WARNING: The information in this section is meant as a general guide for parents and caregivers with certain problems related to enteral nutrition. It is not intended to replace the recommendations of your child’s healthcare team.

Discuss your child’s unique needs with the healthcare team, including WHO and WHEN to contact when problems arise.

NOTE: For ease of reading the rest of the text, the word (nutritional) “formula” also includes “breast milk”, “fortified breast milk” or “infant formula”.

Problems related to nasal tube

Difficulty or inability to irrigate the nasal tube

Difficulty or inability to aspirate stomach (gastric) contents from the nasal tube

Displacement of the nasal tube

Accidental removal of the nasal tube

Difficulty or inability to insert the nasogastric tube (eg, tube coils in the mouth or comes out through the mouth)

Redness around the nostril in a child with a nasal tube

Breathing difficulties (severe coughing, difficulty breathing, noisy breathing, choking, bluish lips, agitation) during nasogastric tube insertion

Discharge through the nasal tube

Bleeding; blood in the nasal tube

Problems related to button or enterostomy long tube

Drainage through or around the button or enterostomy long tube

Accidental removal of the button or enterostomy long tube

Red, crusty, moist, thick, red tissue around the ostomy: looks like cauliflower or a turtleneck, soft to the touch, bleeds easily and may leak yellowish/brownish, sticky fluid

Redness of the skin around the ostomy with or without tenderness, warmth, swelling, discharge different from the usual yellowish or brownish secretions, bad smell and/or fever (≥ 38⁰C rectal or ≥ 37.5⁰C oral or ≥ 37.5⁰C armpit)

Difficulty or inability to aspirate stomach (gastric) contents from the gastrostomy button or long tube

Difficulty or inability to irrigate the button extension set or the enterostomy long tube

Difficulty or inability to insert gastrostomy balloon button or long tube

Button or enterostomy long tube breakage (in place)

Disconnection of the extension set during the feeding session

Bleeding through or around the ostomy

Blood in the (stomach) gastric aspirate from the button or enterostomy long tube

Outward movement of the button or enterostomy long tube

Inward movement of the button or enterostomy long tube

Unable to deflate the balloon of the gastrostomy button or tube (in place)

Inability to rotate the gastrostomy balloon button

Problems related to feeding session or general condition of the child

Feeding pump alarms

Difficulty or inability to administer formula or medication through the tube or button (eg, inability to push the plunger on the feeding syringe, blocked or slowed flow of formula by gravity or pump)

Nausea and/or vomiting between feeding sessions

Nausea and/or vomiting during feeding session

Breathing difficulties (eg, coughing, choking, noisy and/or wheezy breathing, increased work of breathing (retraction of the skin around the ribs and collarbones), bluish discoloration of the lips and skin) during a feeding session

Bloating / swelling of the belly during feeding session

Bloating / swelling of the belly between feeding sessions

Abdominal pain during feeding session

Diarrhea (soft or liquid stools more frequent than usual) with or without cramps and/or abdominal pain

Constipation (infrequent and/or difficult to pass stool for more than a day) with or without nausea, vomiting, abdominal bloating, cramps and/or abdominal pain

Dry mouth

Yellowish or greenish vomiting (bile) or yellowish or greenish liquid visible in the feeding tube

One or more of these symptoms between feeding sessions: Headaches; Chest pain; Vomiting; Blurred vision; Perspiration (sweating); Pallor (pale skin); Fatigue or irritability; Tremors (shakiness); Convulsions

One or more of these symptoms during and/or after feeding session: Headaches; Chest pain; Strong thirst; Weakness; Agitation; Irritability; Abdominal cramps; Diarrhea; Urine more often than usual

One or more of these symptoms: Increased thirst; Dry and sticky tongue; Dry and chapped lips; Hollow or sunken eyes; Darker urine, strong odor and in smaller quantities than usual; Urine less often than usual; Weakness; Dizziness

One or more of these symptoms: Faster breathing, difficulty breathing; Swelling especially in the legs, feet and around the eyes; Quick and sudden weight gain

Please do not hesitate to refer to your healthcare team for any questions or specific advice related to your child’s condition.

When to consult your healthcare team

Nasal tube

  • Persistent recurrent nasal tube blockage.
  • Problem with a nasoduodenal or nasojejunal tube (eg, breakage, accidental removal or displacement).
  • Inability to insert the nasogastric tube, despite your interventions.
  • Persistent redness around the nostril.
  • Bleeding in the gastric aspirates.

Ostomy

  • Skin near the ostomy is red, sensitive, warm, swollen, has a bad odor, with the presence of discharge different from the usual yellowish or brownish secretions.
  • Presence of moist, thick, red crusts on the skin around the ostomy.
  • Bloody discharge through or around the stoma.
  • Persistent fluid discharge around the ostomy.
  • Inability to insert a urinary catheter through the ostomy.

Button and enterostomy long tube

  • Problem related to an ostomy that has been in place for less than 6 to 8 weeks (or other length of time as recommended by your healthcare team).
  • Persistent blockage of the button or enterostomy long tube.
  • Malfunction of the balloon button or enterostomy long tube (eg, inability to deflate balloon, inability to rotate the button).
  • Problem with a non-balloon button, a gastrojejunal button or enterostomy long tube (eg, malfunction, breakage, displacement, leakage of liquid around it, blockage or accidental removal).
  • Inability to insert the gastrostomy balloon button or tube despite your interventions.
  • Bleeding in the gastric aspirates.

Feeding sessions

  • Sudden onset of respiratory distress during a feeding session (EMERGENCY).
  • Persistent nausea and/or vomiting during or between feeding sessions.
  • Persistent bloating and swelling of the belly.
  • Persistent abdominal pain during feeding sessions.
  • Presence of yellowish or greenish liquid in the feeding tube.
  • Persistent problem with the pump (eg, alarms) or equipment, despite your interventions.

General condition

  • Fever (≥ 38⁰C rectal or ≥ 37.5⁰C oral or ≥ 37.5⁰C armpit).
  • Yellowish or greenish vomiting.
  • Persistent nausea and vomiting between feeding sessions.
  • Persistent bloating and swelling of the belly between feeding sessions.
  • Signs of dehydration: increased thirst, dry and sticky tongue, dry and chapped lips, dark urine with strong odor and in small quantities.
  • Diarrhea with the presence of blood and/or fever.
  • Persistent diarrhea.
  • Persistent constipation.
  • Signs of fluid overload: difficulty breathing, swelling in the legs, feet and eye area, sudden rapid weight gain.
  • Signs of hypoglycemia between feeding sessions: chest pain, vomiting, headache, blurred vision, sweating, pallor, fatigue or irritability, tremors, convulsions.
  • Signs of hyperglycemia during and/or after the feeding session: headache, chest pain, severe thirst, weakness, agitation, irritability, abdominal cramps, diarrhea, urinating more often than usual, dizziness.

Your child’s healthcare team will use your child’s regular appointments to verify the proper functioning of the enteral nutrition equipment, to answer your questions and to make adjustments to the care as required.

Do not hesitate to contact your healthcare team with any specific questions concerning your child.