Abstract

Delivery of nutrients by tube is now used in a wide range of paediatric disorders ~ reflecting growing awareness of the importance of good nutrition in severe illness. 2 Enteral tube feeding is indicated in the child who, despite a functional gastrointestinal tract, is unable to ingest sufficient food to maintain or restore normal nutritional status. This definition includes premature infants with immature suck and swallow, as well as older children in whom these mechanisms are either temporarily or permanently impaired. There are a number of additional indications listed in Box 1. The need for reliable and safe enteral nutritional support continues to stimulate innovation both in the field of tube design and the methods for establishing gastrointestinal access. For long-term enteral nutritional support a gastrostomy tube, inserted using a percutaneous endoscopic technique, is increasingly preferred over a nasogastric (NG) tube. The management of complex nutritional problems, including planning, implementation and supervision of tube feeding, is best coordinated by a multi-disciplinary nutritional care team? This brings together the particular expertise of a paediatric surgeon, a paediatric gastroenterologist, a dietitian, a pharmacist and a nutrition nurse specialist. Joint decisions are made about the most suitable approach and type of tube to be used for each patient. Whilst life threatening complications of tube feeding are relatively unusual,

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