Feeding By Artificial Means

General Information

118. Children who are unable to take enough food an fluid by mouth to maintain good nutrition and health may require to be tube fed.  There are two methods of doing this:

• Naso-gastric tube feeding
• Gastrostomy tube feeding

Naso-gastric Tube Feeding

119. A tube is passed through the nose, down the back of the throat into the gullet and so into the stomach.  Fluids and liquid nutrients can then be delivered directly into the stomach.  This tube is at risk of displacement and this method of feeding would not usually be undertaken in a school setting.

Gastrostomy Tube Feeding

120. A gastrostomy is a small plastic tube inserted directly into the stomach through the abdominal wall.  The tube is narrow, about 12 inches long and has a fixation plate (plastic triangle or round disc) positioned close to the surface of the stomach, a plastic clip to open and close it and a plastic cap to keep it clean.

121. Commercially prepared liquid feeds, which have been prescribed for the child, are administered through the gastrostomy tube using a syringe.  The actual technique for doing this varies with the particular tube used and expert advice and demonstration for each child with a gastrostomy should be sought from the Paediatric Nutrition Nurse Specialist (see below).  In addition particular care must be taken in the care of the gastrostomy tube and of the child’s skin and again the Paediatric Nurse Specialist will advise.

Paediatric Nutrition Nurse Specialist:

Royal Aberdeen Children’s Hospital, Cornhill Road, Aberdeen, AB2 2ZG

Tel 01224 681818, Ext 53641.  Bleep - 2119
Working hours - 9.00 am to 5.00 pm Monday to Friday

122. Should a gastrostomy tube come out the parent must be notified immediately as it must be replaced within 4 hours (tubes can be replaced easily at home or hospital by parents or carers).  PEG (percutaneous endoscopic gastrostomy) tubes do not normally fall out or become displaced.

Additional Points

• the child may also be taking some oral food/fluids as well as being gastrostomy fed
• particular care should be paid to maintaining dental hygiene and good dental care
• once the gastrostomy is established and the site is free from redness, swelling or infection the child may undertake normal activities and may go swimming provided that the clip and plastic cap are fully closed and a waterproof  dressing covers the site which must then be dried very thoroughly afterwards
• the provision of adequate supplies of liquid feeds to the school is the responsibility of the parent (see 118 above)

Basic Guidelines

123. If a child with a gastrostomy is enrolled at school the following points should be addressed:

• Ensure an individual protocol is drawn up for the child with advice from the Paediatric Nutrition Nurse Specialist, parents/carers and relevant healthcare staff.  This protocol should cover:

• the care of the gastrostomy tube and site
• the feeding technique involved
• the supply and storage of feeds
• the designation of appropriate staff
• problem identification
• problem reporting

124. This protocol must be countersigned by the parent, Head Teacher, Paediatric Nutrition Nurse Specialist and Paediatrician/ Community Doctor and must be reviewed annually.

125. Ensure that staff have adequate training in the techniques involved BEFORE the child is admitted to school.  The Paediatric Nutrition Nurse Specialist can be contacted to arrange appropriate demonstrations to staff.  It is advised that a teacher and at least two other members of staff be trained.