G-Tube/PEG Vomiting!

My LO recently got a PEG/G-Tube put in his belly for his feeds. He was one week from coming home and this was supposed to be the last big thing.

Well, the roller coaster continues. Since the PEG was put in, he has vomited all of his feedings. They tried slowing down the feeds over hours and nothing has seemed to work. He was taking 50ccs from a bottle and the rest went through an Ng tube before that. He barely vomited at all. Since then all vomit, no taking a bottle. He was good before the tube.

First they thought it could be an infection or something, but all of the tests came back negative. For some reason, the doctors seem puzzled...I can't imagine its the first time they have seen this. I imagine its the tube causing some sort of problem/pressure/feeling in baby's belly.

Please let me know if anyone has had the same experience or found a solution to it.

Thanks Family.

Edited February 28, 2011 at 6:39 pm

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This same thing happened to my daughter when she had her g-tube placed! She was fine with no vomiting before the surgery but after she projectile vomited all the time! It has slowly gotten better, but to be honest, we are coming up on the 1 year anniversary and she still throws up at least once per day for no reason. Everything is fine with her placement and there is no explainable reason for her to be doing it.

With that being said, another family had a similar situation and it turns out that the g-tube had gotten placed to far down. I guess, from what I understand, it was blocking the opening to allow the stomach to empty properly. Once they got that straightened out, he stopped vomiting. They actually discovered the mistake after they had cut him back open to perform a nissen fundoplication on him to control the vomiting! Scary stuff, but everyone can make a mistake; especially doctors!

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having a tube = lots of puke, at least in our experience. My son has had gtube for almost a year, and there is just something about not eating orally that makes puking increase. Its oftentimes hard to find the perfect balance figuring out when/how much/how often to feed.

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I guess for us, the vomiting was one problem that we dodged. One of our 29-weeker twins had a g-tube (without any fundoplication) placed at about less than 3 months old adjusted, and he was in a lot of pain for a couple weeks. He also had granulation tissue around the stoma until the tube had been in for more than 6 months, maybe 8 months. I can't remember that part exactly. But puking was pretty rare, occurring only when we fed him too quickly. (He was 100 percent tube fed.)
I know that probably doesn't help you, but just thought you should know that not all kids with g-tubes throw up frequently.

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So sorry to hear you are dealing with this. My son didn't get his g-tube until he was 11mo. Before the tube, no vomiting. He started vomiting before we even left the hospital after the g-tube surgery. The tube was removed at 21mo, but unfortunately, at 3yrs old we still deal with frequent vomiting. G-tube surgery can often times result in nerve damage. You may want to inquire about this w/ the surgeon. Sometimes it can cause things to not work right w/ the stomach b/c certain nerves are no longer "effective." It may also result in a lot of nerve pain, for which medication can sometimes help (specifically, neurotin). G-tubes can also change the shape of the stomach as the stomach wall is now much closer to the skin... as a result it is being pulled up and out, which can make it difficult for the sphincter (sp?) muscle to close properly (our surgeon drew us a pic, which was very helpful), which in turn makes it easier for stuff to come back up. Sometimes meds that help speed up digestion (such as Erythromycin) can aid in emptying the stomach quicker which can help w/ decreasing vomiting. Unfortunately, it seems like many of the ppl I meet whose kids had g-tubes have also had to deal w/ vomiting.

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Can a G-tube be removed completely and replaced again with an NG tube? Seems like that's going backwards, but if it avoids the vomiting and fundo, then would a doctor consider that? The whole fundo thing scares me and I wouldn't know how to proceed with that. I think the docs were even talking about a G-J Tube that goes directly into the intestine.

This worries me because I wonder how he is able to take a bottle by mouth and then a continuous feed into his intestine. Man, another thing to worry about!

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I think it's very unlikely that a dr would remove the g-tube and go back to ng, unless it wasn't placed well as tara_mommy09 suggested. I would definitely ask to speak with the surgeon who placed it and possibly get another opinion. I'm w/ you on the fundo... that has not been and never will be a consideration of ours w/ our son due to the potential complications. I don't have any experience w/ a J-G tube, other than some friends of ours son had one, but he had many other health issues. Just to help me understand, why was the g-tube placed to start with?

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Ah, the g-tube/vomiting problem. My daughter has a g-tube with a fundoplication, and honestly, the fundo does an AWESOME job of stopping reflux and such. However, she does have A LOT of retching a gagging-- whether that is from the fundo or the g-tube or just oral sensitivity, who knows.

