auriculo condylar syndrome


Gastrostomy Hints

Date of article 26.02.2005

Number 1 hint - The best hint of all is DONT PANIC. In an emergency a clear head is a great tool.

Feeding angle - All gastrostomy & NG fed baby's should be fed on a 30° angle. If you don't have a tilting cot try phone books under head end of the cot to get desired height.

Leakage or discharge - Sometimes you may notice the MicKey button leaking a little after a feed. This is normal & nothing to worry about. Just clean & dry it.

Cleaning - Always keep the Mickey button hole {stoma} clean & dry, a damp gauze or flannel will do fine. You may find crusty lumps appearing round the hole {stoma} this is normal, clean them off with a cotton bud if necessary.

Checking water - On the end of the Mic-Key button in the stomach there is a ball containing 5 ml's of water this stops it coming out of the stomach. Check with a syringe that there is always 5mls of water in it. Do this once every week or two.

Sterilizing equipment - Clean all your equipment first warm soapy water, then use a milton {a container to hold Sterilizing water} To get water into the tubes syringe it into the tubes under the water. Make sure things are apart in the milton so it is all covered with water.

Feeding & priming the line - Fill your bolus {container for milk} to the desired level with milk or substitute with the tube {the line to the Mickey} pinched off so no milk flows down it. Once you have the correct amount in the bolus un pinch the tube & let the milk flow down it till it just dribbles out the end then pinch it off again {this is called priming}. Connect the tube to the Mickey button & again un pinch the tube & your done. We use a 60ml syringe as the bolus & have a stand given to us by our speech therapist Linda B, this is a great thing to stop your arm getting sore.

Drinking - A child with a gastrostomy may need to take all their liquids through the gastrostomy & baby's cant tell you when there thirsty, so you need to keep their liquids up to date especially during summer. More water in the bolus or flush is a good way to keep their fluids up. Our baby Kayla is 8 months old & we are giving her about 18 ml's of water after each feed {don't use this as a measurement for your child}. We use a 30ml syringe for this & fill it to 25ml & flush. The 7ml difference is what stays in the feeding line. Always allow for the difference what ever it is, if doing it this way.

Continuous feeding pump - We use a continuous feeding pump for overnight feeds with Kayla & sometimes the tubes get creased from Kayla kicking her feet & the flow stops. If you use a nappy or small sheet & lay it under, but just short of baby's bottom with the rest flat out to the foot end of the bed like a sheet. Then run feeding tubes out of baby's sleeping clothes through the crotch area & under the cloth nappy to the foot 
end of the bed & into the pump. Baby's legs lie on top of the nappy that the tubes run under, this stops baby's legs tangling in the tubes & keeps them crease free. If using a apnea monitor run lead the same way.

Solid foods & a gastrostomy - Having a totally gastrostomy or nasal fed baby can cause future oral eating problems, as their tummy's end up full without eating. To avoid this solids should be introduced at feeding time. Use baby food to start with & as they get bigger bits off Mum & Dads plate. This will help associate the eating of food with their tummy's being full. Put a drop sheet down & let them play. Try giving them a drink too, but only do this when your specialist ok's it.

Poo's & vomit during feeding - Sometimes your baby might be inclined to do a poo during a feed, this is not  an ideal time for one, but you can't change nature. Pinch the feeding tube off & let your baby do the poo. Sometimes baby might find the food & the poo all a bit much & vomit. This is sometimes messy, but just clean it up, un pinch the tube & finish the feed.

Hard poo's - If your baby's poo's are hard to the touch then your baby probably needs more water. Try adding 5ml of water to the flush at each feed if your feeds are about every 4 hours.

Medicine & gastrostomy - If you are giving medicine through a gastrostomy at feeding time because it says to be taken with food, & you are noticing your child vomiting after it, it is probably because the medicine is curdling the milk. Try giving the medicine about 20 minutes after the feed with a 10ml flush. This should give the tummy time to settle down. If the medicine doesn't need food try giving it at a non feed time.

Rotating the Mic-Key button -  Rotate the Mic-Key button round 1 or 2 turns once a day. This stops it sticking & keeps things clean. It's a bit like a new earring stud that needs twisting.

Lasting time of a Mic-Key button - A Mic-Key button will generally last 3 to 6  months. 6 months if it is in good condition & sometimes longer.

Vomiting a lot - They say a gastrostomy fed baby does vomit more than normal. We would say Kayla vomits a lot (age 18 months) & would also say for Kayla it is caused by a mixture of the gastrostomy & the small airway which inhibits her spitting up saliva or snot which makes her choke & vomit. Some times it can get scary as she vomits out the Trachey even as we are suctioning & with this happening she can't breath. If this happens to you we would suggest keeping calm (as possible) keep suctioning & wiping the vomit away. We've found if you take off the cathida & suction with the big hose (not down the Trachey) this gets rid of the bulk of the vomit quickly & you put the cathida on & off quickly.