Childhood cancer treatments like surgery, chemotherapy or radiotherapy often bring challenging side effects. These side effects, which can include loss of appetite, swallowing issues, and nausea, often have a greater impact on children. While adults know they need to eat, despite their discomfort, to ensure their proper nutrition, children may struggle to meet their nutritional needs during treatment. This can be especially difficult for parents and caregivers to witness. To help children get proper nutrition, and potentially even medications, your healthcare team may suggest having a nasogastric tube or gastrostomy tube. Let’s learn more about them…
Nasogastric Tubes
A Nasogastric (NG) tube is a long, thin flexible tube gently inserted through a child’s nose, down the throat, and into the stomach. It is held in place with tape on their cheek. The process is quick and painless, although it can feel unsettling for children—especially younger ones. Reassurance and distraction during the procedure can help make it easier. Once inserted, the tube’s placement is typically confirmed using pH strips or, if needed, X-ray. The NG tube will directly deliver a specialized, nutrient-rich formula into the child’s stomach at a comfortable pace. Families are usually provided with an enteral feeding pump and feeding bags to manage the process.
A variation of NG tube is the NJ or nasojejunal tube. This tube goes all the way to the small intestine (or jejunum); it is recommended for children who are unable to tolerate food or drink in their stomach, whether due to anatomical reasons or persistent vomiting.
Gastrostomy Tubes
Gastrostomy tubes or devices are surgically placed through a small incision in the child’s abdomen. The procedure takes about 30-45 minutes and is performed under sedation (general anesthesia). The child typically needs to stay in the hospital for 1-2 days for post-operative recovery. The nurse teaches the primary caregiver how to take care of the tube, administer feeds or medications, and handle potential issues, like the tube falling out. Despite being called a tube, it resembles a small button on the child’s abdomen and can be easily concealed under clothing. Children typically heal quickly after the surgery and can soon return to their regular activities, such as playing, bathing, and even swimming. Like NG tubes, G-tubes are also operated through a pump to adjust the rate of feeding of specialized formulas.
End notes
Your healthcare team will recommend the type of tube that your child needs and guide you through the process step by step. Although the idea of tube feeding may initially seem overwhelming, families and children adapt well over time. I still remember the first time my son had an NG tube placed after his brain tumour surgery over a year ago. Seeing it on his sweet little face was hard for me, and he was understandably upset, as any 2-year-old would be during such a procedure. Over time, I realized how the tube was a lifeline, ensuring he received the nutrition he needed when he was too sick and tired from chemotherapy to eat and drink on his own. He also got used to the NG tube, even the monthly tube replacements (NG tube needs to be replaced every 4-6 weeks), and tape/dressing changes whenever needed. He loved the little treats he got after every replacement. This guide can help childhood cancer warriors and their siblings understand NG tubes. Some more resources are:
Feeding Tubes During Cancer Treatment – Cincinnati Children’s Hospital: https://www.youtube.com/watch?v=pj8tJKbMqWM
SickKids NG Feeding: https://www.aboutkidshealth.ca/ngfeeding
SickKids Tube Feeding Learning Hub: https://www.aboutkidshealth.ca/tubefeeding
Nemours Kids Health https://kidshealth.org/en/parents/g-tube.html
Neha Bhatnagar