Nasogastric (NG)

• Should be considered initially where gastric feeds are required
  
• Placement:
  
  
  
  • Measurement of approximate length for NG tube placement is determined by measuring from the ear to the corner of the mouth + mouth to xiphoid. Appropriate placement should be determined either radiologically (between 11th and 12th thoracic vertebrate) or by checking pH. If pH is <4 this is a reliable indicator of position in the stomach
    
  • Difficulties arise in children requiring long-term NG tubes who are on acid suppression as recurrent use of X-rays may result in high radiation dose over time

Nasojejunal

• Useful especially in the critical care setting or for short-term use in superior mesenteric artery (SMA) syndrome
  
• However, they do migrate back into the stomach and in younger children or with vomiting may become dislodged

Gastrostomy

• For longer term gastric feeding (>2 months)
  
• Placement:
  
  
  
  • Can be inserted endoscopically (PEG), laparoscopically or via open procedure
    
  • PEG tubes can be placed with experience even in very small infants (down to about 3 kg
    
  • Can be placed with minimal complications in patients with Crohn’s
    
  • Open placement of gastrostomy tubes may be necessary where there is scoliosis or other risk factors
  
  
• Contraindications for PEG: significant clotting disorders, ascites, peritonitis

Jejunostomy

Direct jejunal insertion or more often gastro-jejunal (G-J) tube with the advantage that the gastric port allows venting/aspiration of stomach contents.