Tag Archives: NG tube

Rashelle Berry: From Tube to Taste

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We had a terrific lecture given to our group by Rashelle Berry. She is a pediatric dietitian specializing in feeding disorders, enteral nutrition, and tube weaning. She practices within the Feeding Program at Children’s Healthcare of Atlanta, partnering closely with a wide variety of disciplines to care for children with significant feeding challenges and GI-related nutrition concerns. My notes below may contain errors in transcription and in omission.

Key Points:

  • Families expectations are often at odds with dealing with tube feeding which makes it more difficult
  • Parents have strong desire to achieve all oral feedings and often look for advice outside of clinical visits
  • Hunger alone is not sufficient to transition off tube feedings
  • Prior to attempts to stop tube feedings, it is important to assess safety and to align feeding patterns to be more physiologic. This includes offering feeds via bolus typically every 3 hours and stopping continuous feedings
  • Hyperosmolar feedings can contribute to GI symptoms
  • Changing formula to improve tolerance can result in quick symptom improvement (1-2 days)
  • Many children with tube feedings are overfed. This can contribute to poor hunger as well as initial weight loss when transitioning off tube feeds
  • Two main options to advance oral feedings: 1. Offer oral feeds prior to tube feeds and reduce tube feedings based on oral intake 2. Plan to reduce tube feedings by a set amount, typically 10-30% and follow to see if oral intake improves
  • Expect some weight loss during transition; if mild weight loss, most often continue to follow closely
In Step 2, these are some of the aspects indicating tolerance

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Data on Bridles -They Work!

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JA Lavoie et al. JPEN 2022; https://doi.org/10.1002/jpen.2409. Nasogastric Bridles are Associated with Improved Tube-Related Outcomes in Children

Retrospective study: 582 children had NGTs secured traditionally and 173 received nasal bridles 

Key findings:

Children with bridled NGTs were compared to their non-bridled NGT counterparts (all results below with p values <0.02):

  • 16.67 times less likely to experience ≥1 dislodgement (OR=0.06)
  • 2.5 times less likely to have one more ED visit (OR=0.4)
  • 4.76 times less likely to require one more radiographic exposure (OR=0.21)

My take: After learning about bridles at N2U in 2015 (thanks Praveen Goday), they quickly became popular in our institution. They improve NG/NJ outcomes.

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