Varying and Prevalent Complications Associated With Pediatric Gastrostomy Tubes

Introduction: Gastrostomy tubes (G-tubes) are the primary approach for providing long-term feeding assistance to children with feeding dysfunction. Numerous complications occur with pediatric G-tube feeding whose prevalences and outcomes remain relatively unstudied. Displacement is widely considered to be particularly serious and may be associated with other complications. This study aims to identify and describe these issues. Methods: A dual-round survey (IRB #00248159) was administered to 98 participants through the Feeding Tube Awareness Foundation, a 501(c)(3) organization that supports parents/caretakers of G-tube-fed children. Information was collected regarding G-tube complications, causes, and attitudes toward such complications. Results: Infection (56%), itching/irritation/redness (52%), and leakage (51%) were the leading at-home G-tube complications. Displacement had a prevalence of 24%. Average G-tube replacement occurred after 3.4 ± 1.2 months, with a median between 2-3 months, compared to the typical recommended period of up to 6 months. For caretakers who had not experienced G-tube displacement, 7.9% wanted to see a change in current G-tubes to address the issue as compared to the 75% for those who had experienced displacement. This 67.1% differential was the largest gap amongst all other listed complications. Amongst children who have experienced displacement, three levels of displacement were distinguished: minor shifting, major shifting, and complete dislodgment. Complete dislodgment (88%) was the most prevalent, followed by minor (68%), and then major (19%) shifting. Though the most serious of the three in degree, complete dislodgment was associated with the lowest prevalences of infection, itching/irritation/redness, and leakage. Conclusion: G-tube complications are prevalent and varied, and frequently result in accelerated replacement timelines, burdening both patients and caretakers. While displacement is not the most prevalent complication, its occurrence results in the most significant increase in caretaker concern, suggestive of its severity and difficulty to address. Complete dislodgment is the most common type of displacement and is considered the most dangerous, but is in fact least associated with other complications. This may be because major and minor shifting are chronic in nature, while complete dislodgment is immediately addressed. Ultimately, mitigating tube displacement may serve to mitigate other leading G-tube complications.