From the Guidelines
If your baby with a G-tube is experiencing vomiting and feeding intolerance, it is crucial to first contact your healthcare provider as these symptoms require immediate medical evaluation to prevent complications and ensure the best possible outcome in terms of morbidity, mortality, and quality of life. In the meantime, trying lifestyle modifications such as slowing the feeding rate, using smaller, more frequent feedings, and ensuring proper positioning (30-45 degrees upright during and after feeds) may help alleviate symptoms, as suggested by guidelines for managing gastroesophageal reflux in infants 1. It is also essential to check that the G-tube is properly positioned and not clogged. Your doctor may recommend medications like metoclopramide (Reglan) or erythromycin to improve gastric emptying, or acid reducers like ranitidine or omeprazole if reflux is contributing to symptoms, based on the clinical presentation and underlying cause of the symptoms. Ensuring the formula is appropriate for your baby's needs is also vital; sometimes switching to a more easily digestible formula (elemental or semi-elemental) helps, especially if the baby has a milk protein allergy, which can mimic GERD symptoms 1. These symptoms often occur because babies with G-tubes may have underlying gastrointestinal motility issues or anatomical abnormalities that affect normal digestion and movement of food through the digestive tract. Documenting feeding volumes, rates, and symptoms will help your healthcare provider determine the best approach for your baby's specific situation, considering the potential benefits and risks of different management strategies, including thickened feedings, which may decrease observed regurgitation but have uncertain effects on the natural history of infantile reflux and potential allergenicity of commercial thickening agents 1.
From the FDA Drug Label
In pediatric patients, the pharmacodynamics of metoclopramide following oral and intravenous administration are highly variable and a concentration-effect relationship has not been established. Although there are insufficient data to support the efficacy of metoclopramide in pediatric patients with symptomatic gastroesophageal reflux (GER) or cancer chemotherapy-related nausea and vomiting, its pharmacokinetics have been studied in these patient populations.
The use of metoclopramide in a baby with a G-tube for vomiting and feeding intolerance is not supported by the FDA drug label due to insufficient data on its efficacy in pediatric patients with these conditions 2. Caution should be exercised when considering the use of metoclopramide in this population.
- The pharmacokinetics of metoclopramide in pediatric patients are highly variable.
- There is no established concentration-effect relationship for metoclopramide in pediatric patients.
- The FDA drug label does not provide guidance on the use of metoclopramide for vomiting and feeding intolerance in babies with a G-tube.
From the Research
Vomiting and Feeding Intolerance in Babies with G-Tubes
- Feeding intolerance is a common issue in preterm infants, and it can be associated with increased risks of infections, prolonged hospitalization, and higher economic costs 3.
- For babies with G-tubes, vomiting and feeding intolerance can be managed with different types of formulas, such as amino acid-based or extensively hydrolyzed formulas 3.
- Amino acid-based formulas have been shown to reduce gastric residual volume in preterm infants, which may help improve feeding intolerance 3.
- Peptide-based formulas, which contain proteins that have been enzymatically hydrolyzed to dipeptides and tripeptides, may also improve enteral feeding tolerance and reduce healthcare utilization 4.
- Transitioning to a tube feeding formula with real food ingredients may also improve feeding tolerance and stool output in pediatric patients with intestinal failure 5.
G-Tube Care and Management
- Gastrostomy tube insertion is a common practice in pediatric patients, and it requires proper care and management to prevent complications 6, 7.
- Pediatricians and pediatric subspecialists should be familiar with the indications, safety, and management of gastrostomies to provide optimal care for children with G-tubes 7.
- Complications such as vomiting and feeding intolerance can be handled with proper management and formula adjustments, and parents should be educated on how to care for their child's G-tube 6.