Tube Feeding (and nutrition)

My child has had a G-tube placed and Nissen at three weeks old. She has been on Isomil since birth. She has recently lost 2 lbs. We have tried Pediasure but my child is not able to tolerate it. My child is able to vomit past the Nissen. The doctor is currently adding sugar to the formula. Is there a better way for my child to obtain nutrition?

Some children with a Nissen fundoplication/G-tube do much better with a pre-digested formula (what we call partially hydrolyzed) which has improved gastric emptying time.  There are several different pre-digested formulas available for tube feeding (such as Peptamen Jr.), and you should check with your GI doc about what they recommend.  These formulas typically are 30 kcal/ounce.

Regarding the fact that your child is able to vomit now suggests that the Nissen may have “slipped”.  We can evaluate whether a Nissen is intact by two different methods.  First, to assess the anatomy, we do a “tube study” where some contrast (like an UGI) is put into the G-tube and radiographs are taken to see if any contrast goes “backwards” and enters the esophagus.  Second, to assess that the Nissen is normally functioning, we can use either a 24-hour pH probe and/or a nuclear medicine “milk scan”.   The “milk scan” can be combined with a gastric emptying scan to see whether emptying is very slow.  This work-up may not be needed if symptoms and weight improve with a pre-digested formula, but if she remains symptomatic, your GI Doctor may recommend the above tests.

LG/TK 7-13-10