumper syndrome, tube migration and stoma infection, blenderised versus commercial feeds, and the home enteral nutrition programme of caregiver training, supplies, monitoring and the emergency plan.
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- Never feed down a nasogastric tube until gastric position is confirmed by aspirate pH of 5.5 or below, or by X-ray: a tube whose position is unverified can lie in the lung or oesophagus, and feeding it can cause aspiration pneumonia or a pleural effusion
- An acutely dislodged gastrostomy stoma can close within hours, so it must be replaced promptly with a suitable catheter to keep the tract patent; if the tube cannot be replaced or the child develops peritonism, treat intraperitoneal feed leak as a surgical emergency with nil by mouth, intravenous fluids, antibiotics and urgent surgical review
- Buried bumper syndrome presents as abdominal pain and feed that will not run: the internal bumper of a percutaneous endoscopic gastrostomy has migrated into and eroded through the gastric wall, and the child needs endoscopic or surgical removal of the buried tube
- A previously malnourished child starting enteral feeding is at risk of refeeding syndrome: start with conservative calories, give thiamine, and monitor and correct phosphate, potassium and magnesium in the first days of feeding
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- Nutrition: enteral feeding tubes and home enteral nutrition in children
- General Paediatrics: selection, insertion, verification and complications of enteral feeding tubes and the home enteral nutrition programme
- The child needing enteral tube feeding: nasogastric versus gastrostomy, position verification, complications and home management
- Short case: the child with cerebral palsy and a gastrostomy
- Long case: the neurologically impaired child with faltering growth referred for enteral feeding
- Nutrition: enteral feeding, gastrostomy care and home enteral nutrition in children
- Enteral feeding devices: nasogastric and gastrostomy tubes, verification, complications and blenderised feeds
- Nutrition and the child with neurodisability: the feeding tube and the stoma site
- Gastroenterology and nutrition: enteral feeding tubes and home enteral nutrition
- Patient Care: enteral access, tube complications and home enteral nutrition management
- Medical Expert: enteral feeding tubes and home enteral nutrition in children
Overview & Definition
Picture the four-year-old with severe cerebral palsy whose mealtimes last ninety minutes and end in a wet cough, the infant recovering from cardiac surgery who cannot yet take enough by mouth, and the adolescent with a metabolic disorder who needs precise overnight calories. Each needs nutrition the mouth cannot reliably deliver, and each will meet an enteral feeding tube. The clinician's job is to choose the right device, place and verify it safely, run the feeding regimen, and hand a workable plan to the family for home. [1] [8]
Enteral nutrition means delivering food into the gastrointestinal tract rather than into a vein, and whenever the gut works it is the route of choice, because it feeds the gut mucosa itself, preserves the intestinal barrier, avoids the line-infection and liver risks of parenteral nutrition, and costs far less. A feeding tube is simply the plumbing that gets nutrition into a stomach or small bowel that the child cannot fill by mouth. The choice between a tube through the nose, a tube through the abdominal wall, and a tube placed beyond the stomach follows the expected length of feeding and the child's reflux and aspiration status. [1] [3]
Home enteral nutrition is where this topic meets real life. Most tube-fed children live at home, fed by parents who must learn to pass a nasogastric tube, run a feed pump, look after a stoma, recognise a blocked or dislodged tube, and know when to come in. The medical role shifts from bedside doctor to designer of a safe, sustainable home programme, with the dietitian, the specialist nurse and the family at its centre. [8] [1]
References12ShowHide
- [1]Homan M; Hauser B; Romano C Percutaneous Endoscopic Gastrostomy in Children: An Update to the ESPGHAN Position Paper. J Pediatr Gastroenterol Nutr, 2021.PMID 34155150
- [2]Cassaro F; Impellizzeri P; Bartolone A Percutaneous endoscopic gastrostomy versus laparoscopic gastrostomy in pediatric age: A systematic review and meta-analysis. J Pediatr Gastroenterol Nutr, 2026.PMID 41229146
- [3]Baker L; Beres AL; Baird R A systematic review and meta-analysis of gastrostomy insertion techniques in children. J Pediatr Surg, 2015.PMID 25783383
- [4]Irving SY; Rempel G; Lyman B Pediatric Nasogastric Tube Placement and Verification: Best Practice Recommendations From the NOVEL Project. Nutr Clin Pract, 2018.PMID 30187517
- [5]Northington L; Kemper C; Rempel G Evaluation of methods used to verify nasogastric feeding tube placement in hospitalized infants and children - A follow-up study. J Pediatr Nurs, 2022.PMID 34763985
- [6]Delcourt H; Van Den Eynde R; De Belder L Blenderized tube feeding for children: A systematic review of health outcomes and impact on upper gastrointestinal symptoms. J Pediatr Gastroenterol Nutr, 2025.PMID 41144871
- [7]Gestels T; Hauser B; Van de Vijver E Complications of Gastrostomy and Gastrojejunostomy: The Prevalence in Children. Pediatr Gastroenterol Hepatol Nutr, 2023.PMID 37214169
- [8]Romano C; van Wynckel M; Hulst J European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment. J Pediatr Gastroenterol Nutr, 2017.PMID 28737572
- [9]Morse J; Baird R; Muchantef K Gastrojejunostomy tube complications - A single center experience and systematic review. J Pediatr Surg, 2017.PMID 28162764
- [10]Cortez AR; Warren PW; Goddard GR Primary Placement of a Low-Profile Gastrostomy Button Is Safe and Associated With Improved Outcomes in Children. J Surg Res, 2020.PMID 31958600
- [11]Noble LJ; Dalzell AM; El-Matary W The relationship between percutaneous endoscopic gastrostomy and gastro-oesophageal reflux disease in children: a systematic review. Surg Endosc, 2012.PMID 22437953
- [12]Sleigh G; Brocklehurst P Gastrostomy feeding in cerebral palsy: a systematic review. Arch Dis Child, 2004.PMID 15155398