Weaning off NG Tube - Help!

  1. I hope there is someone who can help!

    This is in regards to a homecare case. I care for a 6 month old with dx of Teralogy of Fallot and was born with an Omphalocele ( this has been repaired). He is trach dependant and currently has an NG Tube. He regurges after every feed. Doctors say he should be able to feed orally, however he is not tolerating the feeds. Mom has tried cereal but he then gags and vomits. His Zantac has been increased and we recently started him on Pravacid via NG to neutralize stomach acids. He sucks on a pacifier but does not like to swallow.

    Does anyone have any suggestions as to how we can train (?) him to take his feeds better?

    Is there any relation between trachs and swallowing difficulties?

    GI specialist stated that he won't ear because he knows that if he does he will reflux which causes pain.

    Mom is frustrated and doesn't want him to become dependent on a feeding tube.
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  2. 12 Comments

  3. by   Jolie
    He needs a consult with a speech therapist or an occupational therapist experienced in treating infants with feeding disorders.
    The trach in and of itself would not cause the difficulties you describe. Many medically fragile infants become averse to oral feedings for a variety of reasons:

    1. If he was a preemie, he may never have had the chance to develop his suck/swallow/breathing coordination, as term babies learn this by practicing in utero. Therefore he may lack the coordination necessary to feed without choking and gagging himself.

    2. If he required mechanical ventilation and/or frequent oral/nasal suctioning early in life, he may have learned to associate oral stimulation with painful or unpleasant sensations. Ditto the ng tube.

    3. His heart defect may have caused him to become exhausted by the effort of oral feedings, another unpleasant association. If his heart defect is still uncorrected, full oral feedings may be unrealistic for him.

    A good, experienced therapist can make suggestions on how to overcome some of these obstacles.

    If reflux continues to be a problem despite the new medication, then he may need a surgical evaluation for a possible gastric tube placement and fundoplication. The poor guy can't be expected to tolerate pain every time he eats! It sounds like the gi doc might be on the right track, but someone needs to nudge him onto action on behalf of this poor baby!

    Good luck to you and your little patient. Let us know how he's doing.
  4. by   kids
    I don't remember the last time I encountered a kid who didn't or doesn't have a feeding problem. I have 14 kids aged 3 mo to 18 yrs on my caseload, 9 with trachs, all but 1 with a feeding tube.

    I have not seen lack of coordination in suck/swallow/breathe be a problem in trached kids (they don't have to coordinate it).

    I agree this little guy needs some major major involvement with a SLP...believe it or not babies forget how to eat. Getting them to be able to involves a lot of oral desensitizing and stimulation exercises. Gagging/retching/vomiting pretty common when initiating oral feedings, unfortunately the negative experience of it can quickly lead to a serious oral adversion when that happens to a kid it will starve its self before it will willingly take anything by mouth. A good oral stim program, followed religiously can make rapid progress toward oral feeding in a young baby.

    If you can't get a referral to a SLP send me a PM and I will email you the exercises/techniques we are using (all the SLPs working with our kids are following the same basic programs). If there is one in your area I would also recommend a referal to a Shriners (clients can self refer). If your kido is involved with a "Major Medical Center" because of his heart defect I would also suggest a referal to the feeding clinic AND a developemental Pediatritian.
  5. by   MayeRN
    Thanks for the replies. I will discuss them with mom.

    He is being followed by an OT at home, but this person has not had a lot of experience with peds. Myself and mom have discussed getting him referred to someone else.

    He is being seen by an army of specialist at the Children's Hospital of Eastern Ontario so mom can ask for a referral through them.

    Can you e-mail me those exercises?

    Thanks again
  6. by   kids
    What operating system are you using ? (Windows 95? 98? Mac?)

    Will be easiest for me to scan them in and email them as an attachment...need to know your OS so I know which computer to use.

    -nancy
  7. by   MayeRN
    Hi Nancy,

    I use Windows 98.

    I spoke with mom today and she will check to see if she can get a referal to a feeding specialist through the children's hospital

    Sharon
  8. by   kids
    Great.

    I will raid the stuff from the office tomorrow and scan it. The referal process may take a bit so you guys can get a head start on some of it.
  9. by   DiOB
    This reply is off- topic - but I did not get any replies from my post. I am looking for anything related to Peds homecare - such as clinical outcomes, policies, etc.
    Any help would be appreicated.
  10. by   HB123
    Hi there,
    Just wondering if those stimulation exercises you mentioned are still available as trying to wean a 7month old off an NG tube at he moment without much success. Thanks!
  11. by   anonymous_2468
    Hi, I was also wondering if those oral stimulation exercises are available, as would like to move a 11month old with no dx yet but who has been on an NG since 3 months onto more solids. Would really appreciate your help!
  12. by   NotReady4PrimeTime
    This is quite an old thread, from 2002. There may be little interest from the OP but I can tell you that the best way to get the ball rolling would be to arrange for a speech therapist to do an assessment then provide suggestions for oral stim. Some techniques I've used in the past include touching the face frequently and without any noxious activity (mouth care or suctioning for example); using different textures for facial stim such as velour, terry cloth, toys, temperatures. When the child starts accepting having his face touched without displaying any stress symptoms, you can then start touching his mouth, stroking his lips, pressing his cheeks together gently. Whenhhtat no longer produces stress symptoms you can begin introducing tastes of different sorts by dabbing pudding, pureed fruit or juice on his lips. It's a messy and prolonged process but for most kids it's eventually successful. Realize that this child will have no idea how to move food from the front of the mouth to the back for swallowing and will have little or no interest in chewing. Persevere.
  13. by   Rae,Rn
    Hello, Working with a six month old that just had a VSD repair and needs to be weened from the NG tube. Could you also email me a copy of the oral stimulation Baby has an appt. with feeding specialist the end of March, just wanted to get started. Thank you so much.
    Last edit by Rae,Rn on Feb 22, '11
  14. by   NeoPediRN
    I think the best approach would be to treat the reflux first. When was his last scope? His NG should be made an NJ to stop the refluxing and give his stomach and esophagus a chance to heal. The NJ should take care of the vomiting and that will give SLP a chance to work with his oral stimulation. It may be a long road before he can successfully take feeds PO. Babies with trachs often have a severe oral aversion.

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