Chronic kidney disease (CKD) and tube feeding

Some children with CKD may struggle to eat or drink enough for appropriate growth and development. Tube feeding can be a positive step towards making sure a child gets the nutrition and fluid they need.

Tube feeding can help to reduce the pressure on parents or carers. If a child is struggling to meet their nutritional requirements with oral diet, it can be reassuring to know they can supplement the diet with formula when needed. The feeding tube can be used in the short or long term if needed. The medical team, especially the dietitian, is there to provide support and education about tube feeding.

Types of tubes

There are two main types of feeding tubes: a nasogastric tube (NG tube) or a gastrostomy (G-tube for short). The medical team will advise on which is preferable for each child.

Nasogastric tube (NG tube)

Nasogastric tubes are normally for short-term use. They are long, thin tubes that are placed through the nose down the throat and into the stomach. A liquid formula is then given down the tube into the stomach. Healthcare workers, such as nurses, are trained to place these tubes and sometimes parents, guardians, or even older children are trained to insert them themselves. They can be placed in the hospital or at home and can easily be removed.

Gastrostomy (G-tube)

If a child is more likely to need a feeding tube for a longer time, a G-tube may be considered. The child will need to come into the hospital for either an overnight or day procedure depending on the local hospital policy. The G-tube is inserted through a small hole in the skin of the tummy into the stomach. There are many different types of G-tubes; some are held in place by a soft plastic disc and others by a small balloon filled with water. The medical team will advise on which is best suited to each child.

Methods of tube feeding

There are two main ways to deliver formula using a tube: bolus or pump feeding. In some cases, both may be used.

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Bolus feeds

Bolus feeds are given at regular times during the day. Usually a syringe containing the feed is connected to the feeding tube and the feed flows in using gravity. The feed is given over a short period of time with a flush of water before and after the feed. For an infant, this could mean 6-8 feeds a day: in a similar pattern to regular oral feeding. For an older child the boluses could be given 5-6 times a day, which represents normal mealtimes with snacks in between. One major advantage of bolus feeds is that a child can often eat and drink as much as he or she wants or is able to, and their remaining nutrition can be given using a tube feed. As the feed is given at certain times during the day, they are more likely to link a feed with a feeling of satisfying hunger. This means that the child is more likely to be interested in drinking or eating in a similar meal and snack pattern when they start to eat again.

Pump feeds

In this case, the tube is connected to a feeding pump and the feed given over a longer time at a slower rate. The feeding pump can be set to give a certain amount of feed per hour. This method of feeding can be especially helpful if a child is feeling or being sick as the feed can be slowed down to help improve symptoms. Sometimes if a child is eating during the day, but they are not managing to eat enough, the feeding tube can be used to give extra nutrition overnight.

Summary

Although tube feeding may seem overwhelming, it can be very helpful to support a child's growth and development. Regular contact with the dietitian is key to successful tube feeding in CKD.

Other benefits of tube feeds

Children with CKD may need additional fluid or medicines that they struggle to take by mouth. Having a tube makes it easier to give extra fluid when needed, and liquid medicines can be given through the tube, so the child doesn't have to taste them.

Types of formulas

There are many different types of formulas that can be given through a feeding tube. The formula or combination of formulas chosen by the healthcare team will depend on each individual child's age, nutrition needs and medical management. The formulas can be a powder/s that needs to be mixed with water, or a ready-to-use liquid. Breastmilk can also be given through a feeding tube if required. The dietitian will advise on the individual amount and type of formula needed. The healthcare team will provide training on feeding tube management and care.