Benefits and management of gastrostomy

Gastrostomy feeding has become widespread as an effective means of preventing or reversing malnutrition in children with chronic illness. Gastrostomy should be considered in all patients with ‘long-term’ reliance on nasogastric tube feeding; while not clearly defined, this period is usually considered to be more than 6 weeks. Children with neurodisability represent the largest group of patients with gastrostomy; parents must be closely involved in the decision-making process that leads to tube feeding, understand the potential benefits and disadvantages, and be supportive of this intervention. There is a small number of important relative and absolute contra-indications to gastrostomy, which is almost always performed as a percutaneous endoscopic procedure. Complications are well recognized, common, and often avoidable. Ideally, care of children who have a gastrostomy should include clear referral pathways and management protocols, education of parents and carers by specialist nurses, the availability of expert and experienced operators for insertion, advice from a nutrition support team, and rapid referral pathways for management of complications.