Gastrostomy Care For Neonates

WHAT YOU SHOULD KNOW:

  • A gastrostomy tube is a tube that goes through an opening in your baby's skin into his stomach. A gastrostomy tube is also called a G-tube. The G-tube is placed inside an opening that is made in your baby's abdomen. This opening is called a stoma. Part of the tube is inside your baby's stomach and part of the tube extends outside of it. The outside part may be a long tube or may look like a button that rests directly on top of your baby's skin. Your caregiver may first give your baby an external tube and then later replace it with a button.



  • Your baby may need a G-tube if has trouble eating or swallowing. He also may need a G-tube if he has trouble keeping food down. Your baby may have trouble feeding because of problems with his mouth, throat, or stomach. He also may have a brain problem that makes it hard for him to eat or swallow. Cancer and heart problems also may make your baby too weak to eat on his own. With a G-tube, feeding your baby may become easier. Your baby may gain weight, get enough nutrition, and become healthier.

AFTER YOU LEAVE:

Medicines:

  • Keep a current list of your child's medicines: Include the amounts, and when, how, and why they are taken. Bring the list and the medicines in their containers to follow-up visits. Carry your child's medicine list with you in case of an emergency. Throw away old medicine lists. Give vitamins, herbs, or food supplements only as directed.

  • Give your child's medicine as directed: Call your child's healthcare provider if you think the medicine is not working as expected. Tell him if your child is allergic to any medicine. Ask before you change or stop giving your child his medicines.

Ask for more information about where and when to take your child for follow-up visits:

For continuing care, treatments, or home services for your child, ask for information.

  • Your baby's caregiver will check if your baby's G-tube is in the right place in his stomach. He also will check this skin around your baby's tube for signs of infection. Your baby's caregiver will weigh and measure your baby to see if your baby is getting enough nutrition. He also may replace your baby's tube.

Feeding your baby through his gastrostomy tube:

Your baby's caregiver will give you instructions for feeding your baby. Make sure you follow the correct feeding schedule. Ask your baby's caregiver how much milk or formula you should give your baby.

  • Keep the following items that you will need within easy reach:

    • Breast milk or formula.

    • Feeding pump (optional).

    • Feeding set.

    • Syringe. A syringe is a small hollow tube that pushes milk, formula or medicine into your baby's G-tube. It can also be used to take fluid or air out of your baby's stomach.

    • Water.

  • Feed your baby using the following step-by-step instructions: :

    • Use a measuring cup or bottle to measure the correct amount of breast milk or formula for your baby's feeding.

    • Raise your baby's head a few inches if he is lying down.

    • Put some water into the syringe. Push the water from the syringe into the tube to clean it. This helps keep the tube from getting blocked. Ask your caregiver how much water to put into your baby's tube. Never put too much water into your baby's tube.

    • Put the milk into the feeding set or pump.

    • Always follow your caregiver's instructions for how much, and how fast, you should feed your baby.

    • After feeding your baby, push water through the syringe to clean the tube again.

    • Write down how much milk or formula you gave your baby. Also write down how much water you used to clean the tube.

    • Keep the tube open for a few minutes after feeding to help decrease pressure inside your baby's stomach. This will allow your baby to burp.

Knowing if your baby is getting enough food and liquid:

If your baby is getting enough food and liquid, he may be less fussy after a feeding. His stomach also may look slightly bigger. If your baby is getting enough nutrition then he should begin to gain weight and grow.

Caring for the skin around your baby's gastrostomy tube:

  • Things you will need:

    • Bandages.

    • Soap.

    • Special skin care powders.

    • Warm water.

  • Cleaning the skin around your baby's gastrostomy tube:

    • Clean your baby's tube site with soap and warm water. Check your baby's skin for redness or swelling at the tube site. You may clean the skin around the tube while giving your baby a bath.

    • If your baby's original G-tube has already been replaced, you may gently turn the new tube. This may help relieve the pressure on your baby's skin and prevent skin infection. It may help keep the tip of the tube in place. Ask your caregiver when it will be okay to start turning the tube or button.

    • Use skin care powder and bandages to keep the skin around the tube dry. Ask caregivers what kind of skin care powder and bandages you should use. Also ask your caregivers for instructions for putting bandages near your baby's G-tube.

Caring for your baby's gastrostomy tube:

  • G-tube care: The following things may help you care for your baby's G-tube:

    • Clean your baby's tube before and after feeding your baby. Always follow your caregiver's instructions on how much water to use. Never put too much water into your baby's tube.

    • If your baby's tube has a balloon tip then make sure that there is enough air inside it. Ask your caregiver how much air should be inside the balloon.

    • Your baby may need to have the external tube replaced every two weeks. Your caregiver may show you how to replace the tube. Your caregiver also may ask you to come to his office to replace the tube.

