[Dysphagia] pediatric NG tube

[eripley at yahoo.com (Irene Campbell-Taylor)]

Michelle

You don?t indicate the reason for his being NG fed or whether or not he is taking any medications regularly. I offer an example of a case I had some years ago of a boy of five, who also had been NG fed since the removal of a chiasmal tumor at the age of eleven months. He suddenly stopped accepting anything by mouth except saltines and old cheese that he would mash in his mouth and then spit out. There was nothing wrong with the swallow per se.  We went through the usual ? is he not hungry etc.etc ? but the real reason was that, because of the location of the tumor and the fact that he had been treated with radiation (that should not have happened) ? he had neither taste (except for salt) nor smell. He is the only child for whom I have ever insisted on a PEG because the stress on the mother and child of passing the NG every night and removing it in the morning was too much ? and, no, I?m not making this up. It was through a major, world known children?s hospital at that. It took a
 very long time for him to accept some foods p.o. but, as far as I know, he has been mainly fed by PEG ever since. I?m not suggesting that your patient has the same problem. That would be too much of a coincidence, but that it s essential to get to the bottom of the reason for the food refusal that may not be what it appears on the surface.

Good luck,

Irene.

I work with paediatrics and I have a case at the moment that is a bit 

tricky and has emotional implications as well.  I have a young boy (just 

over 1 year) who has been fed by NG tube all his life and mum has been 

very proactive with stimulating him orally and giving him oral feeds as 

much as he will tolerate.  His oral motor skills are fine however he 

has a delayed swallow for all consistencies and will often hold food or 

push it out with his tongue.  His interest in food is nil and he does 

not show any signs of hunger or desire to take food orally.  We have 

decided as a team (mum as well) to trial not giving NG feeds for a few days 

to see whether we can increase his awareness of hunger and oral feeding 

and ultimately wean him off the tube.  MUm is giving him some food via 

NG at nights just for reassurance.  He is at a healthy weight at the 

moment and has gained weight well in the past however mum is very nervous 

about him not eating and is showing a great deal of anxiety. !

  Despite this, she is keen to continue with the trial (she really 

wants him to feed orally) however is looking for some information on other 

children who have gone through this before.  If anyone can provide 

information on this it would be GREATLY appreciated. 

Regards
Michelle Snead



Dr I Campbell-Taylor
Clinical Neuroscientist
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