Jejunal tube feeding in children and adolescents

Jejunal tube feeding is increasingly becoming the standard of care for children in whom gastric tube feeding is insufficient to fulfil caloric needs. Jejunal tube feeding is defined as postpyloric feeding through a feeding tube with its tip placed distally to the Treitz ligament. The jejunal tube bypasses the stomach when gastric feeding is not tolerated or is associated with unacceptable complications including significant gastroesophageal reflux disease. There is growing evidence suggesting that feeding by jejunal tube is a safe and effective means of enteral feeding in children and adolescents; however, because of the frequent need for tube maintenance and replacement leading to increased morbidity, gastrojejunal tube feeding is more a temporary alternative to, for example, cutaneous jejunostomy and antireflux surgery. A number of factors should be considered before placement of a jejunal or a gastrojejunal tube. The symptoms of feeding failure, such as nausea, vomiting, gagging, retching and volume intolerance may be caused by anatomical or nongastrointestinal problems, which will need to be dealt with before considering placement of a jejunal tube. The decision to place a jejunal tube has to be made by a multidisciplinary team, working in close cooperation and providing active follow-up and care. The management of a child awaiting a jejunal feeding tube should begin well before its insertion. The multidisciplinary team should be familiar with and have access to a range of alternative strategies to the insertion of a jejunal feeding tube. These may include food or regimen changes, specific feeding therapy, speech and swallowing assessments and access to psychological support. The team should include a pediatric gastroenterologist, a dietitian, a psychologist, and a speech and language therapist. Adequate planning, including discussion of ethical issues, guarantees that all parties have a clear understanding of the indications and rationale for placement of a jejunal tube. In addition, ongoing and future strategies to increase possible oral feeding and enable weaning off the jejunal tube should be discussed. The aim of this article is to provide a comprehensive guide for healthcare professionals on the safe, effective, and appropriate use of jejunal feeding tubes in children and adolescents.