Figure. A mother and father (providing expressed milk by tube feeding) join a nurse and attending physician during presentation by a medical student. (C) 2017, American Academy of Pediatrics. Textbook of Pediatric Care, 2nd Edition. Accessed via Pediatric Care Online on 1/3/17.Caring for children with complex health care needs is one of the most vital and rewarding parts of our jobs as pediatricians. But this care also can be one of the most daunting challenges for many pediatric providers, particularly for new resident physicians.
We graduate from medical school armed with an exhaustive differential diagnosis for the child who comes in with bilious emesis. But many residents find themselves at a loss when it comes time to troubleshoot problems with the G, J, GJ, OG, NG, ND tubes, buttons, adaptors, pumps, and other types of medical technology that many of our most vulnerable patients rely on.
Many early physicians have had limited formal education about medical support devices and learn on the job, at the bedside and in the clinic. Sometimes our education occurs through an unfortunate process of trial and error (just ask me how I learned that some lansoprazole suspensions are much too viscous to be given through a G-tube).
Oftentimes, our most valuable teacher is the experienced parent who has become an expert in the care of these devices after spending sleepless nights in the ER with their child and a dislodged, leaking, or clogged tube.
This month’s Pediatrics in Review features a much-needed review article “Tube Feeding in Children,” by Dr. Singhal, et al, which addresses this important education gap. The article reviews the indications for tube feeding (TF), recommendations for TF initiation and advancement, and how to select an appropriate formula based on your patient’s needs.
The article also includes a useful table that I’m sure I will regularly reference on how to troubleshoot commonly encountered complications of TF.
Enteral tube feeding is a lifeline for many of our most high-risk patients, and it is essential that all pediatricians feel comfortable managing this mode of nutritional support.