How to reduce gastrointestinal problems
Gastrointestinal problems are quite common in children that are tube fed. Identifying the source of the discomfort is key in finding the possible solutions.
Share your observations and concerns with your healthcare professional team before changing anything in your child’s feeding routine. Sometimes, simple measures are enough to alleviate the problem.
Gastrointestinal problems may include: slow gastric emptying, constipation, diarrhoea and an upset stomach.
What is slow gastric emptying?
Slow gastric emptying is when food and/or liquid from a previous tube feed remain in the stomach longer than normal, and may even be in the stomach at the start of the next feeding. If your child suffers from slow gastric emptying, they may spit up or vomit. If this happens often enough your child may not receive the full volume of their formula and could loose valuable nutrition.
Possible causes may include:
- How the feed is given
- The type of formula
- The amount of formula being given per meal
- The rate of feeding
Possible solutions that you can try:
- An option is to change the amount of time between feeds. More time between feeds can give the stomach time to empty
- Or, the rate of the feeding can be adjusted in order to provide the formula over a longer period of time
- Some formulae have been shown to empty from the stomach more quickly than other types of formula and this may be an option that you can discuss with your doctor or dietitian
What if my child is constipated?
During tube feeding, bowel movements may be less frequent than usual. If your child is constipated, he or she may feel uncomfortable or bloated.
Possible causes may include:
- Not enough water is being given
- Lack of fibre, or not enough fibre, in the formula
- Your child being unable to get enough physical activity
- Certain medications
Possible solutions that you can try:
- Provide additional water flushes through the feeding tube as instructed by your healthcare professional
- Check with your doctor or dietitian to see if your child should change to a formula that contains fibre, or if you should add a fibre supplement
- If it is permitted, and your child is able, increase your child's physical activity by doing fun activities together
- Ask your healthcare professional to review your child's medications to see if any may be causing constipation
What to do in case of diarrhoea?
A child who is tube fed may normally have more frequent or watery stools, but if he/she is having four or more loose or watery stools a day, speak with your doctor.
Possible causes:
- Medications
- Rate of feeding is too fast
- Formula may be contaminated by bacteria after opening
- Intolerance to the formula
Possible solutions:
- Because emotions can affect digestion, help your child to relax during feeding
- Remove opened formulae from the refrigerator at least 30 minutes prior to feeding, allowing the formula to warm to room temperature
- Contact your child's healthcare professional for advice on slowing the feeding rate
- Do not use formula that has been opened and left at room temperature for longer than the manufacturer's recommendation
- Do not use formula that has been opened and left in the refrigerator for longer than 24 hours
- Check with your healthcare professional about changing to a formula that contains fibre, or adding a fibre supplement
- Check with your healthcare professional to see if your child should change to a special formula that contains ingredients that are easier to digest
- Wash your hands thoroughly before you open, or handle the formula
- Replace the feeding container and tubing as directed by your healthcare professional
What if my child has an upset stomach?
Occasionally, your child may feel nauseous and belch or vomit if he/she has an upset stomach.
Possible causes:
- Formula is being fed too fast
- Formula is too cold
- Too much formula at one feeding
- Lying flat while taking the feeding
- Engaging in too much activity right after feeding
- Intolerance to the formula
Possible solutions:
- Consult your child's healthcare professional for advice on slowing the rate of feeding
- Do not refrigerate unopened formula
- Make sure you are following the directions for the prescribed amount of formula and/or correct flow rate
- Do not allow your child to lie flat during or just after a feeding. Your child should sit or lie at a 45 degree angle during the feeding and for an hour after the feeding
- If directed by your doctor, check the residuals in your child's stomach before restarting the next feeding
- Ask your child's doctor or dietitian to re-evaluate your child's formula. You may need to switch to a formula that has more calories in less volume or to a special formula that contains ingredients that are easier to digest and absorb
Gastrointestinal problems can be a burden, but, with the appropriate advice and recommendations, things do get better, and you will learn how to deal with the different tube feeding challenges.