New statement on 'PEG' feeding tubes in children published

July 15, 2014, Wolters Kluwer Health

Placement of a percutaneous endoscopic gastrostomy tube has become an "essential" technique for children and young people with a wide range of problems with feeding and nutrition, according to a position statement in the Journal of Pediatric Gastroenterology and Nutrition, official journal of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

The new position statement was developed by the ESPGHAN Gastroenterology Committee. "The PEG tube now plays a key role in the management of children and with nutritional compromise, providing safe and effective access to the gastrointestinal tract," comments lead author Dr Robert B. Heuschkel of Addenbrookes Hospital, Cambridge, United Kingdom. "This document reviews all the current evidence on this important practice in children and presents it as a practical and accessible guide for all involved in the care of these tubes."

PEG is safe and effective for nutritional support in children

Gastrostomy tubes are devices placed into the stomach through an opening in the stomach wall. They are used to provide nutritional support to children (and adults) patients with problems affecting feeding or nutrition—for example, conditions causing inability to swallow or chronic diseases leading to malnutrition. At one time, open surgery was always required to place gastrostomy tubes.

But in more recent years, the PEG technique—using an endoscope to guide tube placement in the stomach and to create the opening in the abdominal wall—has become the standard. "There are very few clinical scenarios which require open, more major, surgery rather than the quicker, less invasive, PEG tube," Dr Heuschkel notes.

The availability of PEG has improved nutritional management of children with many different diseases and conditions. However, they add that the decision to insert a PEG, as well as the procedure itself, should only be performed only by a team experienced in carrying out PEG placement in children, with a pediatric surgeon available to manage possible complications.

Practical guidance on PEG tube placement and care

In addition to medical factors, the decision to perform PEG should consider possible ethical, psychological, and quality of life issues. The patient and parents may need some time and preparation to accept the idea of feeding tube placement. "As a result, the date for gastrostomy insertion may need to be delayed for all parties to be comfortable with the procedure," the Committee writes.

The statement addresses practical considerations and techniques related to PEG tube placement. Concerns that PEG causes gastroesophageal reflux are "misplaced," the Committee writes. They summarize the various techniques for PEG tube placement—the newer "push" technique may have advantages over the previous "pull" technique.

If the PEG tube is placed for long-term nutritional care, pediatric dietetic expertise is essential. After a few months of healing, the gastrostomy tube can be replaced with a more convenient "button" or "balloon" device.

The statement includes discussions of feeding considerations and supplies, care of the PEG tube after placement, and short- and long-term complications and their management. "Techniques and devices continue to evolve to reduce complications such as infection and displacement," the Committee adds.

The members of the ESPGHAN Gastroenterology Committee hope that their position statement will serve as a useful and practical guide to PEG tube placement, thus helping to optimize nutritional support for the diverse group of children in need. They emphasize, "The decision to place an endoscopic gastrostomy has to be made by an appropriate multi-disciplinary team, which then provides active follow-up and care for the child and device."

Explore further: Prolonged use of stomach feeding tubes in children may increase risk of stomach fistulas

More information: journals.lww.com/jpgn/Abstract … gement_of.98231.aspx

Related Stories

Prolonged use of stomach feeding tubes in children may increase risk of stomach fistulas

July 3, 2014
Pediatric patients with intestinal failure often need gastrostomy tubes, or feeding tubes inserted into an opening created in the stomach, for long-term nutrition. The use of such tubes can lead to persistent gastrocutaneous ...

New guidelines and technology needed for placement of feeding tubes in pediatric patients

May 21, 2014
Universal guidelines and improvements in technology are needed to reduce injuries and deaths from improper placement of nasogastric feeding tubes in pediatric patients, according to a comprehensive review of published literature.

Experts voice concerns over arsenic in rice

July 15, 2014
Inorganic arsenic in rice and rice-based foods poses health concerns in infants and young children, and steps should be taken to minimize exposure, according to a commentary in the Journal of Pediatric Gastroenterology and ...

Recommended for you

Baby brains help infants figure it out before they try it out

January 17, 2018
Babies often amaze their parents when they seemingly learn new skills overnight—how to walk, for example. But their brains were probably prepping for those tasks long before their first steps occurred, according to researchers.

NeuroNext biomarker study explores natural history of infantile-onset SMA

January 9, 2018
Research led by The Ohio State University Wexner Medical Center to define the natural history of infantile-onset spinal muscular atrophy (SMA) has been "critical" to accelerate the development of effective therapies and hasten ...

No link between childhood lead levels, later criminality

December 27, 2017
(HealthDay)— Exposure to higher levels of lead during early childhood can affect neurological development—but does that mean affected kids are doomed to delinquency?

Early puberty in girls may take mental health toll

December 26, 2017
(HealthDay)—A girl who gets her first menstrual period early in life—possibly as young as 7—has a greater risk for developing depression and antisocial behaviors that last at least into her 20s, a new study suggests.

Technology not taking over children's lives despite screen-time increase

December 21, 2017
With children spending increasing amounts of time on screen-based devices, there is a common perception that technology is taking over their lives, to the detriment and exclusion of other activities. However, new Oxford University ...

Higher blood sugar in early pregnancy raises baby's heart-defect risk

December 15, 2017
Higher blood sugar early in pregnancy raises the baby's risk of a congenital heart defect, even among mothers who do not have diabetes, according to a study led by researchers at the Stanford University School of Medicine.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.