Tube Feeding Criteria for Children

Many times it seems like there are no definite tube feeding criteria in determining whether or not tube feeds are appropriate for your child. Depending on your particular doctor or the parents you have spoken to, you may get many different opinions on whether or not your child needs a G-tube feeding. There are objective criteria that have been developed, however.

Although this is not an all exclusive list, here are the main criteria doctors use to determine if a child can benefit from a NG, J or G-tube feeding.

1. Inability to consume at least 80% of calculated energy needs by mouth.

If your child is unable to consume 80% of her estimated calorie needs no matter how hard you try, and she isn’t gaining weight, a feeding tube should be considered. Before turning to a feeding tube try to calorie boost and offer high calorie supplements. These may do the trick. If not though, this is a tube feeding criteria that indicated a need for a tube to be considered.

2. Total feeding time >4 hours/day.

If you are feeding your child for more than 4 hours a day, or if any given meal takes longer than 30 minutes, a tube may be indicated. It is exhausting for both you and your child to be feeding for greater than 4 hours a day, and if the process is upsetting for both of you and you feel she would benefit from not trying so hard, a tube may be beneficial.

3. Inadequate growth or weight gain for >1 month (younger than age 2) or Weight loss or no weight gain for 3 months (older than age 2).

These are pretty self explanatory. If you didn’t realize she wasn’t gaining weight or haven’t tried other options yet, this criterion by itself is not a reason to immediately get a tube placed. Offer some high calorie foods before making an appointment to get a tube placed, and look at it as a red flag that something needs to be done. This in combination with other factors may indicate a need for intervention.

4. Change in weight/age or weight/height on two growth percentile rankings on CDC growth charts.

This is a serious one that shouldn’t be taken lightly. If you feel your child is eating well and is still dropping percentile rankings, medical tests should be considered to see if there is an issue which would explain the drop. For more information on growth charts, click here.

5. Triceps skinfolds consistently <5th percentile for age.

Not many pediatricians do triceps skinfold, but if your doctor does it and it’s below the 5th percentile, this is a sign of malnutrition.

High calorie foods are the first thing to start, but if your child will not eat a tube feeding may be needed.

In Conclusion...

None of these tube feeding criteria by itself indicate a definite need for a tube feeding. For most of them the first step is adding calories to the diet and encouraging more food. The problem comes in when this doesn’t work and your child refuses to eat more or different foods.

When considering a tube feeding for your child remember it is not your fault or your child's, and it does not make you a bad parent. Having a child who has a hard time eating enough can be quite a challenge and tube feeding is a medical treatment. It does not mean you are giving up on your child or that she will never eat. G-tube feeding can be a great supplement to your child's regular diet and help her gain weight while she learns to eat enough to thrive on her own.

These tube feeding criteria for children should be used as a reference. If you find your child fits a few of these criteria, it may be a good idea to have a tube placed. Reference: Axelrod D, Kazmerski K, Iver K. JPEN. 2006;30(suppl 1):S21-S26