Paeds Vivas · gastroenterology-hepatology-and-nutrition
Enteral feeding tubes and home enteral nutrition — branching viva
Branching viva from the principles of enteral feeding and device selection through the child with cerebral palsy referred for a gastrostomy, the nasogastric tube whose pH will not confirm, the non-functioning gastrostomy with buried bumper syndrome, and the dislodged tube at home, testing position verification, complication recognition and the home programme.
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RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the paediatric registrar in a general clinic. The consultant asks you to talk through four children referred with enteral feeding questions: a four-year-old with cerebral palsy referred for a gastrostomy, a two-year-old whose newly passed nasogastric tube has aspirate pH 6.5, a six-year-old whose gastrostomy will not run, and a child whose balloon button fell out at home.
Station opening
Examiner: "When do you choose enteral over parenteral nutrition in a child, and how do you decide between a nasogastric tube and a gastrostomy?" [1]
Strong candidate (must-hit)
- States that enteral nutrition is preferred whenever the gut is functional because it feeds and protects the gut mucosa, avoids the line-infection and liver risks of parenteral nutrition, and is cheaper; chooses the device by the expected duration of feeding, with a nasogastric tube for short-term feeding under four to six weeks and a gastrostomy, as a percutaneous endoscopic gastrostomy or low-profile balloon button, for anything longer, adding a post-pyloric jejunostomy or gastrojejunostomy when reflux, aspiration or gastric intolerance make the stomach unsafe. [1]
Weak candidate
- "A gastrostomy is for any child who cannot feed, and I would put one in straight away." [1]
References5ShowHide
- [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
- [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
- [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