Tube feeding - Common problems with your child’s gastrostomy button

Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.

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There are a few common problems that your child may experience with their gastrostomy button.

  • Leakage
  • Red and irritated skin
  • Hyper granulation
  • A blocked button
  • A button that has fallen out

Leakage

To stop the leak, you must first determine where is the leak is coming from

(i.e. is it through, under or around the button) and why is there a leak. 

Leaking through the button may indicate:

  • A problem with the button

- Check if the button is blocked by gently flushing it. (See the blocked button section).

- Make sure the lid is closed properly.

- If leaking is happening out of the gastrostomy lid, the gastrostomy button may need to be replaced as the one way valve may no longer be working.

Leaking around the button may indicate:

  • A deflated or burst balloon.

- Check the water level in the gastrostomy balloon (if your child has a balloon device),      3-5 mL of water is usually recommended.

  • Constipation, vomiting or gas in the stomach.

- Monitoring bowel motions and managing constipation. 

- Try venting the tube before each feed.  Venting is the process of allowing excess air to escape from the stomach.

            To vent the tube:

  1. Attach a syringe, outside only (without the plunger), to the feeding port.
  2. Hold the syringe barrel below the stomach to allow gas to escape.
  3. Allow stomach juices and air to fill the syringe.
  4. Drain contents back into the stomach by raising the syringe above the stomach.
  • A poorly fitting gastrostomy button. Perhaps your child has grown or gained weight and now needs a larger sized button.

- Contact your health professional

  • Your child’s stomach may still be full from the previous feed.

- If you suspect his or her stomach is not emptying between feeds contact your dietitian for advice.

Leaking under the button may indicate:

  •  An infection or a growth in hypergranulation tissue.

- Contact your health professional or seek medical advice.

If you can’t determine why the button is leaking or stop the leak, contact your health professional.

Something else to try:

Barrier cream may be used to protect the skin around the button while the site is leaking, but this will not stop the leak.

Red and irritated skin around the gastrostomy button

It is important to gently wash around the tube with warm soapy water and dry the area thoroughly every day.  This will keep help the skin around the gastrostomy button healthy.

If the skin around the button is looking red and irritated, try more frequent washing.  It is generally recommended to keep the area dry and uncovered unless leaking is excessive.

If despite the extra care the skin does not improve you should contact your health professional.

Signs that the skin around the gastrostomy button may be infected include:

If the skin looks red or swollen; there is discharge (white or yellow); the site smells foul; the area is unusually warm to touch; your child is in pain or experiencing fevers.

If you suspect the site is infected you should contact your health professional for advice.

Hyper granulation around the gastrostomy button

It is normal for a small amount of skin to grow around your child’s tube. Granulation tissue is pink tissue that sometimes occurs when there is too much friction (rubbing) around the button site.

Hyper granulation tissue may cause some bleeding, leaking, or redness to the surrounding skin.

Contact your health professional for advice on how to manage this problem.

A blocked gastrostomy button

Blocked tubes can mostly be avoided if the gastrostomy button and feeding tubing is flushed after giving feeds and medications. Be sure to follow instructions on the volume and timing of water flushes.

If your child’s gastrostomy button becomes blocked:

Fill the syringe with 10mL warm water and flush the gastrostomy button using moderate pressure. You can try a gentle push-pull action on the syringe for a couple of minutes to see if you can move the blockage.

If this doesn’t work, contact your health professional or local hospital for advice.

What to do if your child’s gastrostomy button falls out

Sometimes a gastrostomy button will accidentally fall out. If this happens, the hole will stay open for about an hour and then may start to close.

 As soon as you discover that the gastrostomy button has fallen out you will need to:

  • Replace the button with a new one (if you are trained to do so) or
  • Place the old button back into the hole, secure it with tape and contact your local hospital for advice or
  • Place a foley catheter (if provided) inside the hole to keep the hole open until a new gastrostomy button can be placed.

If you are unable to do any of the above you should present to your local hospital immediately.

Remember

  • It is common to experience the above mentioned problems.
  • This information should be used as a guide only.
  • If you have been provided with alternate instructions from your health professional you should follow those.
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The Children's Hospital at Westmead
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Sydney Children's Hospital, Randwick
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Hunter New England Kids Health
www.hnekidshealth.nsw.gov.au

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