In fact, we are going today to have a GJ placed, to see if that helps stop some of the gagging. I'll let you know if it helps.

But as for the vomiting with a g-tube, sometimes the g-tube takes up too much space in the belly and the kids just don't have enough room for food. How slowly can they run the feeds? Charlotte HAS to be run continuously at 38 mL/hr and she is almost 19 pounds. Any more than that and she just retches uncontrollably. Maybe you can try one of the mini balloons that takes up a little less room?

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My ex 24 weeker has a mickey button and she used to vomit as the feed was going in. Projectile vomit. She is on prevacid as that worked the best for her. Also, try slowing the feed AND make sure he doesn't have a milk protein allergy. My 33 weeker was doing the same as my 24 in the NICU (not wanting the bottle, turning red, arching) so they put him on soy and he did better. When he came home he still seemed uncomfortable so he went on Nutramigen and that is what he stayed on. Makes me wonder if my 24 weeker had a milk protein allergy too and never needed the button!!!

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@ Henrysmom
We were all set for coming home this week after 4 months in the NICU. Little Ryan has CLD and on oxygen. He wasn't able to fully take a bottle yet, so they put in the G-tube so he could continue to learn to feed and take the rest via tube. He was doing so well and seemed like he was almost ready to take a full bottle by mouth. It just wasn't consist. So the tube was placed.

That's when everything has gone haywire. Vomiting. Even had a couple desats which he hadn't had in a long time.

They are trying to run his feeds VERY slowly today, added some reflux meds, and are going to see how he does with that. Hopefully this works.

They tried to do an upper GI test this weekend and the dye came up as quickly as it went down.

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Hopefully the slow feeds will work, but it sounds like Ryan has some nasty reflux, which of course, is always made worse by the g-tube. Go figure. Have they checked him for dumping syndrome or for delayed gastric emptying? Those can both cause vomiting.

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@ afknick
The funny (or sad) part was that before the g-tube, there wasn't much reflux. The doctors are perplexed as they said the tube is in correctly and everything looks normal. Today they put the tube in the intestine to see if he tolerates feeds that way. Then they can diagnose that its something wrong with the g-tube...which I could make that diagnosis right now! Doesn't make sense.

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This happened to my kiddo as well. For some reason, no one ever seems to discuss the fact that a PEG/G-tube will make vomiting worse for a time. You can find a lot of information on this at the parent-2-parent website. Your kiddo will probably need a reflux medication if not on one already. My son had to have a g-tube to come home and, while he was vomiting, the most important thing was that he was gaining weight. That being said, the doctors kept telling me the vomiting was 'just a nuisance.' Um, yeah, it was a helluva lot more than that - scary, frustrating, smelly, worrisome, troubling, and exhausting for us and the baby are just a few things I can think of. This is not permanent. I promise you.

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Hi Marcsd.... I was in that similar situation my daughter who now is 4 1/2 still has the peg.. But she had it put in at 11 mths and we always had to bolus feed, then gravity feed but everything we have tried she would throw up not all feeds but most of them
and the doctors couldnt figure out why.. She is now eating orally so were not really using the tube.. I also thought about the tube
" something about the tube making her vomit too " .. But of course no answers.. 4 1/2 yrs later. So now were not feeing her
formula thru tube and no vomiting.. SO it's been nice !! But just wanted to share my experience as well... Good luck.. Hope you
get answers and please keep me posted, I'm curious :) Thanks

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@ cherhaley
So my question is - if you don't mind me asking - why does your daughter still have a PEG at age 4? My thoughts behind the tube was to get my baby out of the NICU until he can take a full bottle himself without it being too much work (He's still on oxygen, so he falls asleep and gets tired after half to 3/4 of a bottle). So I figured that was only a 6 month to 1 year thing and then they remove the tube?

When I talked to the doctors and said he was on his way to taking a full bottle before the tube and said why can't they take the tube out, he was like "We don't do that". I just don't understand the path they are going down. It seems to be going away from bottle feeding and totally to tube feeding.

I'm just so frustrated that this week was going to be the week he went home after 4 months in the NICU, but the peg has ruined everything.

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Taking out the tube at this point probably won't help. the stomach has already been sewn to the abdominal wall. Most of the time this is what causes the vomiting.

When Teddy got his nissen and gtube we were only going to use the tube to vent after his nissen. Within about 24hrs after surgery he developed such a severe oral aversion quit taking anything by mouth. He will be 3 in April and is 100% tube fed. We are traveling 4hrs each way to see a gi specialist and still have no answers as to why he retches, vomits and gags all the time. The good part in this is that we give him medicine that really helped with the gag and vomiting. We have seen the most improvement after starting to use ferral bags - they allow him to be fed and vented at the same time. What a difference this has made. I wish we had know if these sooner.

