Manipulating tube feeds are a necessary part of having a child on G-tube feeds. Chances are if your child is being fed continuously over a 24 hour period he is not going to be hungry and therefore will not want to eat.
For example, if Johnny receives tube feeds of Pediasure at 45cc/hour over 24 hours, tube feeds can be condensed gradually by increasingtube feeds by 5cc/hour every 2-3 days and decreasing the amount of hours to a goal of 90cc/hour. Not following me? Here’s what manipulating tube feeds for Johnny would look like:
Day 1: 45cc/hour x24 hours (Total Volume= 1080cc)
Day 3: 50cc/hour x 21.6 hours (TV= 1080cc)
Day 5: 55cc/hour x 19.6 hours (TV= 1080cc)
Day 7: 60cc/hour x 18 hours (TV= 1080cc)
Day 9: 65cc/hour x 16.6 hours (TV= 1080cc)
Day 11: 70cc/hour X 15.4 hours (TV= 1080cc)
Day 13: 75cc/hour x 14.4 hours (TV= 1080cc)
Day 15: 80cc/hour X 13.5 hours (TV= 1080cc)
Day 17: 85cc/hour x 12.7 hours (TV= 1080cc)
Day 19: 90cc/hour x 12 hours (TV= 1080cc)
So at the end of 19 days Johnny is only receiving tube feeds 12 hours a day, probably from just before bed to right after he wakes up, and he is free the whole day to get hungry and start eating. Besides this his quality of life will improve because he is not constantly attached to the feeding pump and is able to move around freely. As with everything else though, Johnny needs to be monitored throughout this transition to make sure he is able to tolerate the higher rate.
If he exhibits any signs of intolerance such as vomiting, diarrhea or bloating, pause for a few days and start again when you think he can handle it. If he is unable to handle, stop where you are for a few months until he grows and may be more ready for this change. Manipulating G-tube feeds can be challenging but will usually pay off in the end and a decrease in hours can usually be achieved.
As an alternative to this schedule, many doctors like to transition to bolus feeds, which large amounts of formula are fed over short periods of time. This is a popular method because it mimics a natural eating plan and allows the stomach to stretch and accommodate a reasonable amount of food or formula. It is often a challenge when children are continuously fed to get them to drink a significant amount because their systems are so used to only receiving 1-2 ounces per hour over many hours they don’t know how to handle 8 ounces over 20 minutes like a regular meal.
Feeds can be manipulated to promote a more regular schedule of bolus feeds. So let’s take the example of Johnny, who was getting 45cc Pediasure over 24 hours. If we didn’t want to condense the hours of his feeds and instead wanted a bolus schedule we could take the 1080cc of tube feeds and give 180cc 6x/day, every 4 hours. His new schedule would look like this:
6am: 180cc Pediasure
11am: 180cc Pediasure
3pm: 180cc Pediasure
7pm: 180cc Pediasure
11pm: 180cc Pediasure
3am: 180cc Pediasure
This will allow his stomach to expand to allow the 180cc Pediasure at once and eventually when he begins eating the amount he eats can be deducted from the feed and he can receive the feed after he eats by mouth.
Finally, a combination of continuous feeds and bolus feeds can be incorporated. This is a good idea if Johnny can’t tolerate the whole feed of 180cc or if his parents can’t wake up to bolus feed him at 3am. His typical day with a combination of methods could be:
8pm-6am: 60cc/hour x 10 hours (600cc)
10am: 120cc Pediasure
1pm: 120cc Pediasure
4pm: 120cc Pediasure
6:30pm: 120cc Pediasure
Once he is able to tolerate a greater amount via bolus feeds overnight feeds can be eliminated.
There are a number of ways feeds can be manipulated to encourage PO intake. You should speak to your child’s doctor before making changes to his feeds, and monitor your child for signs of discomfort. Although it may take time for your child to adjust to a new schedule, in the end it will be worth it to work through issues so your child is able to begin eating by mouth. As the amount your child eats increases, the amount he will need to be tube fed will decrease.
It is recommended you speak to a health care professional before making any changes to your child's tube feeding schedule. Manipulating tube feeds can bring great rewards and get your child to eat better, however it needs to be done carefully to reap the benefits.