SPEECH AND LANGUAGE THERAPY
Speech and language therapists, sometimes referred to as SALT, help with both communication and feeding difficulties.
An inability to communicate verbally is incredibly debilitating for children and adults who have already developed these skills as well as for those who have never acquired these skills. A Speech and Language Therapist can help with this, through training and techniques to make communication easier. They can help with simple sign language and objects of reference and appropriate communication aids.
Speech and language therapist also help with any feeding difficulties, including suggestions for making food and drink easier to swallow, this may be through thickening drinks, mashing or pureeing foods. They are also responsible for observing and referring for tests if the person is having difficulty swallowing (dysphagia). You may then be referred to a dietician.
If swallowing becomes very difficult or there is a risk of aspiration then it will be recommended that Enteral feeding is considered. Enteral feeding is the delivery of a nutritionally complete feed, containing protein, carbohydrate, fat, water, minerals and vitamins, directly into the stomach, duodenum or jejunum via a nasogastric tube (NG) or a gastrostomy. Your child can still eat and drink normally if they are able and it is safe for them to do so. Sometimes the feeding tubes are just used to ‘top up’ if the child hasn’t eaten or drunk very much, they are also very useful for administering medications.
WHAT IS A NASOGRASTRIC TUBE?
A Naso-gastric (NG) tube is a thin, plastic tube that is inserted into one nostril, down the back of the throat and into the stomach. A nurse will insert the NG tube. Once the tube has been passed to the required length it will be secured to the face with some adhesive tape. Inserting the tube does not hurt, but it may be uncomfortable for a short while for children it can cause distress but is a very quick procedure. It may also make you sneeze, cough or retch as it tickles your throat. This soon passes.
WHAT ARE THE ADVANTAGES & DISADVANTAGES OF AN NG TUBE?
• Provides a safe method of feeding
• Can be removed when not in use
• No anaesthetic is needed for insertion
• Child may feel more comfortable because their stomach is filled as with normal feeding
• Can appear unsightly
• Insertion can sometimes cause distress although this soon resolves once the tube is in place.
• Can be dangerous if inserted into the airway instead of the food pipe.
Can increase the secretions in the nostril especially when first passed or if you have a cold
HOW TO CHECK THE POSITION OF THE NASOGASTRIC TUBE
It is important to check that the NG tube is in the correct place, (the stomach). The food pipe and the airway separate from each other below the voice box and there is a small risk that the NG tube could end up in the airway instead of the stomach. If your nurse is at all concerned that the tube is not in the correct place the tube will be removed immediately and replaced. Checking the position of the tube should occur on insertion as well as every time it is used. It is also important to check the tube position after periods of vomiting or a coughing episode as the tube can change its position. The contents of your child / baby’s stomach are normally acidic. The most reliable way of checking that the tube is in the stomach is by checking the acid level of some of the fluid drawn back from the tube. If the tube is in the stomach, the fluid will normally have a pH (acid level) of 4.0 or below.
WHAT IS A GASTROSTOMY?
A gastrostomy is a hole (stoma), from the skin into the stomach. A feeding device is put in the stoma so that the child can have a liquid feed, water or medication straight into the stomach.
An operation is needed to make the stoma and to place the feeding device into the stomach. This will be carried out under a general anaesthetic (medicine given to make your child go to sleep).
There are two types of feeding devices that your child can have:
A gastrostomy tube (PEG): is a long tube that fits in the stoma and is held in the stomach with a soft plastic disc. A PEG can generally stay in place for around 18 months and then will need to be changed.
A gastrostomy button is a feeding device that fits into the stoma. It is held in the stomach by a balloon filled with water. This type of gastrostomy needs to be changed every 3-6 months but doesn’t involve a general anaesthetic when being changed and will be done at home by your specialist nurse.
You will be able to talk to the consultant about which device would be most suitable for your child.
Your child will stay in hospital for two to three days so that they can recover from the operation and start their new feeds. This also gives time for you to learn how to use the gastrostomy.
Using the gastrostomy
When your child is first due a feed, you will be shown how to use the device. There are lots of different liquid feeds available and a dietitian will talk about the type and the amount of feed for your child.
There are two ways that the milk feed can be given:
The feed is given at regular times during the day. A syringe is attached to the tube and the feed is poured into it and allowed to flow by gravity down the tube, through the gastrostomy and into the stomach.
The feed is given using an electric pump. This allows the right amount of feed to slowly flow into the stomach over a set time. The method used will depend on many factors, the most common plan is a combination of both, bolus feeds during the day and a continuous feed overnight.
You can also use the gastrostomy to give your child their medicine and you will be shown how to do this by the nursing staff.
You will be shown how to care for your child’s gastrostomy while you are staying on the ward. The condition of the stoma site should be checked regularly, and the skin should be kept clean and dry. This is to stop an infection around the stoma site.
Children’s community nurses
If your child does not already have a children’s community nurse, a referral will be made. They will be able to provide ongoing support for you and your child once you are at home.