I know my last paragraph sounds really negative about the gtube and nissen. It really did not help with what we were told it would however, with the amount of lung disease Teddy has - his gtube has literally bena life saver. I know that I can ALWAYS get food and fluids into him. Even when he is sick. It may not be the same volume or rate but it will go in. Because of this when he has been hospitalized in the past with resp issues he did not have to have IV fluids.

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When my daughter got her PEG/G-Tube, they told us that there was a chance that her colon or intestines could be clipped during insertion and they wouldn't know until a problem came about. I think it is more prevalent when they switch over to a button but you may want to inquire about it.

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My son, had feeding issues in the Nicu, he would tire easily. He was 4 lbs 7oz, 34 weeks. They used the ng tube (feeding via the nose). When he came home he was 4 weeks old. He tired very easily and we had to wake and feed him every other hour 24/7 for mostly the first year to get him to take 14 oz in a 24 hour period. It was torturous. He was bottle fed. He would cry during and after every feed like he was in so much pain. Later it was discovered he was aspirating some of the formula and had GERD. They thickened the formula with rice cereal, had us add extra formula powder to make his formula 30 cals per ounce and that kept him from aspirating.

To keep my son's oral skills we bottle fed him, but if I had been offered to hook him up at night for g tube or ng tube feedings, that would have helped an incredible amount. As long as the doctors feel it is safe to bottle feed (like it's not going into his lungs, or some other reason) and supplement with the tube feedings, then you get the best option. Also, get a feeding therapist asap. They can help you a lot as your baby develops. For us, it was all about getting the calories into our son and it was literally a sprint every day, it was so much effort and in retrospect try should have given us that option. Also, the feeding therapist can tell yiu how best to keep and develop your baby's oral skills. You can get a feeding therapist from Early Intervention to keep the cost minimal. They can come to your home once a week and see how things are going and advise you and really help.

Big hugs to you. It can be so frustrating dealing with the docs. keep questioning them, it's your right to know as this is your child whom you love and often docs need to be reminded of that.

For all the times my son would get sick with whatever cold virus was going around, we had to rush him 1.5 hours away so they could get a vein and give him IV fluids to avoid dehydration. Some type of feeding tube will allow you to hydrate him and give him medication, which may really help as babies (my preemie at least) got sick very easily these first two years.

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I can relate...on the day my son was to come home they told us his diaper rash had to keep him here?! We called back and said you've got to be kidding, right? Then they said that he needed immediate heart surgery, which he had the next day. It was a roller coaster ride, and very stressful on us. He required round the clock care, which we gave him at home.

Also: get a second opinion on your son. You have every right to have all of his medical records sent over to another doctor, even at a different hospital, without them taking any time to do that. If there are any x-rays, barium swallows they video taped,etc. Those can be put on disk and sent as part of what another doctor can review. For my son's emergency heart surgery we had a cardiologist from a different hospital review his records and then he called us on our cell and we made sure he answered all our questions.

I have also gone and gotten 3rd, 4th, and a 5th opinions in certain situations. Dont be afraid of angering any doc if you ever need to do that. It is your legal right and it is done all the time.

I wish I had the answers you need. I really feel for you. I will say a prayer for you. Please keep us updated as we all care a lot.

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Same thing happened to my daughter with the vomiting, she lost weight initially and they wanted to do a gj tube. Turned out she had gastric emptying delay. With a drug called domperidone she is much much better and is beginning to eat again. Make sure they've tested for that, and get a 2 nd opinion too. Sorry you're going through this, its so frustrating.

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@ Marcsd...

We still have tube in just in case.. we had to use it a couple times when she was sick to give her pedialyte.. for hydration..
We also use it for meds b/c she wont take meds or vitamins by mouth yet. I'm sooo sorry you are going thru this..
I know it's very frustrating ! My daughter eats but not alot yet.. She will only eat certain things.. It's still very hard
to feed her . I guess it's up to your lil' man now to take the bottle. IT all depends on him I guess when the tube comes
out. My daughter did take bottle when she came home only for few months and refused after that didnt want the bottle at
all.. :( But now she's not doing to bad hopefully next doctor visit we can discuss maybe when he thinks the tube can come
out .. Have to see her weight gain..
Again, I hope things get better for you, and your lil' man starts drinking again w/out any problems... Keep us posted :) Thanks

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