Tube feeding, also known as enteral feeding, is the delivery of food directly into the digestive system for those who have difficulties in chewing and swallowing. Tube feeding might be required if changes to diet or feeding practices are not sufficient to provide sufficient nutrient supply.
Improper brain development in patients with Rett syndrome may result in several gastrointestinal complications, including difficulty in swallowing food, which mandates special attention to diet and feeding strategies. Tube feeding can be of immense help in ensuring that patients are able to overcome feeding difficulties and receive proper nutrition.
Before deciding on tube feeding, it is helpful for the patient to undergo an evaluation by a trained speech-language pathologist (SLP) who, apart from suggesting appropriate speech therapy measures, also can identify breathing and swallowing difficulties.
Types of tube feeding
There are three main types of feeding tubes depending on where they are inserted into the body.
Nasogastric tube
A nasogastric feeding tube is inserted via the nose into the stomach. It is a quick way to increase nutrient uptake and also helps assess whether a gastrostomy (surgical opening into the stomach) eventually would prove to be beneficial to the patient.
A nasogastric tube is best suited for short-term use and may cause discomfort and skin irritation where the tube is taped. There also is a risk of gastro-esophageal reflux disease (GERD).
Gastrostomy tube
A gastrostomy feeding tube, also known as a G-tube, is inserted into the stomach either via the mouth (percutaneous endoscopic gastrostomy, PEG) or surgically via the abdomen. This is a more long-lasting solution than a nasogastric tube and reduces feeding stress. It also is a better way to administer medication than a nasogastric tube.
While feeding via gastrostomy, care must be taken as there is a possibility of the G-tube leaking or getting dislodged, and a risk of reflux. There also is a risk of surgical complications while inserting the tube.
Gastro-jejunostomy (PEG-J) tube
In this method, a feeding tube is inserted directly into the jejunum of the small intestine. This is a less common procedure compared to the other two and is recommended most often when there is a risk of reflux disease or a risk of aspiration (accidental entry of food into the lungs or airways).
Since the stomach is bypassed in this method, the flow of food and liquids into a PEG-J tube must be monitored because fast flow rates can cause undigested food to enter the small intestine. Like gastrostomy, there is a possibility of surgical complication during tube insertion.
Advantages of tube feeding
Tube feeding has several advantages that can make life easier for parents, caregivers, and patients alike. Tube feeding can ensure that the nutritional needs of children with Rett syndrome are met as the chances of spitting out food are eliminated. This reduces a lot of stress for parents and caregivers.
There also are pumping mechanisms available that can allow scheduling food delivery via a G-tube or PEG-J tube if the patient is immobile and bedside monitoring is not possible.
In tube feeding, the food directly enters the digestive system and this helps to greatly reduce the risk of aspiration and coughing. Research has shown that gastrostomy helped in gaining weight.
Important considerations
A few important points should be kept in mind to ensure hassle-free tube feeding.
Since there is no chewing involved in tube feeding, the food must be prepared and textured so that it can freely pass through the tube without causing any blocks and be easily digested.
It is important to ensure that the recommendations of the dietician or clinician are followed exactly and ingredients are mixed in the correct ratio. Any change to the diet formula must be made only in consultation with the dietician. Appropriate water content must be calculated to prevent changes in calorie and protein concentration.
It also is important to ensure that the patient takes part in the normal mealtime routine even if they are tube feeding. This prevents any sense of isolation and increases environmental awareness. In some cases, oral feeding can be combined with tube feeding depending on the child’s ability to swallow.
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