A child’s feeding tube is a vitally important tool. It’s a direct delivery system providing the nutrition your child needs to help promote their healthy growth and development. However, it’s not uncommon for a child with a feeding tube (e.g., a percutaneous endoscopic gastrostomy or “PEG tube”) to experience gastrointestinal (GI) issues, such as nausea, vomiting, and diarrhea. These complications can contribute to “lost” calories and must be addressed immediately to prevent unintended weight loss.
What Causes GI Issues for Kids on Tube Feedings?
GI intolerance can lead to serious health complications such as dehydration and weight loss. Common symptoms include nausea, vomiting, diarrhea, bloating, constipation, or abdominal discomfort.
There may be one or several reasons causing the GI intolerance issue:
- Formula may not be appropriate for the child’s physical condition
- Incompatible feeding schedule
- Formula may be delivered too quickly
- Formula volume may be excessive
- The type of formula being administered may be incorrect for the child’s needs
- Underlying medical conditions
- Food intolerance or sensitivity
- Incorrect type of feeding tube
Is My Child Getting Enough Nutrition?
If your child has a PEG tube, you may worry whether they’re getting enough nutrition and hydration to help foster a healthy weight gain. Be sure to work with a registered dietitian nutritionist who specializes in tube feeding support so they can help you determine your child’s unique caloric and nutrient needs.
Many factors play a role in calculating the appropriate nutrient needs for a tube-fed child in order to promote a steady, desirable weight gain. These factors include the current height and weight of the child, their activity level, any specific medical conditions, current medications, and more.
Providing nutrition through enteral feedings not only can help your child reach and maintain a healthy weight, but it also can support their overall energy and improve their ability to fight off infections.
How Much Weight Should My Child Gain?
When it comes to weight-gain goals, there’s no one-size-fits-all recommendation. It’s important to work with members of your medical team, like a registered dietitian nutritionist, to determine what’s best for your child.
Keep in mind, weight gain results from consuming more calories than you burn off. If a tube-fed child is not gaining weight as expected, then their overall medical plan, including their tube feeding regimen, should be re-evaluated. In fact, a child’s tube feeds should be adjusted regularly since children are continuously growing and developing, and their nutrient needs change as they grow.
5 Ways to promote weight gain with a PEG tube
- Increase the Volume: For those receiving bolus tube feedings, a type of feeding that uses a syringe to deliver formula through the feeding tube, a common strategy is to slowly increase the total calories by increasing the amount of formula given at each feed. For those on a continuous feeding, which runs nonstop for a set number of hours via pump, you would slowly increase the rate, as tolerated, to deliver more nutrition in that set time frame.
- Increase the Frequency: For those on bolus tube feedings, this can be achieved by either adding an additional bolus “meal” per day or by adding 2-3 smaller “snack” bolus feeds.
- Increase the Nutritional Value: Get more nutrition per milliliter (mL) of formula by selecting one that provides 1.2, 1.5, or 2.0 calorie/mL options, as opposed to the standard 1.0 calorie/mL formula. When you choose a more nutrient-dense formula, you will need to increase the water flushes throughout the day because these formulas contain less free water.
- Add “Modular Nutrients”: Modular nutrients are liquid or powdered supplements that contain single nutrients, typically carbohydrates, protein, or fat that can be added as “building blocks” to your foundational formula. One example is liquid MCT (medium-chain-triglycerides) which is a more readily digestible type of fat that can help those experiencing GI issues, like diarrhea and malabsorption.
- Change the Formula: If your child shows signs of GI intolerance on a standard tube feeding formula, that may be a sign that they aren’t properly digesting or absorbing the nutrients. As a result, they may experience unintended weight loss. In this case, switching to a formula that is more easily digested and absorbed, such as Peptamen® Junior peptide-based nutritionally complete formula, may be indicated. Peptide-based formulas contain ingredients that have been broken down into smaller units providing nutrients they need in a way that can be more easily digested and absorbed by their GI tract.
Remember, everyone’s nutrient needs are unique and finding the right formula and feeding approach that’s best for your child can take time. Talk to your doctor and registered dietitian nutritionist if you’re worried about your child’s tube feeding tolerance or changes in weight.
