Gastrostomy Tube (G-Tube)

What Is a G-Tube?

Some kids have medical problems that make it hard for them to get enough nutrition by mouth. A gastrostomy tube (also called a G-tube) is a tube inserted through the belly that brings nutrition directly to the stomach. It's one of the ways doctors can make sure kids who have trouble eating get the fluid and calories they need.

A surgeon puts in a G-tube during a short procedure called a gastrostomy. The G-tube can stay in place for as long as a child needs it.

Kids who have had a gastrostomy (ga-STROSS-teh-mee) can get back to their normal activities fairly quickly after they have healed.

Who Needs a G-Tube?

Kids need G-tubes for different kinds of health problems, including:

• congenital (present at birth) problems of the mouth, esophagus, stomach, or intestines
• sucking and swallowing disorders (due to premature birth, injury, a developmental delay, or another condition)
• failure to thrive (when a child can't gain weight and grow normally)
• extreme problems with taking medicines

What Happens Before G-Tube Placement?

Doctors often order several tests before a child can get a G-tube. The most common test is an X-ray of the upper gastrointestinal (GI) system. This lets the doctor see the upper part of the digestive system.

Sometimes the surgeon asks the family to meet with specialists, such as a gastroenterologist, dietitian, or social worker. This is to prepare a care plan so everything will be set up when the child goes home with the G-tube.

To get ready for the procedure, you will need to carefully follow instructions about when your child must stop eating and drinking. When you get to the hospital, the doctor will describe what will happen and answer any questions. The anesthesiology team will ask about your child's medical history and when your child last ate and drank.

Before the procedure begins, the care team sets up monitors to keep track of your child's vital signs (like blood pressure and oxygen level) and puts in an intravenous line (IV) to give medicines and anesthesia.

Your child will go to the operating room, and you'll go to a waiting area. A hospital staff member will tell you when the procedure is over.

What Happens During G-Tube Placement?

There are three ways doctors can insert a G-tube. Sometimes a combination of methods is used.

• The laparoscopic technique is done by making two small incisions (cuts) in the belly. One is for inserting the G-tube, and the other is where the surgeon inserts a tiny telescope called a laparoscope. The laparoscope helps the surgeon see the stomach and other organs and guide the G-tube into place.
• Open surgery is done with larger incisions. Surgeons choose this method to guide the G-tube into place when other methods are not a good choice — for example, if there is scar tissue from a past surgery or if the child needs another surgery done at the same time.
• The PEG procedure stands for percutaneous (through the skin) endoscopic gastrostomy. The surgeon inserts an endoscope (a thin, flexible tube with a tiny camera and light at the tip) through the mouth and into the stomach to guide the G-tube into place.

How Long Does G-Tube Placement Take?

Putting in a G-tube takes only about 30 to 45 minutes.

What Happens After G-Tube Placement?

Kids usually stay in the hospital for 1 or 2 days. Most hospitals let a parent stay with their child. While in the hospital, your child will get pain medicine as needed.

The nurses will teach you how to:

• Care for the tube and the skin around it to keep it clean and infection-free.
• Handle potential problems, such as the tube accidentally falling out.
• Give a feeding through the tube. You will also learn what to feed.
• Help your child eat independently, if the doctor says it's OK.

By the time your child is ready to go home, you should have:

• detailed instructions on home care, including bathing, dressing, physical activity, giving medicines through the tube, and venting (releasing gas from) the tube
• a visit scheduled with a home health care nurse to make sure things are going smoothly
• follow-up visits scheduled with your doctor to check the tube and your child's weight

Are There Any Risks From G-Tube Placement?

All surgeries come with some risks. The surgical team will discuss them with you before the procedure and do everything possible to minimize them. If you have any concerns, be sure to bring them up before the procedure.

Complications of surgery can include:

• extra tissue (granulation tissue) forming at the tube site
• leaking
• problems from anesthesia
• bleeding
• an allergic reaction
• infection

Granulation tissue or leaking can usually be fixed by caring for the wound as instructed or changing the feeding schedule. Sometimes surgery is needed to fix a problem at the surgery site.

How Can Parents Help After G-Tube Placement?

It's normal to feel a little bit nervous about the G-tube at first, but it's important that you feel comfortable taking care of it. Here are some tips:

• Always wash your hands well before caring for the G-tube.
• Always keep the feeding set tubing out of the way of infants and children. There is a risk that the feeding set tubing can get wrapped around a child’s neck, which could lead to strangulation or death.
• Know what to expect as the G-tube heals. Talk to your child's care team if you have questions.
• Get support from other parents. It can help to connect with other parents whose kids have G-tubes. Ask your child's doctor about a support group, or look online.
• Talk with a social worker. Some kids with a G-tube worry about how the tube looks and how others might react. If your child is concerned, ask your care team to recommend a social worker who can help.

When Should I Call the Doctor?

Call your doctor if your child has any of these problems:

• a dislodged tube
• a blocked tube
• any signs of infection (including redness, swelling, or warmth at the tube site; discharge that's yellow, green, or foul-smelling; fever)
• excessive bleeding or drainage from the tube site
• severe belly pain
• vomiting or diarrhea that keeps happening
• trouble passing gas or having a bowel movement
• pink-red tissue coming out from around the tube

Most problems can be treated quickly when they're found early.