Problems that may happen after your baby has a gastrostomy tube put in place:

  • Your baby's stomach might hurt and he may be more fussy than usual. He may get diarrhea or vomiting (throwing up). He may get a fever (high body temperature). The skin around your baby's stoma may get infected. The tube may leak fluid, blood, or pus. Your baby may have food or liquid go into his lungs by mistake. His gastrostomy tube may fall out and he may need to have another tube put into his stomach. Your baby's tube may shift and block other organs in your baby's abdomen.

  • Your baby's skin may turn yellow if your baby's liver does not work properly. Your baby's tube also may cause fistulas (abnormal paths) in your baby's abdomen. Your baby may get a hernia, which may cause his stomach to squeeze through the muscle wall. Your baby also may get air or fluid trapped in the lining of his abdomen. This may cause swelling called peritonitis. If peritonitis is not treated, your baby may get sepsis (blood infection) and die. Call your caregiver if you have concerns or questions about your baby's G-tube, condition, or care.

Avoiding problems with my baby's gastrostomy tube:

  • Follow your caregiver's instructions for the proper care of your baby's gastrostomy tube.

  • Look at the marks on your baby's tube to check if it is in the right place.

  • Put the tube under your baby's clothes to keep the tube from getting pulled out.

  • Check to see if there is milk or formula blocking the tube.

  • Keep your baby's skin clean and dry around the tube.

  • Check your baby's skin each feeding for redness, swelling, and pus.

  • Measure the length of the external tube from the stoma to the end. Ask your baby's caregiver how long this part of the tube should be and measure it every day. This will help you see if the tube has moved inside your baby's abdomen.

Gastrostomy tube replacement or removal:

  • First replacement: Between 6 and 12 weeks, your caregiver may replace your baby's tube. At this time, the skin is usually strong enough to have the tube replaced.

  • The tube has fallen out: If the tube falls out, your baby may need to have the procedure again. A different tube may be put in another place in your baby's stomach. If enough time has passed, your caregiver may replace the tube or instruct you how to do it.

  • The tube has moved inside the abdomen: If this happens, other organs in your baby's abdomen may be blocked or injured. Your baby's caregiver may place the tube back into the correct position. He also may put another tube into a different position in your baby's stomach.

  • Recovery from illness or condition: Your baby may not need the tube anymore once he becomes healthier. This may mean that your baby is now able to swallow and eat on his own.

Helping your baby be more comfortable when he has a gastrostomy tube:

  • Hold or talk to your baby during feeding time. You may put a pacifier into your baby's mouth during feeding. This may help your baby learn how to use his mouth.

  • Wash the tube site with soap and water.

  • Keep the tube site dry.

  • Put bandages around your baby's stoma if he has skin problems.

If your baby's gastrostomy tube falls out:

Do the following if your baby's G-tube falls out or moves out of place.

  • Cover the stoma with a bandage.

  • Call your caregiver right away. If you do not call your caregiver right away then the hole may close. If this happens, your baby will need to have the procedure again.

  • Your caregiver may instruct you how to replace the tube. He also may ask you to seek care immediately.

For support and more information about babies who have gastrostomy tubes:

You may feel frustrated, anxious, or afraid because of your baby's gastrostomy tube. You may get support from your baby's caregivers. You also may contact any of the following for more information:

  • American Society for Gastrointestinal Endoscopy (ASGE)
    1520 Kensington Road
    Oak Brook , IL 60523
    Phone: 1- 630 - 573-0600
    Phone: 1- 866 - 353-2743
    Web Address: http://www.asge.org
  • American Academy of Pediatrics
    141 Northwest Point Boulevard
    Elk Grove Village , IL 60007-1098
    Phone: 1- 847 - 434-4000
    Web Address: http://www.aap.org

CONTACT A CAREGIVER IF:

  • The tube is blocked or broken.

  • Fluid is leaking from your baby's stoma.

  • The tube has moved out of place.

  • There is redness, swelling, or thickened skin at the site of your baby's stoma.

  • Your baby has watery or milk-colored stool (bowel movements).

  • Your baby has more bowel movements than usual.

  • You have questions or concerns about your baby's condition, treatment or care.

SEEK CARE IMMEDIATELY IF:

  • Your baby's tube falls out.

  • Blood or pus is coming out of your baby's tube.

  • Your baby has sudden trouble breathing.

  • Your baby has a fever or is more irritable (cranky) than usual.

  • Your baby's abdomen feels stiff or tight.

  • Your baby's skin is becoming yellowish.

  • Your baby is vomiting (throwing up).

  • Your baby suddenly has a swollen or hard abdomen.

  • If any of these problems occur, do not feed your baby. Call 911 or take your baby to the emergency department right away.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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